{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T12:07:45Z","timestamp":1792066065046,"version":"4.4.0"},"reference-count":79,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2025,7,3]],"date-time":"2025-07-03T00:00:00Z","timestamp":1751500800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"ABHC cohort study"},{"DOI":"10.13039\/501100017510","name":"UK Dementia Research Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100017510","id-type":"DOI","asserted-by":"publisher"}]},{"name":"NIHR Academic Clinical Lectureships"},{"name":"Imperial NIHR BRC"},{"DOI":"10.13039\/501100000691","name":"Academy of Medical Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Epidemiological studies have shown that elite rugby players are at greater risk of neurodegenerative disease in later life, with post-mortem studies conducted in ex-players demonstrating the presence of neuropathologies related to repetitive head impacts, such as chronic traumatic encephalopathy. However, detailed prospective data establishing the clinical presentation of former rugby players with brain health concerns are lacking. In particular, the rates of traumatic encephalopathy syndrome, the clinical correlate of chronic traumatic encephalopathy, and the relationship between clinical outcomes and repetitive head impacts are unknown.<\/jats:p>\n               <jats:p>Two hundred former elite rugby players with brain health concerns and 33 matched healthy control subjects were assessed. Self-reported concussion history, career duration, player position, self-rated scales of depression, anxiety, sleep quality, post-concussion symptoms and quality of life, self and informant ratings of neuropsychiatric symptoms and executive function behaviours, were obtained. Formal cognitive testing, traumatic encephalopathy syndrome classification and 3 T MRI were performed.<\/jats:p>\n               <jats:p>Former players had a median age of 44 years (90.5% male, median career length = 10.5 years, median self-reported career concussions = 7); 63% were forwards and 37% were backs. Ex-players had elevated scores compared to controls on all symptom scales except sleep quality. Despite frequent subjective memory complaints, performance on cognitive testing did not significantly differ from controls. No players fulfilled criteria for dementia. Twenty-four former players fulfilled research criteria for traumatic encephalopathy syndrome (seven with cognitive impairment, 12 with neurobehavioral dysregulation, five with both). Provisional levels of certainty for chronic traumatic encephalopathy were relatively low (21 \u2018suggestive\u2019, three \u2018possible\u2019, zero \u2018probable\/definite\u2019). Forwards and those with higher self-reported concussions were more likely to be classified as having traumatic encephalopathy syndrome based on neurobehavioral disturbance. Symptom burden (depressive and anxiety symptoms, post-concussion symptoms, behaviour rating of executive dysfunction, and neuropsychiatric symptom severity) was higher in those with higher self-reported concussions but was unrelated to years of play or position played. Cavum septum pellucidum was visible on structural imaging in 24% of players (12% in controls) and was more common in the high compared to low concussion group (32% versus 16%).<\/jats:p>\n               <jats:p>In summary, former elite rugby players in mid-life had significant symptom burden, especially those self-reporting more concussions. In contrast, objective cognitive impairments and traumatic encephalopathy syndrome were relatively uncommon and there was no evidence of dementia. These results provide insights into the clinical presentations of former elite rugby players with brain health concerns during mid-life and highlight the complex relationship between symptoms, cognition and head impact exposure.