Skip to main content
PMC home page
British Journal of Sports Medicine logoLink to British Journal of Sports Medicine
. 2005 Aug;39(Suppl 1):i70–i77. doi: 10.1136/bjsm.2005.019646

Effects of heading exposure and previous concussions on neuropsychological performance among Norwegian elite footballers

T Straume-Naesheim, T Andersen, J Dvorak, R Bahr
PMCID: PMC1765315  PMID: 16046359

Abstract

Background: Cross-sectional studies have indicated that neurocognitive performance may be impaired among football players. Heading the ball has been suggested as the cause, but recent reviews state that the reported deficits are more likely to be the result of head injuries.

Objective: To examine the association between previous concussions and heading exposure with performance on computer based neuropsychological tests among professional Norwegian football players.

Methods: Players in the Norwegian professional football league (Tippeligaen) performed two consecutive baseline neuropsychological tests (Cogsport) before the 2004 season (90.3% participation, n = 271) and completed a questionnaire assessing previous concussions, match heading exposure (self-reported number of heading actions per match), player career, etc. Heading actions for 18 players observed in two to four matches were counted and correlated with their self-reported values.

Results: Neither match nor lifetime heading exposure was associated with neuropsychological test performance. Nineteen players scored below the 95% confidence interval for one or more subtasks, but they did not differ from the rest regarding the number of previous concussions or lifetime or match heading exposure. The number of previous concussions was positively associated with lifetime heading exposure (exponent (B) = 1.97(1.03–3.75), p = 0.039), but there was no relation between previous concussions and test performance. Self-reported number of headings correlated well with the observed values (Spearman's ρ = 0.77, p<0.001).

Conclusion: Computerised neuropsychological testing revealed no evidence of neuropsychological impairment due to heading exposure or previous concussions in a cohort of Norwegian professional football players.

