Cognitive and Behavioral Functioning in Female Former Soccer Players: Results from the Head Impact and Trauma Surveillance Study (HITSS)

Background/Objectives: Repetitive head impacts (RHI) from contact and collision sports have been associated with later-life cognitive and neurobehavioral impairments, as well as neurodegenerative conditions such as chronic traumatic encephalopathy (CTE). RHI-associated clinical sequelae among female former soccer players, specifically, are not well understood. This cross-sectional study aimed to examine the relationship of RHI exposure proxies (e.g., total years of soccer play, concussion history, highest level of play, and estimated cumulative heading frequency) with clinical measures (e.g., subjective cognitive complaints, objective cognitive performance, behavioral dysregulation, and depressive symptoms) among 2732 women, aged 40 years or above, enrolled in the Head Impact and Trauma Surveillance Study (HITSS), all of whom formerly played organized soccer. Methods: HITSS participants completed an online battery that elicited self-reported cognitive and behavioral complaints and depressive symptoms and that assessed cognitive performance via computerized tests. Multivariable linear regression models estimated associations between soccer-related RHI proxies and outcome measures, adjusting for age and education. Results: Among the former soccer players, longer duration of soccer play, higher level of play, greater estimated cumulative heading frequency, and concussion history were significantly associated with worse self-reported cognitive functioning, greater behavioral dysregulation, and elevated depressive symptom severity. Apart from a single association between concussion history and visual learning and episodic memory performance, we found no other associations between RHI proxies and objective cognitive test performance. Conclusions: Among middle-aged women who played organized soccer, cumulative RHI exposure corresponded to a higher degree of subjective cognitive complaints, worse behavioral functioning, and more severe depressive symptoms. Continued monitoring of this large cohort of female former soccer players offers a more comprehensive understanding of long-term health consequences of soccer play.