<\/jats:p>","DOI":"10.1093\/brain\/awae416","type":"journal-article","created":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T20:02:51Z","timestamp":1751486571000},"page":"2698-2713","source":"Crossref","is-referenced-by-count":11,"title":["Brain health concerns in former rugby players: clinical and cognitive phenotypes"],"prefix":"10.1093","volume":"148","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7679-4220","authenticated-orcid":false,"given":"Thomas D","family":"Parker","sequence":"first","affiliation":[{"name":"Department of Brain Sciences, Division of Medicine, Imperial College London , London W12 0BZ ,","place":["UK"]},{"name":"UK Dementia Research Institute Centre for Care Research & Technology, Imperial College London and University of Surrey, London W12 0BZ, UK"},{"name":"Department of Neurodegenerative Disease, The Dementia Research Centre, UCL Queen Square Institute of Neurology , London WC1N 3BG ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5534-6418","authenticated-orcid":false,"given":"Jessica A","family":"Hain","sequence":"additional","affiliation":[{"name":"Department of Brain Sciences, Division of Medicine, Imperial College London , London W12 0BZ ,","place":["UK"]},{"name":"UK Dementia Research Institute Centre for Care Research & Technology, Imperial College London and University of Surrey, London W12 0BZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin J","family":"Rooney","sequence":"additional","affiliation":[{"name":"Department of Brain Sciences, Division of Medicine, Imperial College London , London W12 0BZ ,","place":["UK"]},{"name":"UK Dementia Research Institute Centre for Care Research & Technology, Imperial College London and University of Surrey, London W12 0BZ, UK"},{"name":"Institute of Sport, Exercise and Health (ISEH), University College London \u00a0 W1T 7HA ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl A","family":"Zimmerman","sequence":"additional","affiliation":[{"name":"Department of Brain Sciences, Division of Medicine, Imperial College London , London W12 0BZ ,","place":["UK"]},{"name":"UK Dementia Research Institute Centre for Care Research & Technology, Imperial College London and University of Surrey, London W12 0BZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Brain Sciences, Division of Medicine, Imperial College London , London W12 0BZ ,","place":["UK"]},{"name":"UK Dementia Research Institute Centre for Care Research & Technology, Imperial College London and University of Surrey, London W12 0BZ, UK"},{"name":"Institute of Sport, Exercise and Health (ISEH), University College London \u00a0 W1T 7HA ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Del Giovane","sequence":"additional","affiliation":[{"name":"Department of Brain Sciences, Division of Medicine, Imperial College London , London W12 0BZ ,","place":["UK"]},{"name":"UK Dementia Research Institute Centre for Care Research & Technology, Imperial College London and University of Surrey, London W12 0BZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0183-3368","authenticated-orcid":false,"given":"Neil S N","family":"Graham","sequence":"additional","affiliation":[{"name":"Department of Brain Sciences, Division of Medicine, Imperial College London , London W12 0BZ ,","place":["UK"]},{"name":"UK Dementia Research Institute Centre for Care Research & Technology, Imperial College London and University of Surrey, London W12 0BZ, UK"},{"name":"Centre for Injury Studies, Imperial College London , London W12 0BZ ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maneesh","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Brain Sciences, Division of Medicine, Imperial College London , London W12 0BZ ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5176-5420","authenticated-orcid":false,"given":"Adam","family":"Hampshire","sequence":"additional","affiliation":[{"name":"Department of Brain Sciences, Division of Medicine, Imperial College London , London W12 0BZ ,","place":["UK"]},{"name":"Department of Neuroimaging, Kings College London , London SE5 8AF ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathew G","family":"Wilson","sequence":"additional","affiliation":[{"name":"Institute of Sport, Exercise and Health (ISEH), University College London \u00a0 W1T 7HA ,","place":["UK"]},{"name":"HCA Healthcare Research Institute , London W1T 7HA ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Friedland","sequence":"additional","affiliation":[{"name":"Department of Brain Sciences, Division of Medicine, Imperial College London , London W12 0BZ ,","place":["UK"]},{"name":"Institute of Sport, Exercise and Health (ISEH), University College London \u00a0 W1T 7HA ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J","family":"Sharp","sequence":"additional","affiliation":[{"name":"Department of Brain Sciences, Division of Medicine, Imperial College London , London W12 0BZ ,","place":["UK"]},{"name":"UK Dementia Research Institute Centre for Care Research & Technology, Imperial College London and University of Surrey, London W12 0BZ, UK"},{"name":"Centre for Injury Studies, Imperial College London , London W12 0BZ ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J","family":"Sylvester","sequence":"additional","affiliation":[{"name":"Institute of Sport, Exercise and Health (ISEH), University College London \u00a0 W1T 7HA ,","place":["UK"]},{"name":"Acute Stroke and Brain Injury Unit, National Hospital for Neurology and Neurosurgery, Queen Square , London WC1N 3BG ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,7,3]]},"reference":[{"key":"2025080112522482600_awae416-B1","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1136\/bjsports-2015-094982","article-title":"Professional rugby union players have a 60% greater risk of time loss injury after concussion: A 2-season prospective study of clinical outcomes","volume":"50","author":"Cross","year":"2016","journal-title":"Br J Sports Med"},{"key":"2025080112522482600_awae416-B2","doi-asserted-by":"crossref","first-page":"fcaa137","DOI":"10.1093\/braincomms\/fcaa137","article-title":"Plasma glial fibrillary acidic protein and neurofilament light chain, but not tau, are biomarkers of sports-related mild traumatic brain injury","volume":"2","author":"Laverse","year":"2020","journal-title":"Brain Commun"},{"key":"2025080112522482600_awae416-B3","doi-asserted-by":"crossref","first-page":"1262","DOI":"10.1136\/jnnp-2022-329675","article-title":"Neurodegenerative disease risk among former international rugby union players","volume":"93","author":"Russell","year":"2022","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"2025080112522482600_awae416-B4","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1002\/alz.12455","article-title":"Concussion and long-term cognitive function among rugby players-The BRAIN Study","volume":"18","author":"Gallo","year":"2022","journal-title":"Alzheimers Dement"},{"key":"2025080112522482600_awae416-B5","doi-asserted-by":"crossref","first-page":"fcab133","DOI":"10.1093\/braincomms\/fcab133","article-title":"White matter abnormalities in active elite adult rugby players","volume":"3","author":"Zimmerman","year":"2021","journal-title":"Brain Commun"},{"key":"2025080112522482600_awae416-B6","doi-asserted-by":"crossref","first-page":"fcad257","DOI":"10.1093\/braincomms\/fcad257","article-title":"Active elite rugby participation is associated with altered precentral cortical thickness","volume":"5","author":"Parker","year":"2023","journal-title":"Brain Commun"},{"key":"2025080112522482600_awae416-B7","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1038\/s41582-018-0114-8","article-title":"Chronic traumatic encephalopathy\u2014Confusion and controversies","volume":"15","author":"Smith","year":"2019","journal-title":"Nat Rev Neurol"},{"key":"2025080112522482600_awae416-B8","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1007\/s00401-023-02540-w","article-title":"Chronic traumatic encephalopathy (CTE): Criteria for neuropathological diagnosis and relationship to repetitive head impacts","volume":"145","author":"McKee","year":"2023","journal-title":"Acta Neuropathol"},{"issue":"Pt 1","key":"2025080112522482600_awae416-B9","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1093\/brain\/aws307","article-title":"The spectrum of disease in chronic traumatic encephalopathy","volume":"136","author":"McKee","year":"2013","journal-title":"Brain"},{"key":"2025080112522482600_awae416-B10","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1002\/ana.25611","article-title":"Duration of American football play and chronic traumatic encephalopathy","volume":"87","author":"Mez","year":"2020","journal-title":"Ann Neurol"},{"key":"2025080112522482600_awae416-B11","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1001\/jama.2017.8334","article-title":"Clinicopathological evaluation of chronic traumatic encephalopathy in players of American football","volume":"318","author":"Mez","year":"2017","journal-title":"JAMA"},{"key":"2025080112522482600_awae416-B12","doi-asserted-by":"crossref","first-page":"3470","DOI":"10.1038\/s41467-023-39183-0","article-title":"Leveraging football accelerometer data to quantify associations between repetitive head impacts and chronic traumatic encephalopathy in