In middle-aged and older adults, exposure to repetitive head impacts (RHI) and traumatic brain injury (TBI) have been shown to be independently associated with worse depression symptom severity and cognitive functioning. Results of the analysis were published in the journal Neurology.

The investigators sought to explore the contributions of RHI (ie, from contact sports participation, military service, and abuse) and history of TBI (both with and without loss of consciousness [LOC]) on symptoms of cognitive functioning and depression.

A cross-sectional study was conducted among individuals from the Brain Health Registry (BHR) who completed online evaluations. The study authors compared middle-aged and elderly participants who reported a history of RHI and/or TBI with those individuals without this history with respect to measures of cognition and depression.

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A total of 13,323 participants were included in the study. The mean participant age was 61.95 years; 72.5% of the enrollees were female. All of the participants were from the BHR and had completed such online assessments as the Ohio State University TBI Identification Method, the CogState Brief Battery and Lumos Labs NeuroCognitive Performance Tests, and the Geriatric Depression Scale (GDS-15).

Overall, 725 of the participants noted RHI exposure—most of which was linked to contact sports and abuse—and 7277 reported TBI, with 2604 of these cases accompanied by LOC. A total of 13,168 participants completed the GDS-15, with 16.4% (2160 of 13,168) of them reporting clinically meaningful symptoms of depression (ie, GDS-15 score of >5). When compared with the unexposed group, those individuals who reported a TBI with LOC reported 0.75 higher scores on the GDS-15 (95% CI, 0.59 to 0.91). In contrast, those participants who reported a TBI without LOC reported 0.43 higher scores on the GDS-15 (95% CI, 0.31 to 0.54).

Moreover, the greatest effects on the GDS-15 were observed in those with RHI, with those who had a history of RHI reporting 1.24 higher scores on the GDS-15 compared with those in the unexposed arm (95% CI, 0.36 to 2.12).

TBI without LOC had a negative effect on CogState Identification (95% CI, 0.001 to 0.01) and CogState One Back Test (95% CI, 0.0002 to 0.01). Additionally, RBI was predictive of worse CogState One Back Test scores (95% CI, –0.01 to 0.05). Individuals with a history of both TBI with LOC and RHI had the worse cognition and depression.

Limitations of the study include small sample sizes, lack of appropriate “control” groups, focus on male American football players, and reliance on retrospective reports to assess clinical status.

The investigators concluded that TBI and RHI are both linked to mid-life to later-life neuropsychiatric and cognitive functioning.  They recommend that different types of head impact exposures and TBIs are accounted for and assessed together, considering their potential long-term effects in middle-aged and elderly individuals.


Alosco ML, Tripodis Y, Baucom ZH, et al. The late contributions of repetitive head impacts and TBI to depression symptoms and cognition[published online June 26, 2020]. Neurology.  doi: 10.1212/WNL.0000000000010040