FORMER American football players showed poorer cognitive and neuropsychiatric function, with symptoms worsening by exposure level.
Cognitive and Neuropsychiatric Function Tied to Exposure
Repetitive head impacts are a longstanding concern in American football, yet prior evidence has often been limited by smaller samples, emphasis on elite cohorts, or limited use of comparable control groups. This cross sectional analysis evaluated cognitive and neuropsychiatric function in men aged 40 years or older, using online assessments from the Head Impact and Trauma Surveillance Study collected between March 2022 and April 2025.
The study included 3,970 former American football players (mean age about 56 years). A matched subanalysis compared 661 players with 282 male controls from the Brain Health Registry who denied repetitive head impact exposure. Outcomes focused on computerized cognitive testing and patient reported symptoms, including paired associates learning performance, subjective cognitive concerns, and depressive symptoms.
Matched Comparison Shows Differences vs Controls
Compared with matched controls, former players performed worse on computerized memory testing and reported more subjective cognitive concerns. Former players also reported more severe depressive symptoms. These between group findings aligned with the study’s central question about whether prior football participation is associated with later life cognitive and neuropsychiatric function.
Dose Response Signals by Years and Level of Play
Within the football cohort, the analysis used proxies for repetitive head impact exposure, including total years of play, highest level of play, position, and age of first exposure. Higher levels of play, particularly professional participation, were associated with worse cognitive and neuropsychiatric outcomes compared with lower levels. More years of play was also associated with worse scores across several measures, including greater cognitive concerns and greater neuropsychiatric symptom burden. Models adjusted for demographics and vascular risk factors, and multiple comparisons were addressed using false discovery rate control.
Clinical Context and Limits
Because the design is cross sectional and relies on remote, unsupervised testing and self report exposure histories, the findings support association rather than causation. Still, the size of the cohort, inclusion of multiple levels of play, and the matched control analysis provide added context for clinicians evaluating cognitive concerns and depressive symptoms in former players.
Reference: Aaronson A et al. Cognitive and Neuropsychiatric Function in Former American Football Players. JAMA Netw Open. 2026;9(2):e2560077.