males","volume":"14","author":"Daneshvar","year":"2023","journal-title":"Nat Commun"},{"key":"2025080112522482600_awae416-B13","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1186\/s13195-021-00928-y","article-title":"Structural MRI profiles and tau correlates of atrophy in autopsy-confirmed CTE","volume":"13","author":"Alosco","year":"2021","journal-title":"Alzheimers Res Ther"},{"key":"2025080112522482600_awae416-B14","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1093\/qjmed\/hcv070","article-title":"Chronic traumatic encephalopathy: A potential late and under recognized consequence of rugby union?","volume":"109","author":"Stewart","year":"2016","journal-title":"QJM"},{"key":"2025080112522482600_awae416-B15","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1186\/s40478-019-0751-1","article-title":"Chronic traumatic encephalopathy in two former Australian National Rugby League players","volume":"7","author":"Buckland","year":"2019","journal-title":"Acta Neuropathol Commun"},{"key":"2025080112522482600_awae416-B16","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1007\/s00401-019-02030-y","article-title":"Chronic traumatic encephalopathy is a common co-morbidity, but less frequent primary dementia in former soccer and rugby players","volume":"138","author":"Lee","year":"2019","journal-title":"Acta Neuropathol"},{"key":"2025080112522482600_awae416-B17","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1007\/s00401-015-1435-y","article-title":"Beta-amyloid deposition in chronic traumatic encephalopathy","volume":"130","author":"Stein","year":"2015","journal-title":"Acta Neuropathol"},{"key":"2025080112522482600_awae416-B18","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1007\/s00401-023-02576-y","article-title":"The perils of contact sport: Pathologies of diffuse brain swelling and chronic traumatic encephalopathy neuropathologic change in a 23-year-old rugby union player","volume":"145","author":"Lee","year":"2023","journal-title":"Acta Neuropathol"},{"key":"2025080112522482600_awae416-B19","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1007\/s00401-023-02644-3","article-title":"Risk of chronic traumatic encephalopathy in rugby union is associated with length of playing career","volume":"146","author":"Stewart","year":"2023","journal-title":"Acta Neuropathol"},{"key":"2025080112522482600_awae416-B20","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1212\/WNL.0000000000011850","article-title":"National institute of neurological disorders and stroke consensus diagnostic criteria for traumatic encephalopathy syndrome","volume":"96","author":"Katz","year":"2021","journal-title":"Neurology"},{"key":"2025080112522482600_awae416-B21","doi-asserted-by":"crossref","first-page":"e082902","DOI":"10.1136\/bmjopen-2023-082902","article-title":"A prospective cohort study of long-term neurological outcomes in retired elite athletes: The advanced BiomaRker, Advanced Imaging and Neurocognitive (BRAIN) Health Study protocol","volume":"14","author":"Zimmerman","year":"2024","journal-title":"BMJ Open"},{"key":"2025080112522482600_awae416-B22","doi-asserted-by":"crossref","first-page":"e2021086","DOI":"10.4178\/epih.e2021086","article-title":"The BRAIN-Q, a tool for assessing self-reported sport-related concussions for epidemiological studies","volume":"43","author":"James","year":"2021","journal-title":"Epidemiol Health"},{"key":"2025080112522482600_awae416-B23","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1097\/01.HTR.0000300227.67748.77","article-title":"Initial reliability and validity of the Ohio state university TBI identification method","volume":"22","author":"Corrigan","year":"2007","journal-title":"J Head Trauma Rehabil"},{"key":"2025080112522482600_awae416-B24","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1111\/j.1360-0443.1993.tb02093.x","article-title":"Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on early detection of persons with harmful alcohol consumption\u2014II","volume":"88","author":"Saunders","year":"1993","journal-title":"Addiction"},{"key":"2025080112522482600_awae416-B25","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1159\/000081413","article-title":"Evaluation of the Drug Use Disorders Identification Test (DUDIT) in criminal justice and detoxification settings and in a Swedish population sample","volume":"11","author":"Berman","year":"2005","journal-title":"Eur