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J Neurotrauma. 2017 Aug 15;34(16):2389-2395. doi: 10.1089/neu.2016.4960. Epub 2017 Jun 9.

Impaired Cognitive Performance in Youth Athletes Exposed to Repetitive Head Impacts.

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1 Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilians-Universität , Munich, Germany .
2 Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital , and Harvard Medical School, Boston, Massachusetts.
3 Department of Biostatistics, Boston University School of Public Health , Boston, Massachusetts.
4 Department of Applied Sciences and Mechatronics, University of Applied Sciences , Munich, Germany .
5 Department of Neurobiology and Anatomy, McGovern Medical School, University of Texas Health Science Center , Houston, Texas.
6 Department of Ophthalmology and Visual Science, McGovern Medical School, University of Texas Health Science Center , Houston, Texas.
7 Institute for Clinical Radiology , Ludwig-Maximilians-Universität, Munich, Germany .
8 Department of Radiology, Charité, Berlin, Germany .
9 Department of Pediatric Neurology, Dr. von Hauner Children's Hospital , Ludwig-Maximilians- Universität, Munich, Germany .
10 Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital , Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts.
11 VA Boston Healthcare System , Boston, Massachusetts.


Worldwide, more than 22 million children and adolescents are exposed to repetitive head impacts (RHI) in soccer. Evidence indicates cumulative effects on brain structure, but it is not known whether exposure to RHI affects cognitive improvement in adolescents. The aim of the study was to determine whether exposure to RHI while heading the ball in soccer affects improvement in cognitive performance in adolescents over time. The study group consisted of a convenience sample of 16 male soccer players (mean age 15.7 ± 0.7 years). A comparison cohort of 14 male non-contact sports athletes (mean age 14.9 ± 1.1 years) was recruited from competitive athletic clubs and group-matched in age. Using the ProPoint and AntiPoint tasks, sensorimotor and cognitive functions were measured over both immediate (pre- vs. post-training) as well as across multiple time points within a play season. The number and type of head impacts that occurred during the training were counted. The main outcome measure was the change in response time (RT) in the ProPoint and AntiPoint tasks. The immediate (pre- vs. post-training) and longer-term (across a play season) change in RT was analyzed, and the effect of the number and type of head impacts was tested. Thirty athletes with and without exposure to RHI demonstrated a decrease in RT in both tasks immediately after training. Over the play season, both groups showed improvement in sensorimotor function. While the control group also improved in cognitive performance, the soccer players did not, however. Further, the more long headers performed, the slower the improvement in RT over the season. Youth athletes experience an immediate cognitive improvement after training most likely because of physical exercise. Results of this study also suggest an association between exposure to specific RHI (long headers) and lack of improvement in cognitive performance in youth athletes over time.


cognitive function; cognitive improvement; heading; repetitive head impact; soccer; sports-related brain trauma

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