Disparate Associations of Years of Football Participation and a Metric of Head Impact Exposure with Neurobehavioral Outcomes in Former Collegiate Football Players

Objectives: Years of sport participation (YoP) is conventionally used to estimate cumulative repetitive head impacts (RHI) experienced by contact sport athletes. The relationship of this measure to other estimates of head impact exposure and the potential associations of these measures with neurobehavioral functioning are unknown. We investigated the association between YoP and the Head Impact Exposure Estimate (HIEE), and whether associations between the two estimates of exposure and neurobehavioral functioning varied. Methods: Former American football players (N = 58; age = 37.9 +/- 1.5 years) completed in-person evaluations approximately 15 years following sport discontinuation. Assessments consisted of neuropsychological assessment and structured interviews of head impact history (i.e., HIEE). General linear models were fit to test the association between YoP and the HIEE, and their associations with neurobehavioral outcomes. Results: YoP was weakly correlated with the HIEE, p = .005, R ( 2 ) = .13. Higher YoP was associated with worse performance on the Symbol Digit Modalities Test, p = .004, R ( 2 ) = .14, and Trail Making Test-B, p = .001, R ( 2 ) = .18. The HIEE was associated with worse performance on the Delayed Recall trial of the Hopkins Verbal Learning Test-Revised, p = .020, R ( 2 ) = .09, self-reported cognitive difficulties (Neuro-QoL Cognitive Function), p = .011, R ( 2 ) = .10, psychological distress (Brief Symptom Inventory-18), p = .018, R ( 2 ) = .10, and behavioral regulation (Behavior Rating Inventory of Executive Function for Adults), p = .017, R ( 2 ) = .10. Conclusions: YoP was marginally associated with the HIEE, a comprehensive estimate of head impacts sustained over a career. Associations between each exposure estimate and neurobehavioral functioning outcomes differed. Findings have meaningful implications for efforts to accurately quantify the risk of adverse long-term neurobehavioral outcomes potentially associated with RHI.