Abstract
Dear Editor:
I congratulate Montenigro and coworkers on their article 1 “Cumulative Head Impact Exposure Predicts Later-Life Depression, Apathy, Executive Dysfunction, and Cognitive Impairment in Former High School and College Football Players.” It adds to the the growing body of literature that will help us understand the effects of traumatic brain injury.
I do find the results of Montenigro and coworkers somewhat surprising, however, given the findings of Lehmen and coworkers. 2 Lehman and coworkers looked at the mortality for neurodegenerative causes of death in 3439 former National Football League (NFL) players with at least 5 years of pension-credited playing seasons between 1959 and 1988. They divided the players into two groups: nonspeed players (linemen) and speed players (all other positions except punter/kicker). They found that the relative risk of neurodegenerative disease was 3.29 (0.92–11.7) (95% C.I) times higher in the speed players.
Comparing the grouping of of the subjects in the two studies by position, there is a very close matching of the groups. In Montenigro and coworkers’ weighting of mean impacts per season by position, the offensive and defensive linemen had highest cumulative head impact indices. In contrast to Lehman and coworkers, they found that the lineman groups were at the highest risk for impairment of cognition, executive function, and behavior, as well as for apathy and depression.
Unfortunately, Montenigro and coworkers did not assess the pre-playing function of the players.
I am unaware of any studies that address the intellectual, social, and dispositional makeup of high school and college football players by position. It would not be surprising to find that different position groups might be distinctly different socially and intellectually, and destined for different outcomes later in life, independent of the degree of brain trauma experienced. Future studies should make an attempt to control for baseline function. For example, grade school achievement tests could be used control for differences in baseline function. Until we have further data, we should assume that concussive injuries have a more significant impact on brain function than nonconcussive injuries.