“ In football and hockey, the number of actual concussions is six or seven times higher than the number diagnosed. Approximately 70 percent of football players and 62 percent of soccer players get at least one concussion per year.”
Traumatic Brain Injury (TBI), in particular concussions, is a growing concern that often goes initially undiagnosed yet leads to ongoing chronic cognitive difficulties. Effects of TBI can include impaired thinking or memory, mood instability, or emotional functioning (e.g., personality changes, depression). The majority of TBI cases can be attributed to falls, motor vehicle accidents, motorcycle accidents, bicycle accidents, and pedestrian injuries. It is also a major concern in football, soccer, rugby, baseball , lacrosse and ice hockey. The facts are startling affecting our youth, collegiate and professional athletes.
- High school football accounts for 47 percent of all reported sports concussions, with 33 percent of concussions occurring during practice. After football, ice hockey and soccer pose the most significant head health risk.
- While the first hit can prove problematic, the second or third head impact can cause permanent long-term brain damage. Cumulative sports concussions are shown to increase the likelihood of catastrophic head injury leading to permanent neurologic disability by 39 percent.
- According to the CDC, from 2001 to 2009, the rate of ED visits for sports and recreation-related injuries with a diagnosis of concussion or TBI, alone or in combination with other injuries, rose 57% among children (age 19 or younger)
Importance of Cognition and Elite Athletic Performance
University of Montreal Neurophysicist Dr. Jocelyn Faubert ’s ground-breaking piece on the subject, Perceptual-Cognitive Training of Athletes, was published in 2012 by the Journal of Clinical Sports Psychology. Specifically, the paper aims to identify what is needed for optimal cognitive perception and then discuss possible training methods to improve those abilities in high-level athletes. The paper does not speak about athletes in general, but more about the differences between “elite” athletes (e.g. professionals) and “sub-elite” (e.g. high level amateurs). Dr. Faubert makes reference to Tom Brady, an undrafted college quarterback and his success in as a premier athlete. Her findings suggest that optimal cognitive training can be integral in predicting athletic prowess despite genetics and natural talent.
A study from the Karolinska Insitute found that elite soccer players demonstrated above-average cognitive abilities. In particular , the area of thinking at which soccer players excel is executive function — a term that includes creative problem solving, multi-tasking, inhibition and working memory. That last one, working memory, refers to the ability to recall previously stored information on the spot and use it to problem solve. Many of these are skills that can be seen on the field: employing strategy in the midst of a game (creativity, working memory), executing a play while also surveying the field (multi-tasking) and following the rules of the game (inhibition).
Researchers administered an established cognitive function exam (for which there is a national average) to 57 male and 26 female soccer players from Sweden’s three top ranked national divisions. They then compared the players’ results to the average score from a 2007 nation-wide sample. Not only did the elite players’ score above average for executive function, their cognitive scores went up as their playing scores did: in other words, the more skilled a player was on the field, the higher they tested for executive function. That’s important because it implies an actual association between soccer skill and cognitive ability.
Post Concussion Syndrome
Concussion is a mild traumatic brain injury, usually occurring after a blow to the head as in contact sports football and soccer. Loss of consciousness isn’t required for a diagnosis of concussion or post-concussion syndrome. In fact, the risk of post-concussion syndrome doesn’t appear to be associated with the severity of the initial injury. This may play a factor in the unfortunate misdiagnosis of concussions in many contact sports.
Symptoms of post-concussion syndrome are often vague and non-specific. Commonly reported symptoms include as depressed mood, sleep disruption, irritability and cognitive problems involving memory, concentration, and thinking. Deficits in any combination of these can markedly impair an athletes performance at any given time.
In terms of NFL concussions, a 2000 survey reported 26 percent of former professional players having three or more concussions during their careers. Retired NFL player Arizona Cardinal Sean Morey, special team specialist, followed doctors recommendations to hang up his helmet after four concussions in one game in 2009, Now his medicine cabinet has Lexapro, an anti-depressant – Trazodone, a sleep aid and Propranolol for his debilitating headaches, needless to say his cognitive abilities are a far cry from his pre concussion days. Sean admits though not the most physically gifted athlete his ability to make decisions , field surveying and creativity played key role in his success. Sean hopes his retiring early will help him avoid CTE.
Concussions and Cognitive Decline
Good players become better players when they have optimal cognitive abilities including executive functioning. Sports history shows evidence of many naturally physically gifted athletes who failed due to lack of cognitive abilities.
Research shows that perceptual-cognitive abilities, needed for elite athletic performance, are severely compromised by concussions. Concussions and repeated head injuries sustained in contact sports can further present as an obstacle in success on the football field. Repeated concussions can add an unfair disadvantaged to cognitive decline and even be career ending as in the case of Buffalo Bills quarterback, Kevin Kolb, who at age 30 after six years in the NFL retired in 2013.
The former Cowboys running back Tony Dorsett said that when he took a flight from Dallas to Los Angeles for testing, he repeatedly struggled to remember why he was aboard the plane and where he was going. Such episodes, he said, are commonplace when he travels. Dorsett said he also gets lost when he drives his two youngest daughters, ages 15 and 10, to their soccer and volleyball games.
Former San Francisco 49ers lineman George Viser’s memory began fading in 1982. He states his memory and mental acuity is hampered in his opinion by hundreds of concussions beginning in Popo Warner football days. His professional career was shortened by concussions and now uses notebooks to help him remember basic things everyday. Viser continues to struggle with depression , cognitive decline and bouts of rage.
Kevin Guskiewicz, he research director at the Center for the Study of Retired Athletes at UNC Chapel Hiland colleagues found that retired NFL players with a history of three or more concussions are more likely to experience clinical depression and mild cognitive impairment, which is an early hallmark of Alzheimer’s disease. Guskiewicz and colleagues are studying ways to slow down the progression of early brain damage they are finding in ex-athletes. They are testing the theory that omega-3 fatty acids, found in products such as fish oil supplements, could prevent or slow down the ravages of CTE in the brain.
Treatment Options and Neuroprotective Strategies
Despite the technological advances made during the last several decades, there still is no effective neuroprotective therapy currently available for mild let alone severe traumatic brain injuries. The mainstay of treatmen for patients with concussions is rest and while the majority of patients have a spontaneous resolution of their symptoms over a short period of time, approximately 10-20% of patients will have persistent symptoms. That percentage is too high for having persistent symptoms.
As the contact sports of football, soccer and boxing are here to stay and will be for centuries to come, the optimal goal is prevention of concussions , repeated concussions and thus chronic neurodegenerative issues including CTE (Chronic Traumatic Encepalopathy). For those with post concussion cognitive issues there is hope. Dr. Guskiewicz thoughts regarding promoting supplements in the prevention or slowed progression of CTE is of paramount significance and mirrors the potential benefits of neuroprotective, mood-enhancing brain optimizatrion supplements like ADVYNDRA®.
Megadoses of the essential B vitamins B 6, Folic Acid (B9) and B 12 in conjunction with trimethyglycine (betaine) and dopamine enhancing amino acids has potential neuroprotective advantages and may also help cognitive functioning in post concussion syndrome. B12, folate and B6 are all involved in neurotransmitter synthesis in the brain and controlling inflammation from preventing elevated homocysteine and high nitric oxide (NO) levels. It is believed that high NO levels may be in part responsible for much of the degeneration that occurs after strokes and subsequent cognitive decline in some diseases on the nervous system.
ADVYNDRA® offers these in a unique synergistic fashion promoting a healthier brain environment to enhance mental sharpness, executive functioning, focus, attention span, energy while minimizing brain fog associated with cognitive decline. L-Tyrosine aids in enhancing mental alertness. Vitamins B 6, B 12 couple with Folate (B9) increase brain chemicals dopamine, serotonin and norepinephrine – all important in executive functioning including focus, mood stability and concentration. Individuals deficient in dopamine level have higher incidence of cognitive deficiencies including those reported by athletes suffering for post concussion syndrome.
In 2015, ADVYNDRA® , 8 week, Open Label Clinical Trial was conducted to assess the safety and efficacy of ADVYNDRA in improving Overall Quality of Life As Measured by PHQ 9 and Beck Anxiety Inventory (BAI). Key components measured by these two rating scales include concentration, fear of losing control, mood stability, energy, quality of sleep and inability to relax. Any of which can impair elite athletic performance.
Study participants totaling 27 adults between ages 18 and 75 subjectively reported feeling depressed and anxious impacting their quality of life occupationally, academically and/or socially. If on antidepressants, no new antidepressants or changes in dosing of current antidepressants was done within previous 4 weeks of entering study. Results showed a statistically significant difference between the initial PHQ 9 with 8 weeks PHQ 9 and initial BAI with 8 weeks BAI. There were no adverse events or side effects reports and ADVYNDRA® was well tolerated.
In closing, further research will be invaluable in tailoring all natural therapies to promote brain optimization supplements and regimens that may not only aid in treatment of debilitating post concussion symptoms but may also serve as a neuroprotective measure. Brain disease such as CTE and the associated cognitive symptoms may also be alleviated . More research will also be needed to see if daily supplementation will ward off the onset and possibly the severity of CTE symptoms. It is our hope that ADVYNDRA® will be a harbinger of a class of such supplements.
Faubert, PhD. Jocelyn. Journal of Clinical Sports Psychology 2012 ” Perceptual-Cognitive Training of Athletes”