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We examined the burden and distribution of WMH, and their association with years of play, age of first exposure, and clinical function in former American football players.<\/jats:p><\/jats:sec>Methods<\/jats:title>A total of 149 former football players and 53 asymptomatic unexposed participants (all men, 45\u201374 years) completed fluid\u2010attenuated inversion recovery magnetic resonance imaging, neuropsychological testing, and self\u2010report neuropsychiatric measures. Lesion Segmentation Toolbox estimated WMH. Analyses were performed in the total sample and stratified by age 60.<\/jats:p><\/jats:sec>Results<\/jats:title>In older but not younger participants, former football players had greater total, frontal, temporal, and parietal log\u2010WMH compared to asymptomatic unexposed men. In older but not younger former football players, greater log\u2010WMH was associated with younger age of first exposure to football and worse executive function.<\/jats:p><\/jats:sec>Discussion<\/jats:title>In older former football players, WMH may have unique presentations, risk factors, and etiologies.<\/jats:p><\/jats:sec>Highlights<\/jats:title>\nOlder but not younger former football players had greater total, frontal, temporal, and parietal lobe white matter hyperintensities (WMH) compared to same\u2010age asymptomatic unexposed men.<\/jats:p><\/jats:list-item>\nYounger age of first exposure to football was associated with greater WMH in older but not younger former American football players.<\/jats:p><\/jats:list-item>\nIn former football players, greater WMH was associated with worse executive function and verbal memory.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><\/jats:sec>","DOI":"10.1002\/alz.12779","type":"journal-article","created":{"date-parts":[[2022,8,23]],"date-time":"2022-08-23T00:30:08Z","timestamp":1661214608000},"page":"1260-1273","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["White matter hyperintensities in former American football players"],"prefix":"10.1002","volume":"19","author":[{"given":"Michael L.","family":"Alosco","sequence":"first","affiliation":[{"name":"Boston University Alzheimer's Disease Research Center Boston University CTE Center Department of Neurology Boston University School of Medicine Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yorghos","family":"Tripodis","sequence":"additional","affiliation":[{"name":"Boston University Alzheimer's Disease Research Center Boston University CTE Center Boston University School of Medicine Boston 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