Addict Res"},{"key":"2025080112522482600_awae416-B26","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1001\/archpsyc.1961.01710120031004","article-title":"An inventory for measuring depression","volume":"4","author":"Beck","year":"1961","journal-title":"Arch Gen Psychiatry"},{"key":"2025080112522482600_awae416-B27","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: The GAD-7","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch Intern Med"},{"key":"2025080112522482600_awae416-B28","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/S1389-9457(00)00065-4","article-title":"Validation of the insomnia severity index as an outcome measure for insomnia research","volume":"2","author":"Bastien","year":"2001","journal-title":"Sleep Med"},{"key":"2025080112522482600_awae416-B29","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/0165-1781(89)90047-4","article-title":"The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research","volume":"28","author":"Buysse","year":"1989","journal-title":"Psychiatry Res"},{"key":"2025080112522482600_awae416-B30","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1080\/13854046.2021.1942555","article-title":"Validating the modified Rivermead post-concussion symptoms questionnaire (mRPQ)","volume":"37","author":"Brooks","year":"2023","journal-title":"Clin Neuropsychol"},{"key":"2025080112522482600_awae416-B31","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1007\/s11136-011-9903-x","article-title":"Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)","volume":"20","author":"Herdman","year":"2011","journal-title":"Qual Life Res"},{"key":"2025080112522482600_awae416-B32","doi-asserted-by":"publisher","DOI":"10.1037\/t86244-000","article-title":"Behavior rating inventory of executive function\u00ae\u2014Adult version","author":"Roth","year":"2005","journal-title":"APA PsycTests"},{"issue":"5 Suppl 6","key":"2025080112522482600_awae416-B33","first-page":"S10","article-title":"The neuropsychiatric inventory: Assessing psychopathology in dementia patients","volume":"48","author":"Cummings","year":"1997","journal-title":"Neurology"},{"key":"2025080112522482600_awae416-B34","doi-asserted-by":"publisher","DOI":"10.1037\/t15169-000","article-title":"Wechsler Adult Intelligence Scale. Fourth Edition","author":"Wechsler","year":"2008","journal-title":"APA PsycTests"},{"key":"2025080112522482600_awae416-B35","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1093\/arclin\/17.7.625","article-title":"Sensitivity and specificity of the Rey dot counting test in patients with suspect effort and various clinical samples","volume":"17","author":"Boone","year":"2002","journal-title":"Arch Clin Neuropsychol"},{"key":"2025080112522482600_awae416-B36","doi-asserted-by":"publisher","DOI":"10.1037\/t15082-000","article-title":"Delis-Kaplan executive function system","author":"Delis","year":"2001","journal-title":"APA PsycTests"},{"key":"2025080112522482600_awae416-B37","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/S0887-6177(03)00039-8","article-title":"Trail making test A and B: Normative data stratified by age and education","volume":"19","author":"Tombaugh","year":"2004","journal-title":"Arch Clin Neuropsychol"},{"key":"2025080112522482600_awae416-B38","doi-asserted-by":"publisher","DOI":"10.1037\/t15175-000","article-title":"Wechsler Memory Scale. Fourth Edition","author":"Wechsler","year":"2009","journal-title":"APA PsycTests"},{"key":"2025080112522482600_awae416-B39","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1076\/jcen.20.3.310.823","article-title":"The repeatable battery for the assessment of neuropsychological status (RBANS): Preliminary clinical validity","volume":"20","author":"Randolph","year":"1998","journal-title":"J Clin Exp Neuropsychol"},{"key":"2025080112522482600_awae416-B40","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1093\/brain\/awaa067","article-title":"Distinct patterns of structural damage underlie working memory and reasoning deficits after traumatic brain injury","volume":"143","author":"Jolly","year":"2020","journal-title":"Brain"},{"key":"2025080112522482600_awae416-B41","doi-asserted-by":"crossref","first-page":"101980","DOI":"10.1016\/j.eclinm.2023.101980","article-title":"Computerised cognitive assessment in patients with traumatic brain injury: An observational study of feasibility