Neurodegenerative causes of death among retired National Football League players
NicolaVanacore, Researcher, Italian National Institute of Health[email protected]
Submitted September 18, 2012
Lehman et al. reported an increased risk of death from ALS and AD among retired National Football League (NFL) players, especially among players in speed positions. [1] A 40-fold higher prevalence rate for ALS was reported in football players who played after 1960. [2] There was no risk for ALS in high school students who played football from 1946 to 1956, when headgear was less protective than today. [3] I am surprised that Lehman et al. discussed only the causal hypothesis of recurrent traumatic brain injuries or concussions while other possible etiologic factors were not mentioned (i.e., intense physical activity, use of drugs, exposure to neurotoxins). [1] In Italy, a 12-fold higher risk of death from ALS in professional soccer players was observed but not from AD or PD. [4] In 6 out of 8 subjects, age at death was less than 59 years. [4] The risk of ALS was also significantly increased for midfielders but not for other positions. [5] Lehman et al. found a different pattern of risk of death for ALS and AD versus PD [1] so this may indicate a different origin for these diseases. It might be important to know the mean age at death of players deceased from ALS and AD in this study. [1] Further cohort studies in professional players of different sports should be carried out with particular attention to the position of players since this could supply important etiological cues.
1. Lehman EJ, Hein MJ, Baron SL, Gersic CM. Neurodegenerative causes of death among retired National Football League players. Neurology. 2012 Sep 5.
2. Abel EL. Football increases the risk for Lou Gehrig's disease, amyotrophic lateral sclerosis. Percept Mot Skills. 2007;104:1251-1254.
3. Savica R, Parisi JE, Wold LE, Josephs KA, Ahlskog JE. High school football and risk of neurodegeneration: a community-based study. Mayo Clin Proc. 2012;87:335-340.
4. Belli S, Vanacore N. Proportionate mortality of Italian soccer players: is amyotrophic lateral sclerosis an occupational disease? Eur J Epidemiol. 2005;20:237-242.
5. Chio A, Calvo A, Dossena M, Ghiglione P, Mutani R, Mora G. ALS in Italian professional soccer players: the risk is still present and could be soccer-specific. Amyotroph Lateral Scler 2009;10:205-209.
1. Lehman EJ, Hein MJ, Baron SL, Gersic CM. Neurodegenerative causes of death among retired National Football League players. Neurology. 2012 Sep 5.
2. Abel EL. Football increases the risk for Lou Gehrig's disease, amyotrophic lateral sclerosis. Percept Mot Skills. 2007;104:1251-1254.
3. Savica R, Parisi JE, Wold LE, Josephs KA, Ahlskog JE. High school football and risk of neurodegeneration: a community-based study. Mayo Clin Proc. 2012;87:335-340.
4. Belli S, Vanacore N. Proportionate mortality of Italian soccer players: is amyotrophic lateral sclerosis an occupational disease? Eur J Epidemiol. 2005;20:237-242.
5. Chio A, Calvo A, Dossena M, Ghiglione P, Mutani R, Mora G. ALS in Italian professional soccer players: the risk is still present and could be soccer-specific. Amyotroph Lateral Scler 2009;10:205-209.