Q&A: Why are so many former footballers suffering from dementia? | Sport

Is there a link between dementia and playing football?

The science is in its infancy, but, yes, a link was officially asserted when Jeff Astle was ruled to have died by “industrial disease”, caused by repeated blows to the head. Astle died in 2002 at the age of 59, but in 2014 an autopsy on his brain uncovered the presence of chronic traumatic encephalopathy (CTE), the neurodegenerative disease once known as dementia pugilistica. Last year, a study compared thousands of footballers in Scotland with the wider population and found that a former player was three-and-a-half times likelier to develop a neurodegenerative disease than the norm, even allowing for the fact they tended to live longer too. For Alzheimer’s the figure was five-fold.

What is the hypothesis of what is going on?

The simplest pathology here is that of CTE, because it can be caused only by head trauma. Usually this is a function of what is known as “cumulative dose”, which means the number of injuries is as important as the severity. But head trauma can trigger most of the major neurodegenerative disorders, too. The more science uncovers, the more it seems these traumas do not have to result in the symptoms currently classified as concussion. Any time the brain is shaken sufficiently in its cavity, so the hypothesis goes, axons are damaged, which may not register as detectable symptoms in the short term but can take their toll cumulatively. Another factor is the shaking loose of tau proteins from the microtubules of the brain. In time these can gather, much like cholesterol does in the blood, and impede cerebral function. This is the process through which CTE most likely develops, but it is all but certain other neurodegenerative diseases, including Parkinson’s and motor neurone disease, are susceptible. As yet, no one can see this process unfold from cause through to effect, but that does not mean it is not happening. It seems almost certain that it is.

Five of the 11 who won the World Cup with England have or have had dementia. Is this a coincidence?

It is highly unlikely. There are more than 850,000 cases of dementia in the UK. The incidence rate among those over the age of 65 is one in 14. Five out of 11 among the team of 66 is significantly more than there should be. The chances of a sample of 11 returning five cases, if subject to that same incidence rate in the general population, is less than 0.06%. This grave weekend for English football is helping to raise awareness of the likely links, along with the ceaseless work of Astle’s daughter Dawn and that of Dr Judith Gates, whose husband Bill, a former Middlesborough defender, is suffering from dementia.

Nobby Stiles died last week aged 78 after suffering from prostate cancer and dementia. Photograph: Dave Thompson/PA Wire/Press Association Images

Should football be concerned?

Any governing body whose sport brings with it significant health risk must not only take that risk seriously but also be concerned for the impact its dissemination has on their raison d’etre. There was a theory that the heavy leather balls of the 20th century might have been responsible but modern balls travel much faster, and the net effect is thought to be the same. This year the FA introduced a ban on heading in primary-school training and a tapered approach through the teen years. This should take the edge off the strongest association between football and dementia, which is length of time playing the game. Fifa is planning to trial an additional permanent substitution for concussion from next year. There is also talk of their setting up an independent concussion advisory group.

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Nobby Stiles has died at 78; Jack Charlton was 85; Bobby Charlton is 83. They have lived full, worthwhile and long lives, haven’t they?

They have, and it is established that those who play competitive sport do tend to live longer lives than the norm and to benefit from the countless positives of a life in sport. Dementia is not classified as “young onset” unless diagnosed before the age of 65, which approximately 5% of cases are. But those familiar with this most debilitating of conditions might contend that any diagnosis is too early. England’s heroes of 66 may not have returned any remarkably early cases, but they have more than they should. And theirs are just the high-profile cases. It may be each one of them would have done it all again, even if they could have known their fate, but football’s responsibility now is not only to acknowledge the risks but also to investigate and mitigate them as a matter of urgency.

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