and sensitivity relative to established clinical scales","volume":"59","author":"Giovane","year":"2023","journal-title":"EClinicalMedicine"},{"key":"2025080112522482600_awae416-B42","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1056\/NEJMoa2311330","article-title":"Cognition and memory after COVID-19 in a large community sample","volume":"390","author":"Hampshire","year":"2024","journal-title":"N Engl J Med"},{"key":"2025080112522482600_awae416-B43","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1098\/rstb.1982.0082","article-title":"Specific impairments of planning","volume":"298","author":"Shallice","year":"1982","journal-title":"Philos Trans R Soc Lond B Biol Sci"},{"key":"2025080112522482600_awae416-B44","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1089\/neu.2014.3805","article-title":"Cavum septum Pellucidum in retired American pro-football players","volume":"33","author":"Gardner","year":"2016","journal-title":"J Neurotrauma"},{"key":"2025080112522482600_awae416-B45","doi-asserted-by":"crossref","first-page":"1790","DOI":"10.1519\/JSC.0000000000002827","article-title":"Anthropometric and physiological characteristics of elite male rugby athletes","volume":"34","author":"Brazier","year":"2020","journal-title":"J Strength Cond Res"},{"key":"2025080112522482600_awae416-B46","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1519\/JSC.0000000000004237","article-title":"Training and match demands of elite rugby union","volume":"37","author":"Cousins","year":"2023","journal-title":"J Strength Cond Res"},{"key":"2025080112522482600_awae416-B47","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s40798-021-00398-4","article-title":"Quantifying collision frequency and intensity in rugby union and rugby sevens: A systematic review","volume":"8","author":"Paul","year":"2022","journal-title":"Sports Med Open"},{"key":"2025080112522482600_awae416-B48","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1007\/s40279-023-01953-7","article-title":"Instrumented mouthguards in elite-level men\u2019s and women\u2019s rugby union: The incidence and propensity of head acceleration events in matches","volume":"54","author":"Tooby","year":"2024","journal-title":"Sports Med"},{"key":"2025080112522482600_awae416-B49","doi-asserted-by":"crossref","first-page":"101044","DOI":"10.1016\/j.eclinm.2021.101044","article-title":"Cognitive deficits in people who have recovered from COVID-19","volume":"39","author":"Hampshire","year":"2021","journal-title":"EClinicalMedicine"},{"key":"2025080112522482600_awae416-B50","doi-asserted-by":"crossref","first-page":"1801","DOI":"10.1056\/NEJMoa1908483","article-title":"Neurodegenerative disease mortality among former professional soccer players","volume":"381","author":"Mackay","year":"2019","journal-title":"N Engl J Med"},{"key":"2025080112522482600_awae416-B51","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1249\/MSS.0000000000002802","article-title":"Mild cognitive impairment and dementia reported by former professional football players over 50 year of age: An NFL-LONG study","volume":"54","author":"Walton","year":"2022","journal-title":"Med Sci Sports Exerc"},{"key":"2025080112522482600_awae416-B52","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1089\/neu.2016.4413","article-title":"Cumulative head impact exposure predicts later-life depression, apathy, executive dysfunction, and cognitive impairment in former high school and college football players","volume":"34","author":"Montenigro","year":"2017","journal-title":"J Neurotrauma"},{"key":"2025080112522482600_awae416-B53","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1227\/01.NEU.0000175725.75780.DD","article-title":"Association between recurrent concussion and late-life cognitive impairment in retired professional football players","volume":"57","author":"Guskiewicz","year":"2005","journal-title":"Neurosurgery"},{"key":"2025080112522482600_awae416-B54","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1001\/jamaneurol.2021.2403","article-title":"Association of field position and career length with risk of neurodegenerative disease in male former professional soccer players","volume":"78","author":"Russell","year":"2021","journal-title":"JAMA Neurol"},{"key":"2025080112522482600_awae416-B55","doi-asserted-by":"crossref","first-page":"676762","DOI":"10.3389\/fneur.2021.676762","article-title":"Predictors