Even these scientists are now talking about the link between exercise and dementia

There were no fans, no shouting from the stands, no fierce duels between the competing teams. A group of respected scholars met last week at a conference center in Amsterdam. They came from the United States, Switzerland, South Africa and the United Kingdom. Nobody at the Postillion Hotel recognizes them, though they are well known in their field.

However, what this group of scientists decided will affect almost all athletes in the world. They can, unnoticed, change what millions of supporters see in the stands each week. How do athletes recover and how quickly a coach can get them back on the field.

It was a meeting of the Concussion in Sports Group (CISG), a group of leading scientists in the field of brain injury in sports. Every four years, they come together to write an outline of how team physicians and club physicians—from soccer to ice hockey to American football and horse racing—can best deal with athletes’ head and brain injuries. It has been called the bible for dealing with head injuries in sports. The next edition, launched last week, will be published early next year.

The fact that almost every Eredivisie club in the Netherlands now tests the brains of players is due, for example, to these scientists – they wrote the test protocol (SCAT-5) and determined how long an athlete should rehabilitate after a concussion. The last meeting was in 2016 in Berlin. Then came covid. But above all: In the years that followed, there was so much criticism of the sale agreement that the group narrowly escaped. The boss climbed. The group felt compelled to broaden their horizons. Because they can no longer ignore one question, as before: Can people develop dementia through their sport?

Read also: 2020 NRC Research StoryAbout scientists and sports federations ignoring the risk of brain injury

Paid by sports federations

Concussion in Sports Group has been around since 2001 and was established to “improve the safety and health” of athletes. Scholars’ meetings are funded by major sports federations, such as the National Football League (American Football, NFL), National Hockey League (ice hockey, NHL) and the International Olympic Committee (IOC). Many of the scientists involved also do paid or unpaid work for unions. Critics don’t think that’s a good thing. Sports associations may have an interest in minimizing the potential risk of brain injury. Who would want to let their kids play rugby if it was clear that it could cause serious brain damage?

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For a long time there was no reason to actually criticize scientists. There was a fierce discussion and they wrote important protocols, such as the concussion protocol used by Eredivisie clubs.

But as other scientists began making troubling discoveries about exercise’s potential effects on the brain, the picture began to shift.

Since 2008, the brains of hundreds of deceased American football players have been examined in Boston. Their family’s brains were tested because former athletes contracted the disease at the end of their lives. They suffered from severe dementia, mood swings, and personality changes.

The Boston Brain Bank has linked a disease to that scary picture: chronic traumatic encephalopathy (CTE). It can be caused by repeated blows to the head, such as hard tackles in soccer, battling in ice hockey, and possibly headers in soccer. Boston researchers found the disease in the brains of more than 600 deceased athletes (it can only be diagnosed postmortem). In the Netherlands, chronic traumatic encephalopathy was first discovered last year in the brain of a deceased athlete: former footballer Wott Holverda, who suffered from severe dementia at a young age, turns out to have suffered from it. His doctors are convinced that his football career was the determining factor in the disease.

Read also: Rebuild about Brain Research at Wout Holverdaa former striker of Sparta who suffered from dementia

You might say: A salient topic for the scientists gathered at Concussion in Sports Group. To investigate it, to warn about it, to set guidelines.

Ignore the danger

But this did not happen. In fact, it was discovered two years ago Norwegian Refugee Council that the sales agreement willfully ignores the troubling studies on brain injury. At the last meeting in Berlin, there were more than 3,800 scientific publications on the long-term consequences of sports brain injuries. Of those, the group threw over 3,750 unread: they didn’t meet strict “inclusion criteria.”

There is always such a weighting of publications at these kinds of scientific meetings. But the result was that CISG at all no I looked at troubling studies linking exercise and dementia.

Thus, in practice, all of the CTE cases Boston discovered were ignored: very special. A find like Wout Holverda’s would also not meet the group’s criteria. In short, the most influential group of scientists on brain injury in sports has insisted that sport cannot lead to long-term brain injury. And the world’s largest sports federations were happy to repeat it.

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American neurologist Robert Cantu, himself a member of the group, was furious about it and decided to do it Norwegian Refugee Council to talk about. “If you, like our group, eliminate a lot of publications that indicate the danger of sports for the brain, then you deliberately give a distorted picture of reality. Practically speaking, in this way you will never come to the conclusion that physical examinations in ice hockey can be harmful or interfere in American football or headers in soccer.”

The impetus for ignoring disturbing studies was the head of the Concussion in Sports Group, Australian brain scientist Paul McCrory. He joked publicly about scientific studies and media articles that showed how much former football players suffered from brain ailments, which he believed were caused by sports.

McCrory has been a consultant to several sports leagues and once testified for the NHL. He was also its editor-in-chief British Journal of Sports Medicine (BMJ), a major scientific journal in the field of sports medicine. In it he wrote, among other things (in 2001) that there was “no scientific evidence” that multiple concussions suffered by an athlete during his or her career “necessarily result in permanent damage”. This too was a relief to the athletes and their associations: the danger was evidently not so bad.

Only Paul McCrory turned out to be unreliable. In Amsterdam he is no longer there as chairman of the Concussion in Sports Group. Earlier this year, he resigned as chairman of the board because he was caught plagiarizing scientific articles. Two weeks ago, the magazine also retracted the article in which McCrory dismissed the risk of brain injury, along with eight other pieces of his hand. The BMJ has “concerns” about 38 other items. In several cases, McCrory impersonated, according to the magazine.

In Australia, Football Federation Australia last week apologized because the brain problem was wrongfully ignored and underestimated for years, in part because of McCrory’s involvement in various studies. The AFL promised to put more money into research. In the United States, the world’s largest biomedical research institute, NIH, announced this week that it officially recognizes that chronic traumatic encephalopathy can be caused by repetitive blows to the head, such as those often received by athletes. Data from the National Institutes of Health is the basis of much health policy in the United States, so this statement cannot be without consequences for sports leagues.

Jonathan Martin also had a PET scan in Baltimore.
Photo by Jason Andrew/The New York Times

Several unions have slowly begun to realize the problem in recent years. In American football, neurologists actually sit along the line as “watchers” to detect possible brain damage. In the English Football League, mouthguards with sensors are being tested to measure the impact of blows. There are rapid tests that allow sports doctors to see if a player has a concussion – and is therefore at greater risk of brain injury. Heading towards children is illegal in England.

Now things are different

In Amsterdam, the Concussion in Sports Group had its first opportunity last weekend to also pay attention to the potential long-term consequences of blows to the head while playing sports, such as dementia. And it happened. One of the most important publications discussed is an extensive study in which CTE plays a leading role.

Robert Cantu, the scientist who criticized his group and is an expert on CTE, was given an important position on the scientific committee. “We finally realized that repeated blows to the head can lead to long-term damage,” Cantu says.

According to Cantu, there is still a lot of scientific work to be done. Are some people who exercise at a higher risk of brain injury than others? How strong is the hit to inflict damage? How many times does the brain have to shake before something goes wrong?

He hopes that concussions in the now-actually athletic group CTE will warn of CTE — how will become abundantly clear when their “bible” comes out next year. Then he said that sports federations must take action. In his view, it could eventually frustrate heading football associations, play American football with fewer tackles, and prevent fighting in ice hockey. And that’s a good thing, says Cantu, though there are still a lot of unknowns: “The risk is greater than doing nothing.”

A version of this article also appeared in the newspaper on October 31, 2022.

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