[Skip to Content]
[Skip to Content Landing]
Views 1,493
Citations 0
Original Investigation
January 27, 2020

Associations of Apolipoprotein E ε4 Genotype and Ball Heading With Verbal Memory in Amateur Soccer Players

Author Affiliations
  • 1Gruss Magnetic Resonance Imaging Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
  • 2Litwin-Zucker Center for the Study of Alzheimer’s Disease, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
  • 3Division of Geriatric Psychiatry, Northwell Health, Glen Oaks, New York
  • 4Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
  • 5Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
  • 6Department of Neurology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
  • 7HINT Consulting, Orinda, California
  • 8Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
  • 9Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
JAMA Neurol. Published online January 27, 2020. doi:10.1001/jamaneurol.2019.4828
Key Points

Question  Are apolipoprotein E ε4 status and ball heading associated with verbal memory?

Findings  In this cross-sectional analysis of 352 amateur soccer players, those with greater exposure to ball heading in the prior 12 months and the apolipoprotein E ε4 allele demonstrated worse verbal memory than players with low exposure to ball heading.

Meaning  The findings from this study provide evidence to suggest that apolipoprotein E ε4 is a genetic risk factor for cognitive impairment associated with the high levels of long-term ball heading.

Abstract

Importance  Emerging evidence suggests that long-term exposure to ball heading in soccer, the most popular sport in the world, confers risk for adverse cognitive outcomes. However, the extent to which the apolipoprotein E ε4 (APOE ε4) allele, a common risk factor for neurodegeneration, and ball heading are associated with cognition in soccer players remains unknown.

Objective  To determine whether the APOE ε4 allele and 12-month ball heading exposure are associated with verbal memory in a cohort of adult amateur soccer players.

Design, Settings, and Participants  A total of 379 amateur soccer players were enrolled in the longitudinal Einstein Soccer Study from November 11, 2013, through January 23, 2018. Selection criteria included participation in soccer for more than 5 years and for more than 6 months per year. Of the 379 individuals enrolled in the study, 355 were genotyped. Three players were excluded for reporting extreme levels of heading. Generalized estimating equation linear regression models were employed to combine data across visits for a cross-sectional analysis of the data.

Exposures  At each study visit every 3 to 6 months, players completed the HeadCount 12-Month Questionnaire, a validated, computer-based questionnaire to estimate 12-month heading exposure that was categorized as low (quartiles 1 and 2), moderate (quartile 3), and high (quartile 4).

Main Outcome and Measures  Verbal memory was assessed at each study visit using the International Shopping List Delayed Recall task from CogState.

Results  A total of 352 soccer players (256 men and 96 women; median age, 23 years [interquartile range, 21-28 years]) across a total of 1204 visits were analyzed. High levels of heading were associated with worse verbal memory performance (β = −0.59; 95% CI, −0.93 to −0.25; P = .001). There was no main association of APOE ε4 with verbal memory (β = 0.09; 95% CI, −0.24 to 0.42; P = .58). However, there was a significant association of APOE ε4 and heading with performance on the ISRL task (χ2 = 7.22; P = .03 for overall interaction). In APOE ε4–positive players, poorer verbal memory associated with high vs low heading exposure was 4.1-fold greater (APOE ε4 negative, β = −0.36; 95% CI, −0.75 to 0.03; APOE ε4 positive, β = −1.49; 95% CI, −2.05 to −0.93), and poorer verbal memory associated with high vs moderate heading exposure was 8.5-fold greater (APOE ε4 negative, β = −0.13; 95% CI, −0.54 to 0.29; APOE ε4 positive, β = −1.11, 95% CI, −1.70 to −0.53) compared with that in APOE ε4–negative players.

Conclusions and Relevance  This study suggests that the APOE ε4 allele is a risk factor for worse memory performance associated with higher heading exposure in the prior year, which highlights that assessing genetic risks may ultimately play a role in promoting safer soccer play.

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    ×