HJNO Jul/Aug 2026

CTE 26 JUL / AUG 2026 I  U.S. HEALTHCARE JOURNALS CI, 0.16-0.37; adjusted P < .001), log ECog (B=0.006; 95% CI, 0.003-0.009; adjusted P < .001), GDS-15 (B=0.03; 95% CI, 0.009- 0.04; adjusted P = .003), MI (B=0.17; 95% CI, 0.02-0.32; adjusted P =.04), and square root PALTEAscores (B=0.03; 95%CI, 0.004- 0.06; adjusted P =.04) (Table 3). Binary logis- tic regression models demonstrated an association between more years of football play and higher odds of clinically meaning- ful elevation on BRI (OR, 1.04; 95% CI, 1.02- 1.06; P <.001), ECog (OR, 1.03; 95% CI, 1.01- 1.05; P =.003), and GDS-15 (OR, 1.07; 95% CI, 1.03-1.11; P <.001). There were no significant effects for AFE or position on any outcome. Results of Sensitivity Analyses Subgroup analyses substantiated a dose- response pattern across all outcomes, with effect sizes largest for professionals fol- lowed by the college and youth or high school levels, respectively (eTable 6 in Supplement 1). After removing youth play- ers, there were no substantial changes in the direction or magnitude of effect sizes across models, and patterns of statistical significance remained consistent (eTable 7 and eFigure 2 in Supplement 1). The same was true after incorporating drug and alco- hol abuse as covariates. DISCUSSION This study examined associations between football play and cognitive and neuropsychiatric outcomes in formerAmer- ican football players 40 years or older. Key findings included that (1) football players performed significantly worse on cognitive Plots depicting highest level of football play and estimated marginal means of outcome measures. Estimates are adjusted for age, educational level, race, and vascular risk. Everyday Cognition Scale (ECog) was log transformed in analyses, and Paired Associates Learning Total Errors Adjusted (PALTEA) was square root transformed due to nonnormal distribution of residuals. Higher ECog, Behavioral Regulation Index (BRI), and PALTEA scores indicate worse performance. GDS-15 indicates Geriatric Depression Scale-15; MI, Meta-Cognition Index; PALFAMS, Paired Associates Learning First Attempt Memory Score. a Significant difference ( P < .05). Figure 2. Cognitive and Neuropsychiatric Outcomes by Highest Level of American Football Play