and correlates of perceived cognitive decline in retired professional rugby league players","volume":"12","author":"Van Patten","year":"2021","journal-title":"Front Neurol"},{"key":"2025080112522482600_awae416-B56","unstructured":"Prince M, Prina M, Ma\u00eblenn G. World Alzheimer Report 2013: Journey of Caring: An analysis of long-term care for dementia. Published online 21 September 2013. Accessed 25 March 2024. https:\/\/www.alzint.org\/resource\/world-alzheimer-report-2013\/"},{"key":"2025080112522482600_awae416-B57","doi-asserted-by":"crossref","first-page":"655746","DOI":"10.3389\/fneur.2021.655746","article-title":"Predictors and correlates of depression in retired elite level rugby league players","volume":"12","author":"Iverson","year":"2021","journal-title":"Front Neurol"},{"key":"2025080112522482600_awae416-B58","doi-asserted-by":"crossref","first-page":"2871","DOI":"10.1177\/0363546519868989","article-title":"Exposure to American Football and Neuropsychiatric Health in former national football league players: Findings from the football players health study","volume":"47","author":"Roberts","year":"2019","journal-title":"Am J Sports Med"},{"key":"2025080112522482600_awae416-B59","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.jad.2020.09.129","article-title":"Prevalence and age patterns of depression in the United Kingdom. A population-based study","volume":"279","author":"Arias de la Torre","year":"2021","journal-title":"J Affect Disord"},{"key":"2025080112522482600_awae416-B60","doi-asserted-by":"crossref","first-page":"2299","DOI":"10.1016\/S0140-6736(18)31948-2","article-title":"Depression","volume":"392","author":"Malhi","year":"2018","journal-title":"Lancet"},{"key":"2025080112522482600_awae416-B61","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.3233\/JAD-220170","article-title":"Prevalence of depressive symptoms in a memory clinic cohort: A retrospective study","volume":"88","author":"Loreto","year":"2022","journal-title":"J Alzheimers Dis"},{"key":"2025080112522482600_awae416-B62","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1080\/23279095.2019.1660880","article-title":"Towards an embedded symptom validity indicator for the rivermead postconcussion symptom questionnaire","volume":"28","author":"Windle","year":"2021","journal-title":"Appl Neuropsychol Adult"},{"key":"2025080112522482600_awae416-B63","doi-asserted-by":"crossref","first-page":"1906","DOI":"10.1093\/brain\/awac149","article-title":"Reframing postconcussional syndrome as an interface disorder of neurology, psychiatry and psychology","volume":"145","author":"Clark","year":"2022","journal-title":"Brain"},{"key":"2025080112522482600_awae416-B64","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1186\/s40478-021-01197-4","article-title":"Identifying degenerative effects of repetitive head trauma with neuroimaging: A clinically-oriented review","volume":"9","author":"Asken","year":"2021","journal-title":"Acta Neuropathol Commun"},{"key":"2025080112522482600_awae416-B65","doi-asserted-by":"crossref","first-page":"817709","DOI":"10.3389\/fneur.2022.817709","article-title":"Examining for Cavum septum Pellucidum and ventricular enlargement in retired elite-level rugby league players","volume":"13","author":"Stanwell","year":"2022","journal-title":"Front Neurol"},{"key":"2025080112522482600_awae416-B66","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1093\/brain\/aww317","article-title":"Computational modelling of traumatic brain injury predicts the location of chronic traumatic encephalopathy pathology","volume":"140","author":"Ghajari","year":"2017","journal-title":"Brain"},{"key":"2025080112522482600_awae416-B67","doi-asserted-by":"crossref","first-page":"3550","DOI":"10.1093\/brain\/awz290","article-title":"Traumatic microbleeds suggest vascular injury and predict disability in traumatic brain injury","volume":"142","author":"Griffin","year":"2019","journal-title":"Brain"},{"key":"2025080112522482600_awae416-B68","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1136\/jnnp-2017-317557","article-title":"Understanding neurodegeneration after traumatic brain injury: From mechanisms to clinical trials in dementia","volume":"90","author":"Graham","year":"2019","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"2025080112522482600_awae416-B69","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/S1474-4422(14)70324-2","article-title":"Presymptomatic cognitive and neuroanatomical changes in genetic frontotemporal dementia in the Genetic Frontotemporal dementia Initiative (GENFI) study: A cross-sectional analysis","volume":"14","author":"Rohrer","year":"2015","journal-title":"Lancet Neurol"},{"key":"2025080112522482600_awae416-B70","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1056\/NEJMoa1202753","article-title":"Clinical and biomarker changes in dominantly inherited Alzheimer\u2019s disease","volume":"367","author":"Bateman","year":"2012","journal-title":"N Engl J Med"},{"key":"2025080112522482600_awae416-B71","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1056\/NEJMoa2310168","article-title":"Biomarker changes during 20 years preceding Alzheimer\u2019s disease","volume":"390","author":"Jia","year":"2024","journal-title":"N Engl J Med"},{"key":"2025080112522482600_awae416-B72","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1089\/neu.2022.0060","article-title":"Multi-modal biomarkers of repetitive head impacts and traumatic encephalopathy syndrome: A clinicopathological case series","volume":"39","author":"Asken","year":"2022","journal-title":"J Neurotrauma"},{"key":"2025080112522482600_awae416-B73","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1136\/bjsports-2022-105819","article-title":"Traumatic encephalopathy syndrome: Application of new criteria to a cohort exposed to repetitive head impacts","volume":"57","author":"Ritter","year":"2023","journal-title":"Br J Sports Med"},{"key":"2025080112522482600_awae416-B74","doi-asserted-by":"crossref","first-page":"arcr.v40.1.01","DOI":"10.35946\/arcr.v40.1.01","article-title":"Alcohol use disorder and depressive disorders","volume":"40","author":"McHugh","year":"2019","journal-title":"Alcohol Res"},{"key":"2025080112522482600_awae416-B75","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/S0140-6736(20)30367-6","article-title":"Dementia prevention, intervention, and care: 2020 report of the lancet commission","volume":"396","author":"Livingston","year":"2020","journal-title":"Lancet"},{"key":"2025080112522482600_awae416-B76","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1038\/s41467-022-28735-5","article-title":"Associations between alcohol consumption and gray and white matter volumes in the UK biobank","volume":"13","author":"Daviet","year":"2022","journal-title":"Nat Commun"},{"key":"2025080112522482600_awae416-B77","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.nicl.2018.01.005","article-title":"Cortical thickness and subcortical brain volumes in professional rugby league players","volume":"18","author":"Wojtowicz","year":"2018","journal-title":"Neuroimage Clin"},{"key":"2025080112522482600_awae416-B78","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1080\/1750984X.2018.1469162","article-title":"Prevalence and correlates of psychological distress among retired elite athletes: A systematic review","volume":"12","author":"Mannes","year":"2019","journal-title":"Int Rev Sport Exerc Psychol"},{"key":"2025080112522482600_awae416-B79","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1080\/1750984X.2012.687053","article-title":"Athletes\u2019 career transition out of sport: A systematic review","volume":"6","author":"Park","year":"2013","journal-title":"Int Rev Sport Exerc Psychol"}],"container-title":["Brain"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/brain\/advance-article-pdf\/doi\/10.1093\/brain\/awae416\/63625091\/awae416.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/brain\/article-pdf\/148\/8\/2698\/63625091\/awae416.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/brain\/article-pdf\/148\/8\/2698\/63625091\/awae416.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T16:52:41Z","timestamp":1754067161000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/brain\/article\/148\/8\/2698\/8178235"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,3]]},"references-count":79,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,7,3]]},"published-print":{"date-parts":[[2025,8,1]]}},"URL":"https:\/\/doi.org\/10.1093\/brain\/awae416","relation":{},"ISSN":["0006-8950","1460-2156"],"issn-type":[{"value":"0006-8950","type":"print"},{"value":"1460-2156","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,8]]},"published":{"date-parts":[[2025,7,3]]}}}