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Graphic: Jason Csizmadi

"Aside from providing important insights into the nature of depression as it relates to brain damage in retired NFL athletes...this study also may help us to understand the similar behavioral symptoms seen in other sports-related head injuries and in combat-related blast injuries seen in armed service members," said Dr. Kyle Womack, study author. The study was released by the Center for BrainHealth at the University of Texas at Dallas.

NFL takes another hit: Former players at increased risk of depression

by Sandy McAfee
Jan 29, 2013

Related Links

Brain protein from retired NFL players linked with concussions

Symptoms of a Concussion

• Headache
• Confusion
• Unequal pupils or unusual eye movements
• Nausea or vomiting
• Dizziness
• Amnesia
• Seizures
• Muscle weakness
• Trouble concentrating
• Feeling foggy or like you've “lost time”
• Trouble walking
• Double vision
• Loss of consciousness 

(Sources: CDC and Rush University, Chicago)

Not Just Football

The Virginia Tech – Wake Forest University School of Biomedical Engineering and Sciences announced Tuesday that their research on football helmets will expand to include other sports, such as hockey, baseball, softball and lacrosse. The expansion is part of a five-year plan to evaluate helmets worn by athletes and their ability to lessen the likelihood of a concussion. “What our group is doing is lower the head acceleration,” Duma said. “A better helmet can reduce acceleration and that reduces your risk. Reduction in acceleration, that’s part of the solution."  

(See their football helmet ratings here:

Baltimore Ravens safety Bernard Pollard at Super Bowl Media Day

"The league is trying to move in the right direction [with player safety], but at the same time, coaches want bigger, stronger and faster year in and year out. And that means you're going to keep getting big hits and concussions and blown-out knees. The only thing I'm waiting for... and, Lord, I hope it doesn't happen... is a guy dying on the field. We've had everything else happen there except for a death. We understand what we signed up for, and it sucks."

“I’m a big football fan, but I have to tell you if I had a son, I’d have to think long and hard before I let him play football.”

With these words, President Barack Obama on Monday joined the conversation regarding the severity of head-related injuries such as concussions in sports. The President’s voice adds to a chorus of cautions and warnings from both players and doctors against the effects of head injuries in sports.

Last week researchers at the University of Texas at Dallas added depression to the effects of players sustaining concussions and head-related injuries. Their research found that NFL players who suffered concussions are more likely to develop depressive symptoms as they age than the general population. The research is presented in two studies by the Center for BrainHealth that examine the long-term effects of concussions.

“The findings did show the number of concussions were related to depressive symptoms,” said psychologist Nyaz Didehbani, study author and clinical researcher at BrainHealth Institute for Athletes. “Depressive symptoms are not as screened as some of the memory or language symptoms. There is a strong relationship between concussions’ role on mood. We are really measuring mood symptoms.”

The study looked at 34 retired NFL players, ranging in age from 44 to 77. All but two of the players reported experiencing at least one concussion injury during their time playing professional football. One particular player in the study reported experiencing 13. Concussions are considered cumulative.  Symptoms may worsen with succession and can result in long-term memory loss.

The men went through detailed tests that measured a variety of neurological capabilities such as cognition, intelligence, processing speed, memory and mood, and most of the men had MRI brain scans.

Nearly one-fourth of the former players were diagnosed with depression. Four former players were diagnosed with fixed cognitive deficits, eight with mild cognitive impairment and two had dementia. When compared to healthy subjects, the men had more difficulty on certain neurological tests that involved naming, word finding, and visual and verbal episodic memory.

“Our guys were endorsing symptoms of depression, such as tiredness, fatigue, anxiety, low sex drive,” Didehbani said. “They did not realize that these symptoms are related to depression.”

Along with monitoring the moods of the players, a separate neuroimaging study showed that players with mental deficits or depression had decayed white matter in their brain. White matter is the connective tissue that passes information between brain cells.

“Having played 11 years in the NFL and taken countless hits, I’ve heard about the struggles of the players who came before me and the challenges regarding their quality of life,” said Daryl Johnston, a former fullback for the Dallas Cowboys who participated in the study.

“Through the Center for BrainHealth, former players can find if there is an issue, and if you catch it early or late, there are things you can do to improve your condition,” he said. “The brain is regenerative for life, and we can restore faculties that just a few years ago were thought to be lost forever.”

A lot of the players diagnosed with depression have sought treatment, through medication or therapy, and gotten better, Didenhabani said. And BrainHealth will continue to monitor the men’s moods and mental activity as they age.

“We are still connecting new information, we’re doing the same assessments and neuroimaging for year two,” Didehbani said. “We’re checking to see as they age. We’re going to follow these guys for as long as they can.”

The study is one of several looking at the effects of concussions. Last week, a UCLA released research identifying a protein that could diagnose CTE in living patients. Imaging technology has advanced  diagnoses that previously could only be made post-mortem.

On Tuesday, the Virginia Tech – Wake Forest University School of Biomedical Engineering and Sciences announced the expansion of research on football helmets to include other sports such as hockey, lacrosse and baseball. (See box.)

“I think there is much that we know, and still much we do not know,” said Stefan Duma, Ph.D., head for the Virginia Tech research, about concussions research. “We do not yet understand how many times, how hard does someone need to be hit to have long-term problems, especially like CTE. We have to do research, have to have the data to start to answer these questions.”

According to the Centers for Disease Control, approximately 1.6 to 3.8 million sports-related concussions occur in the U.S. every year, and most of these are not treated in a hospital. Some short-term effects include disturbances in mood and thinking. According to Rush University, athletes who have had at least one concussion are at an increased risk for another concussion, and a repeat concussion before the brain is fully healed can result in permanent brain damage or even death.

The two Center for BrainHealth studies that examined mood and brain images of retired NFL playerswere released earlier this month and published online in JAMA Neurology. They will be presented at the American Academy of Neurology’s 65th Annual Meeting in March.