Repetitive Head-Impact Exposure and Cognitive and Emotional Symptoms in Older Retired Female Collegiate Athletes

J Head Trauma Rehabil. 2025 Aug 5. doi: 10.1097/HTR.0000000000001089. Online ahead of print.

ABSTRACT

OBJECTIVES: This retrospective study examined whether contact sport participation, repetitive head impact (RHI) exposure, and concussion history were associated with cognitive and emotional symptoms in former collegiate female athletes.

SETTING: Archival data from the College Level Aging Athlete Study, a hybrid survey of over 1,000 former collegiate athletes aged 50 and older.

PARTICIPANTS: Female athletes (n = 567) were categorized into contact (e.g., soccer, lacrosse, ice hockey, and rugby) and non-contact (e.g., golf, diving, swimming, and gymnastics) groups based on their primary collegiate sport.

DESIGN AND MAIN MEASURES: Analyses of covariance, controlling for age and education, compared subjective cognitive decline (Cognitive Functioning Index), objective cognitive performance (Telephone Interview for Cognitive Status-40 Item Version), depression (Patient Health Questionnaire-8), anxiety (Generalized Anxiety Disorder Scale-7), and emotional dysregulation (Neurological Quality of Life Emotional and Behavioral Dyscontrol). Additional ANCOVAs assessed interactions between contact sport status and RHI variables (self-reported concussions, age of first participation, and years played). A post hoc model examined whether emotional symptoms attenuated cognitive complaints using an emotional symptom index (aggregate of depression, anxiety, and emotional dysregulation measures). Models adjusted standard errors using a heteroskedasticity-consistent method, with significance corrected via the Holm-Bonferroni method.

RESULTS: Contact and non-contact athletes showed similar cognitive and emotional profiles. Concussion history was associated with greater subjective cognitive and emotional symptoms but not objective cognitive decline. Emotional symptoms predicted cognitive concerns better than concussion history.

CONCLUSIONS: In this sample of aging female athletes, RHI exposure and concussions were not associated with objective cognitive impairment. Subjective concerns were greater in those with more reported concussions but were strongly influenced by emotional symptoms.

PMID:40802941 | DOI:10.1097/HTR.0000000000001089