Dementia, denial, and high school football

The National Football League (NFL) commissioned a survey on the incidence of dementia and other memory-related diseases among its retired players. The results that came back showed early-onset dementia occurring “vastly more often” compared to the national population. The NLF dismissed the study as unreliable.

The data comes from the 88 Plan, a financial assistance plan for retired players with dementia. Confidential data from the plan indicates that the rate of dementia among football retirees is several times higher than the general population. The rate may actually be much higher than the data indicate, however, since many retirees are reluctant to admit they have a problem. Even NFL Commissioner Roger Goodell admits that the 88 Plan data underestimates the problem.

“You know N.F.L. players,” Goodell said when asked about the 88 Plan at his annual news conference before last season’s Super Bowl. “They’ve got a lot of pride. When they have a lot of pride, they don’t always want to become public with their needs.”

Scientific evidence indicates that dementia in former football players is the result of repeated blows to the head.

The truth is, you really don’t want to know

Rayfield Wright is one of those NFL veterans who is unwilling to apply to the 88 Plan for financial assistance. Wright, 64, was a Hall of Fame tackle for the Dallas Cowboys from 1967 to 1979. As reported in the New York Times:

His friend and caregiver, Jeannette DeVader, said that Wright had all the signs of early-onset dementia — including short-term memory loss and frequently getting lost — but that he would not see a neurologist, let alone apply to the 88 Plan. Wright confirmed that he did not want what he called the stigma: “Players don’t want to look at themselves that way. The truth is, you really don’t want to know.”

1967 to 1979 is twelve seasons. According to Malcolm Gladwell’s estimate (see my previous post), that could account for as many as 12,000 blows to the head.

The wife of one player experiencing early-onset dementia, who asked not to be identified, said she would not apply for the 88 Plan while her husband was coherent enough to understand it.

“He would be devastated,” she said. “They were so proud as players. They’re not going to admit any weakness now, and I’m not going to break his heart by doing it for him.”

Some players – or their caretakers – underreport the seriousness of their disease and the extent of their financial need. (More than half of 88 Plan members receive $40,000 to $88,000 a year.)

Sharon Hawkins will place her 71-year-old husband, the former Oakland Raiders lineman Wayne Hawkins, in a full-time facility next week after receiving less than $10,000 per year from the 88 Plan since 2007.
“He gets lost walking the dog,” Sharon Hawkins said. “Thank God the dog has known the way home.”

Denial leaves high school players vulnerable

Alan Schwarz, who has written several articles about this issue for the Times, says a reasonable analysis of available data indicates that former NFL players experience dementia four to five times more often than is normal. Yet the NFL continues to downplay the issue:

“I believe that our statistics are very similar to what they are in the general population,” Rooney [owner of the Pittsburgh Steelers] said after Goodell’s news conference. “I don’t think that it’s something that pro football players, every one of them has this. Surely there’s something about getting hit. But they don’t get hit as much as maybe some people are trying to say.”

This story has significance not only for professional sports, but for parents and young adults. In announcing House Judiciary Committee hearings on the subject, Representative John Conyers said: “This issue affects not just N.F.L. players, but millions of high school and college football players as well.”

A study released this summer found that high school football players experienced greater impact during head collisions – from a higher rate of acceleration – than college players. One possible explanation is that college players may have stronger neck muscles, which gives them better control of their head motion after impact. For high school students this finding could very well mean increased danger of injuries such as concussions.

Congressional hearings are scheduled for Wednesday, October 28.

Update 10/15/10:
Traumatic Brain Injury – Football, Warfare, and Long-Term Effects (The New England Journal of Medicine)

What medicine currently understands about the relation between head injuries and subsequent health problems. One interesting fact: Boxing injuries (dementia pugilistica or being punch-drunk) have been systematically documented because knockouts are part of how boxing is scored. In football, by contrast, injuries are downplayed so that players can stay in the game.

In late July, the National Football League introduced a new poster to be hung in league locker rooms, warning players of possible long-term health effects of concussions. Public awareness of the pathological consequences of traumatic brain injury has been elevated not only by the recognition of the potential clinical significance of repetitive head injuries in such high-contact sports as American football and boxing, but also by the prevalence of vehicular crashes and efforts to improve passenger safety features, and by modern warfare, especially blast injuries. Each year, more than 1.5 million Americans sustain mild traumatic brain injuries with no loss of consciousness and no need for hospitalization; an equal number sustain injuries sufficient to impair consciousness but insufficiently severe to necessitate long-term institutionalization.

Update 10/21/10:
As Injuries Rise, Scant Oversight of Helmet Safety (The New York Times)

Alan Schwarz, the author of the article, has been covering this subject extensively since it first emerged.

Helmets both new and used are not — and have never been — formally tested against the forces believed to cause concussions. The industry, which receives no governmental or other independent oversight, requires helmets for players of all ages to withstand only the extremely high-level force that would otherwise fracture skulls.

The standard has not changed meaningfully since it was written in 1973, despite rising concussion rates in youth football and the growing awareness of how the injury can cause significant short- and long-term problems with memory, depression and other cognitive functions, especially in children.

Moreover, used helmets worn by the vast majority of young players encountered stark lapses in the industry’s few safety procedures. Some of the businesses that recondition helmets ignored testing rules, performed the tests incorrectly or returned helmets that were still in poor condition. More than 100,000 children are wearing helmets too old to provide adequate protection — and perhaps half a million more are wearing potentially unsafe helmets that require critical examination, according to interviews with experts and industry data.

Related posts:
Is football the moral equivalent of dogfighting?