Subjective and Performance-Based Cognition and Their Associations with Head Injury History in Older Former National Football League Players

Purpose: Investigate the association between self-reported subjective and performance-based cognition among older (50-70 years) former professional American football players, as well as the relationship of cognitive measures with concussion history and years of football participation, as a proxy for repetitive head impact exposure. Methods: Among older former National Football League (NFL) players (N= 172; mean age = 60.69 +/- 5.64), associations of subjective (Patient Reported Outcome Measurement Information System Cognitive Function-Short Form)and performance-based cognitive measures (Brief Test of Adult Cognition by Telephone [BTACT] Executive Function and Episodic Memory in-dices) were assessed via univariable and multivariable regression models, with aprioricovariates of depression and race. A similar univariate and multivariable regression approach assessed associations between concussion history and years of football participation with subjective and performance-based cognitive measures. In a sample subset (n= 114), stability of subjective cognitive rating was assessed via partial correlation. Results: Subjective ratings of cognition were significantly associated with performance-based assessment, with moderate effect sizes (episodicmemory eta(2)(p)= 0.12; executive function eta(2)(p)= 0.178). These associations were weakened, but remained significant (Ps < 0.05), with the inclusion of covariates. Greater concussion history was associated with lower subjective cognitive function (eta(2)(p)= 0.114,P< 0.001), but not performance-based cognition. The strength of association between concussion history and subjective cognition was substantially weakened with inclusion of covariates (eta(2)(p)= 0.057). Years of participation were not associated with measures of subjective or objective cognition (Ps > 0.05).Conclusions: These findings reinforce the importance of comprehensive evaluation reflecting both subjective and objective measures of cognition, as well as the consideration of patient-specific factors, as part of a comprehensive neurobehavioral and health assessment of older former contact sport athletes