Full Text

The Full Text of this article is available as a PDF (261.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Andersen T. E., Arnason A., Engebretsen L., Bahr R. Mechanisms of head injuries in elite football. Br J Sports Med. 2004 Dec;38(6):690–696. doi: 10.1136/bjsm.2003.009357. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Aubry M., Cantu R., Dvorak J., Graf-Baumann T., Johnston K., Kelly J., Lovell M., McCrory P., Meeuwisse W., Schamasch P. Summary and agreement statement of the First International Conference on Concussion in Sport, Vienna 2001. Recommendations for the improvement of safety and health of athletes who may suffer concussive injuries. Br J Sports Med. 2002 Feb;36(1):6–10. doi: 10.1136/bjsm.36.1.6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bangsbo J., Nørregaard L., Thorsø F. Activity profile of competition soccer. Can J Sport Sci. 1991 Jun;16(2):110–116. [PubMed] [Google Scholar]
  4. Binder L. M., Rohling M. L., Larrabee G. J. A review of mild head trauma. Part I: Meta-analytic review of neuropsychological studies. J Clin Exp Neuropsychol. 1997 Jun;19(3):421–431. doi: 10.1080/01688639708403870. [DOI] [PubMed] [Google Scholar]
  5. Bleiberg J., Halpern E. L., Reeves D., Daniel J. C. Future directions for the neuropsychological assessment of sports concussion. J Head Trauma Rehabil. 1998 Apr;13(2):36–44. doi: 10.1097/00001199-199804000-00006. [DOI] [PubMed] [Google Scholar]
  6. Carlsson G. S., Svärdsudd K., Welin L. Long-term effects of head injuries sustained during life in three male populations. J Neurosurg. 1987 Aug;67(2):197–205. doi: 10.3171/jns.1987.67.2.0197. [DOI] [PubMed] [Google Scholar]
  7. Collie A., Darby D., Maruff P. Computerised cognitive assessment of athletes with sports related head injury. Br J Sports Med. 2001 Oct;35(5):297–302. doi: 10.1136/bjsm.35.5.297. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Collie Alexander, Maruff Paul, Darby David G., McStephen Michael. The effects of practice on the cognitive test performance of neurologically normal individuals assessed at brief test-retest intervals. J Int Neuropsychol Soc. 2003 Mar;9(3):419–428. doi: 10.1017/S1355617703930074. [DOI] [PubMed] [Google Scholar]
  9. Collie Alexander, Maruff Paul, Makdissi Michael, McCrory Paul, McStephen Michael, Darby David. CogSport: reliability and correlation with conventional cognitive tests used in postconcussion medical evaluations. Clin J Sport Med. 2003 Jan;13(1):28–32. doi: 10.1097/00042752-200301000-00006. [DOI] [PubMed] [Google Scholar]
  10. Collins Michael W., Field Melvin, Lovell Mark R., Iverson Grant, Johnston Karen M., Maroon Joseph, Fu Freddie H. Relationship between postconcussion headache and neuropsychological test performance in high school athletes. Am J Sports Med. 2003 Mar-Apr;31(2):168–173. doi: 10.1177/03635465030310020301. [DOI] [PubMed] [Google Scholar]
  11. Darby D., Maruff P., Collie A., McStephen M. Mild cognitive impairment can be detected by multiple assessments in a single day. Neurology. 2002 Oct 8;59(7):1042–1046. doi: 10.1212/wnl.59.7.1042. [DOI] [PubMed] [Google Scholar]
  12. Delaney J. Scott, Lacroix Vincent J., Leclerc Suzanne, Johnston Karen M. Concussions among university football and soccer players. Clin J Sport Med. 2002 Nov;12(6):331–338. doi: 10.1097/00042752-200211000-00003. [DOI] [PubMed] [Google Scholar]
  13. Downs D. S., Abwender D. Neuropsychological impairment in soccer athletes. J Sports Med Phys Fitness. 2002 Mar;42(1):103–107. [PubMed] [Google Scholar]
  14. Echemendia R. J., Putukian M., Mackin R. S., Julian L., Shoss N. Neuropsychological test performance prior to and following sports-related mild traumatic brain injury. Clin J Sport Med. 2001 Jan;11(1):23–31. doi: 10.1097/00042752-200101000-00005. [DOI] [PubMed] [Google Scholar]
  15. Erlanger David, Kaushik Tanya, Cantu Robert, Barth Jeffrey T., Broshek Donna K., Freeman Jason R., Webbe Frank M. Symptom-based assessment of the severity of a concussion. J Neurosurg. 2003 Mar;98(3):477–484. doi: 10.3171/jns.2003.98.3.0477. [DOI] [PubMed] [Google Scholar]
  16. Falleti Marina G., Maruff Paul, Collie Alexander, Darby David G., McStephen Michael. Qualitative similarities in cognitive impairment associated with 24 h of sustained wakefulness and a blood alcohol concentration of 0.05%. J Sleep Res. 2003 Dec;12(4):265–274. doi: 10.1111/j.1365-2869.2003.00363.x. [DOI] [PubMed] [Google Scholar]
  17. Grindel S. H., Lovell M. R., Collins M. W. The assessment of sport-related concussion: the evidence behind neuropsychological testing and management. Clin J Sport Med. 2001 Jul;11(3):134–143. doi: 10.1097/00042752-200107000-00003. [DOI] [PubMed] [Google Scholar]
  18. Guskiewicz Kevin M., Marshall Stephen W., Broglio Steven P., Cantu Robert C., Kirkendall Donald T. No evidence of impaired neurocognitive performance in collegiate soccer players. Am J Sports Med. 2002 Mar-Apr;30(2):157–162. doi: 10.1177/03635465020300020201. [DOI] [PubMed] [Google Scholar]
  19. Guskiewicz Kevin M., McCrea Michael, Marshall Stephen W., Cantu Robert C., Randolph Christopher, Barr William, Onate James A., Kelly James P. Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study. JAMA. 2003 Nov 19;290(19):2549–2555. doi: 10.1001/jama.290.19.2549. [DOI] [PubMed] [Google Scholar]
