The Sydney Morning Herald

By Roy Masters

April 2, 2019

There is a dangerous irony in former footballers, sitting around, pot-bellied and drinking schooners, speculating whether head knocks during their playing careers are the cause of their increasing memory loss.

The debate over concussion, which is seemingly resurrected in the media whenever an NRL player leaves the field jelly-legged, has distracted ex-players from other relevant causes of dementia, such as age, family history, alcohol, a sedentary lifestyle and past brain surgeries.

Most of the players I coached are now in the 55-65 age range and some are genuinely alarmed about dementia. Yet half are only five years away from the 65-70 age category, a grouping in which, statistically, 2 per cent will suffer dementia. 

The statistic doubles every   five years, meaning that 4% of the 70-75 age bracket will experience this disease. So, when the wife of a former great St George player tells me not to bother visiting the 81-year-old in a nursinghome it’s important to know he could be one of the 16 per cent in the 80-85 category suffering from dementia.

Yet the polarising language around the concussion debate means some ex-players, when comparing memory loss, are convinced head knocks all those years ago are the single cause and do nothing to correct their lifestyles.

Dr Martin Raftery, chief medical officer of World Rugby, a former first-grade player with Cronulla and past club medico of the Dragons, has followed the recent debate over concussion and takes issue with assertions that it has been demonstrated "beyond all doubt" that repeated concussions mean brain damage.

Dr Raftery says: "No scientist would agree that the evidence is 'beyond all doubt'. In actual fact, half of the experts think there is a link between head injury and CTE [Chronic Traumatic Encephalopathy] and the other half don’t believe the evidence is strong enough to support this link."

Dr Raftery, who divides his time between World Rugby’s headquarters in Dublin and his Sydney home, says the cause of dementia is multifactorial and complex.

"One way to think about the cause of dementia is the letters AGE – Age, Genetics and Environmental factors. Age and genetics are key factors and environmental factors, of which head injury is one, are also contributing factors.

"We don’t know how many head injuries or what severity of head injuries is required to increase the risk of dementia following head injury, so our responsibility as a governing body is to reduce risk. Other high-risk environmental factors include, alcohol, drugs [illicit and performance-enhancing], brain infection and brain surgery but these seem to be forgotten."

Dr Raftery, whose role means he will oversee the code’s concussion protocols at the Rugby World Cup in Japan this year, says: "I want to highlight that I am not saying that head injuries are good, they are not. My responsibility as CMO of a governing body is to minimise risk but elimination of risk is impossible because risk is part of life.

I agree sports should be minimising head injuries and take responsibility for establishing programs to achieve this goal but taking extreme positions often allows facts to be distorted, which doesn’t help."

He says over-simplification of statistics distorts the truth. For example: "Half the people who suffer a moderate or severe head injury - an injury which is typically hospitalised and may require surgery - suffer memory issues, an early sign of dementia."

Dr Raftery highlights that concussion is medically classified as a mild head injury and is therefore not included in this definition of moderate or severe head injuries.

"So if you want to take a negative stance, only tell half the truth – concussions cause dementia, which is not true because the research confirms it is moderate or severe injuries that are linked to memory loss, not isolated mild head injuries."

The banter I observe between ex-players and their wives over concussion has, as Dr Raftery points out, an intriguing paradox. While only 20 per cent of the cases of head injuries that are presented at hospitals' emergency departments are sport-related, most are men. But if you study the dementia rates, there is a far higher risk for women, allowing for the fact more females live to older ages.

So, when neither husband nor wife can remember who drove the car last while they search for the keys, is it his head injuries, alcohol consumption, slothful life style, age or gender? Or is it a combination of all these factors?

 © 2019 BIC

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