Current Environment:

Findings | Overview

Brett BL, Walton SR, Kerr ZY, Nelson LD, Chandran A, Defreese JD, Echemendia RJ, Guskiewicz KM, Meehan Iii WP, McCrea MA. Distinct latent profiles based on neurobehavioural, physical and psychosocial functioning of former National Football League (NFL) players: an NFL-LONG Study. J Neurol Neurosurg Psychiatry. 2021 Mar;92(3):282-290.

NFL-LONG researchers identified five distinct profiles of self-reported functioning in former NFL players.

  1. global higher functioning (GHF)
  2. average functioning (Average)
  3. mild somatic (pain and physical functioning) concerns (Somatic)
  4. somatic and cognitive difficulties with mild anxiety (SCA)
  5. global impaired functioning (GIF) 

Former players in groups 4 and 5 reported the highest levels of medical/psychiatric conditions and psychosocial stressor levels, as well self-reported more lifetime concussions.

Interestingly, total years of participation was not significantly associated with group, although group 1, those with higher global functioning, reported the greatest total years of tackle football played.

Graph showing findings from NFL-LONG Study.

Figure 2. The five latent profiles identified and their relative position on the respective LPA measures. (GHF) (LP1)=global higher functioning; average (LP2) functioning; somatic (LP3)=mild somatic (pain and physical functioning concerns); SCA (LP4)=somatic and cognitive difficulties with mild anxiety; GIF (LP5)=global impaired functioning. Measures include Patient Reported OutcomesMeasurement Information System (PROMIS)-29 domains Anxiety, Depression, Fatigue, Sleep Disturbance, Physical Functioning, Ability to Participate in Social Roles and Activities, and Pain Interference; PROMIS Cognitive Function Short-Form version 2.0, Emotional and Behavioral Dyscontrol-Short-Form version 2.0, General Self-Efficacy Short-Form version 1.0 and Meaning and Purpose Short-Form version 1.0; Neuro-QoL Emotional and Behavioral Dyscontrol Short-Form version 1.0. Standardized T-scored based on normative data obtaining within the general population (mean=50 and SD=10). Higher T-score equals greater dysfunction for all domains (measure reflecting positive functioning were inverted).

Walton SR, Kerr ZY, Brett BL, Chandran A, DeFreese JD, Smith-Ryan AE, Stoner L, Echemendia RJ, McCrea M, Meehan III WP, Guskiewicz KM. Health-promoting behaviours and concussion history are associated with cognitive function, mood-related symptoms and emotional-behavioural dyscontrol in former NFL players: an NFL-LONG Study. Br J Sports Med. 2021 Jun;55(12):683-690

Former NFL players who reported a higher number of lifetime sports related concussion were shown to have worse cognitive function, more depression and anxiety symptoms, and emotional-behavioral dyscontrol.

It was identified that several behaviors that were related to better functioning:

  1. frequent exercise
  2. sleep six or more hours per night
  3. better diet quality

Walton SR, Brett BL, Chandran A, et al. Mild Cognitive Impairment and Dementia Reported by Former Professional Football Players over 50 Years of Age: An NFL-LONG Study [published online ahead of print, 2021 Sep 28]. Med Sci Sports Exerc. 2021

Self-reported Mild Cognitive Impairment (MCI) and dementia prevalences were found to be higher in former NFL players than national estimates. Additionally, MCI and dementia were associated with numerous personal factors:

  1. mood-related disorders
  2. high number of self-reported concussions
  3. recent pain intensity
  4. diagnosis of depression and/or anxiety

Predictors of higher MCI and dementia prevalence may be modifiable and warrant consideration by clinicians and researchers as potential targets to mitigate the onset of these conditions.


Brett BL, Kerr ZY, Walton SR, et al. Longitudinal trajectory of depression symptom severity and the influence of concussion history and physical function over a 19-year period among former National Football League (NFL) players: an NFL-LONG Study. Journal of Neurology, Neurosurgery & Psychiatry Published Online First: 18 October 2021

  • Concussion history, not years of participation, was associated with greater depressive symptom severity in former NFL players. However, researchers found that neither concussion history nor years of participation were predictive of changes over a 19-year period.
  • Decline in physical function was a significant predictor of a steeper trajectory of increased depressive symptoms over time, independent of concussion effects.

Brett BL, Kerr ZY, Aggarwal NT, Chandran A, Mannix R, Walton S, DeFreese J, Echemendia RJ, Guskiewicz KM, McCrea MA, Meehan III WP. Cumulative Concussion and Odds of Stroke in Former National Football League Players. Stroke. 2021;(November). doi:10.1161/STROKEAHA.121.035607

  • The prevalence of stroke among former National Football League players aged ≥50 years was lower than the general population, with significantly increased risk among those with 10 or more prior concussions.
  • Findings add to the evidence suggesting that traumatic brain injuries are associated with increased risk of stroke.
  • Clinically, management of cardio- and cerebrovascular health may be pertinent to those with a history of multiple prior concussions.

We are currently recruiting former NFL players to participate in this study.