{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T21:28:22Z","timestamp":1789507702995,"version":"build-2803163510"},"reference-count":64,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Repetitive head impacts (RHI) from American football have been associated with later-life cognitive and neuropsychiatric changes. Findings have been limited by small samples, focus on elite players, and lack of appropriate control groups.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To assess the association between American football participation and cognitive and neuropsychiatric function in men 40 years or older.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n In this cross-sectional study, online data from male football players in the Head Impact &amp;amp; Trauma Surveillance Study (HITSS) were collected between March 7, 2022, and April 9, 2025. In a subanalysis, football players were matched to Brain Health Registry controls without RHI.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n RHI proxies, including self-reported total years of football play, highest level of play, position, and age of first exposure.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Linear regression models with multiway cluster-robust SEs compared performance of players vs controls on computerized cognitive tests (Cambridge Automated Neuropsychological Battery Paired Associates Learning Test First Attempt Memory Score [PALFAMS] and Total Errors Adjusted [PALTEA]), subjective cognitive concerns (Everyday Cognition Scale [ECog]), and depressive symptoms (Geriatric Depression Scale 15 [GDS-15]). Multivariable linear regressions, analyses of covariance, and binary logistic regression models tested associations between RHI proxies and PALFAMS, PALTEA, ECog, GDS-15, and additional neuropsychiatric (Behavior Rating Inventory of Executive Function\u2013Adult [BRIEF-A] Behavioral Regulation Index [BRI]) and cognitive (BRIEF-A Meta-Cognition Index [MI]) measures. Models were adjusted for age, race, educational level, and vascular risk.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The study sample included 3970 male former American football players (mean [SD] age, 55.93 [10.00] years) enrolled in HITSS. Two substudies were performed: (1) all 3970 football players and (2) 943 players and controls (mean [SD] age, 58.46 [10.37] years), including 661 football players and 282 Brain Health Registry controls. Overall, all study participants were highly educated (561 [85%] had a \u22654-year degree). Compared with controls, players had worse scores on PALFAMS (B\u2009=\u2009\u22120.64; 95% CI, \u22121.23 to 0.05; \u03b2\u2009=\u2009\u22120.15;\n P<\/jats:italic>\n \u2009=\u2009.03), PALTEA (B\u2009=\u20090.31; 95% CI, 0.07-0.54; \u03b2\u2009=\u20090.18;\n P<\/jats:italic>\n \u2009=\u2009.01), ECog (B\u2009=\u20090.11; 95% CI, 0.07-0.15; \u03b2\u2009=\u20090.38;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001), and GDS-15 (B\u2009=\u20090.62; 95% CI, 0.39-0.86; \u03b2\u2009=\u20090.37;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). Among the 3970 total players (mean [SD] years of education, 16.11 [2.20]), professional players had worse scores than college and high school or youth players. Years of play was associated with higher ECog (B\u2009=\u20090.006; 95% CI, 0.003-0.009; adjusted\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001), MI (B\u2009=\u20090.17; 95% CI, 0.02-0.32; adjusted\n P<\/jats:italic>\n =\u2009.04), BRI (B\u2009=\u20090.27; 95% CI, 0.16-0.37; adjusted\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001), GDS-15 (B\u2009=\u20090.03; 95% CI, 0.009-0.04; adjusted\n P<\/jats:italic>\n =\u2009.003), and PALTEA (B\u2009=\u20090.03; 95% CI, 0.004-0.06; adjusted\n P<\/jats:italic>\n =\u2009.04) scores.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cross-sectional study of former American football players, prior American football participation was associated with worse later-life cognitive and neuropsychiatric function. These findings support a dose-response association with years and level of play, providing context to help clinicians and researchers assess the risk of symptoms among former players.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.60077","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T16:30:34Z","timestamp":1772209834000},"page":"e2560077","source":"Crossref","is-referenced-by-count":3,"title":["Cognitive and Neuropsychiatric Function in Former American Football Players"],"prefix":"10.1001","volume":"9","author":[{"given":"Anna","family":"Aaronson","sequence":"first","affiliation":[{"name":"Boston University Alzheimer\u2019s Disease Research Center, Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Badlam","sequence":"additional","affiliation":[{"name":"Boston University Alzheimer\u2019s 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