  20. Jordan S. E., Green G. A., Galanty H. L., Mandelbaum B. R., Jabour B. A. Acute and chronic brain injury in United States National Team soccer players. Am J Sports Med. 1996 Mar-Apr;24(2):205–210. doi: 10.1177/036354659602400216. [DOI] [PubMed] [Google Scholar]
  21. Kirkendall D. T., Jordan S. E., Garrett W. E. Heading and head injuries in soccer. Sports Med. 2001;31(5):369–386. doi: 10.2165/00007256-200131050-00006. [DOI] [PubMed] [Google Scholar]
  22. Lovell M. R., Collins M. W. Neuropsychological assessment of the college football player. J Head Trauma Rehabil. 1998 Apr;13(2):9–26. doi: 10.1097/00001199-199804000-00004. [DOI] [PubMed] [Google Scholar]
  23. Lovell Mark R., Collins Michael W., Iverson Grant L., Field Melvin, Maroon Joseph C., Cantu Robert, Podell Kenneth, Powell John W., Belza Mark, Fu Freddie H. Recovery from mild concussion in high school athletes. J Neurosurg. 2003 Feb;98(2):296–301. doi: 10.3171/jns.2003.98.2.0296. [DOI] [PubMed] [Google Scholar]
  24. Lovell Mark R., Collins Michael W., Iverson Grant L., Johnston Karen M., Bradley James P. Grade 1 or "ding" concussions in high school athletes. Am J Sports Med. 2004 Jan-Feb;32(1):47–54. doi: 10.1177/0363546503260723. [DOI] [PubMed] [Google Scholar]
  25. Macciocchi S. N. "Practice makes perfect:" retest effects in college athletes. J Clin Psychol. 1990 Sep;46(5):628–631. doi: 10.1002/1097-4679(199009)46:5<628::aid-jclp2270460514>3.0.co;2-v. [DOI] [PubMed] [Google Scholar]
  26. Macciocchi S. N., Barth J. T., Alves W., Rimel R. W., Jane J. A. Neuropsychological functioning and recovery after mild head injury in collegiate athletes. Neurosurgery. 1996 Sep;39(3):510–514. [PubMed] [Google Scholar]
  27. Makdissi M., Collie A., Maruff P., Darby D. G., Bush A., McCrory P., Bennell K. Computerised cognitive assessment of concussed Australian Rules footballers. Br J Sports Med. 2001 Oct;35(5):354–360. doi: 10.1136/bjsm.35.5.354. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Matser E. J., Kessels A. G., Lezak M. D., Jordan B. D., Troost J. Neuropsychological impairment in amateur soccer players. JAMA. 1999 Sep 8;282(10):971–973. doi: 10.1001/jama.282.10.971. [DOI] [PubMed] [Google Scholar]
  29. Matser J. T., Kessels A. G., Jordan B. D., Lezak M. D., Troost J. Chronic traumatic brain injury in professional soccer players. Neurology. 1998 Sep;51(3):791–796. doi: 10.1212/wnl.51.3.791. [DOI] [PubMed] [Google Scholar]
  30. Matser J. T., Kessels A. G., Lezak M. D., Troost J. A dose-response relation of headers and concussions with cognitive impairment in professional soccer players. J Clin Exp Neuropsychol. 2001 Dec;23(6):770–774. doi: 10.1076/jcen.23.6.770.1029. [DOI] [PubMed] [Google Scholar]
  31. Mollica Catherine M., Maruff Paul, Vance Alasdair. Development of a statistical approach to classifying treatment response in individual children with ADHD. Hum Psychopharmacol. 2004 Oct;19(7):445–456. doi: 10.1002/hup.624. [DOI] [PubMed] [Google Scholar]
  32. Murelius O., Haglund Y. Does Swedish amateur boxing lead to chronic brain damage? 4. A retrospective neuropsychological study. Acta Neurol Scand. 1991 Jan;83(1):9–13. doi: 10.1111/j.1600-0404.1991.tb03952.x. [DOI] [PubMed] [Google Scholar]
  33. Rutherford Andrew, Stephens Richard, Potter Douglas. The neuropsychology of heading and head trauma in Association Football (soccer): a review. Neuropsychol Rev. 2003 Sep;13(3):153–179. doi: 10.1023/a:1025525613477. [DOI] [PubMed] [Google Scholar]
  34. Saunders J. B., Aasland O. G., Babor T. F., de la Fuente J. R., Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II. Addiction. 1993 Jun;88(6):791–804. doi: 10.1111/j.1360-0443.1993.tb02093.x. [DOI] [PubMed] [Google Scholar]
  35. Silbert B. S., Maruff P., Evered L. A., Scott D. A., Kalpokas M., Martin K. J., Lewis M. S., Myles P. S. Detection of cognitive decline after coronary surgery: a comparison of computerized and conventional tests. Br J Anaesth. 2004 Apr 2;92(6):814–820. doi: 10.1093/bja/aeh157. [DOI] [PubMed] [Google Scholar]
  36. Straume-Naesheim T. M., Andersen T. E., Bahr R. Reproducibility of computer based neuropsychological testing among Norwegian elite football players. Br J Sports Med. 2005 Aug;39 (Suppl 1):i64–i69. doi: 10.1136/bjsm.2005.019620. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Tysvaer A. T. Head and neck injuries in soccer. Impact of minor trauma. Sports Med. 1992 Sep;14(3):200–213. doi: 10.2165/00007256-199214030-00006. [DOI] [PubMed] [Google Scholar]
  38. Tysvaer A. T., Løchen E. A. Soccer injuries to the brain. A neuropsychologic study of former soccer players. Am J Sports Med. 1991 Jan-Feb;19(1):56–60. doi: 10.1177/036354659101900109. [DOI] [PubMed] [Google Scholar]
  39. Webbe Frank M., Ochs Shelley R. Recency and frequency of soccer heading interact to decrease neurocognitive performance. Appl Neuropsychol. 2003;10(1):31–41. doi: 10.1207/S15324826AN1001_5. [DOI] [PubMed] [Google Scholar]
  40. Witol Adrienne D., Webbe Frank M. Soccer heading frequency predicts neuropsychological deficits. Arch Clin Neuropsychol. 2003 May;18(4):397–417. [PubMed] [Google Scholar]

Articles from British Journal of Sports Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES