The New England Journal of Medicine November 7, 2019; Vol. 381; No. 19; pp. 1801-1808

Daniel F. Mackay, Ph.D., Emma R. Russell, M.Sc., Katy Stewart, Ph.D., John A. MacLean, M.B., Ch.B., Jill P. Pell, M.D., and William Stewart, M.B., Ch.B., Ph.D.: From the University of Glasgow. This study cites 32 references.


In the world of sports, elite-level athletes often enjoy lifelong health benefits, including lower all-cause mortality and reduced cardiovascular disease risk. However, a recent retrospective cohort study focusing on former professional Scottish soccer players has raised concerns about the potential link between participation in contact sports, particularly soccer, and an increased risk of neurodegenerative diseases.

Key Findings:

  • Higher Mortality from Neurodegenerative Disease:

The study, spanning 18 years and involving 7,676 former male professional soccer players and 23,028 matched controls, revealed a higher mortality rate from neurodegenerative diseases among former players. Mortality with neurodegenerative disease listed as the primary cause was 1.7% among former soccer players, compared to 0.5% among controls.

  • Prescriptions of Dementia-Related Medications:

Former soccer players were found to be prescribed dementia-related medications about 400% more frequently than the control group. The study suggests a concerning correlation between soccer participation and an increased need for such medications.

  • Association with Chronic Traumatic Encephalopathy (CTE):

Studies have indicated neuropathologic changes consistent with CTE in 75% of former soccer players. This raises questions about the potential long-term consequences of repetitive head impacts, as even routine heading of the ball, a common practice in soccer, has been associated with altered cerebral neurochemistry and structural changes in the brain.

Editorial Reflections:

In response to the study, an editorial by Dr. Robert A. Stern emphasizes the complex relationship between sports participation and cognitive health. While moderate exercise and sports engagement offer notable health benefits, contact and collision sports, such as soccer, may pose risks of cognitive impairment and neurodegenerative diseases.

Key Insights from the Editorial:

  • Balancing Benefits and Risks of Sports Participation:
  • Participation in sports is generally associated with health benefits, but the editorial emphasizes the need to balance these advantages with potential risks, particularly in contact sports that involve repetitive head impacts.
  • Repetitive Head Impacts and Neurodegenerative Risk:
  • The editorial underscores that it’s not just symptomatic concussions but the cumulative effect of repetitive head impacts, including subconcussive injuries without symptoms, that may contribute to neurodegenerative risk.
  • Occupational Risk in Professional Soccer:
  • Dr. Stern suggests that the evidence from the study indicates that repeated blows to the brain from heading in professional soccer may be considered an occupational risk that requires attention and further research.


The findings from the study and the accompanying editorial shed light on the potential risks associated with soccer participation, urging a closer examination of the long-term consequences of repetitive head impacts. As discussions on player safety and the impact of sports on cognitive health gain momentum, it becomes crucial to strike a balance between the love of the game and the well-being of the athletes.