Head trauma and dementia
Health outcomes as a result of head trauma injuries in former athletes has been in sharp focus in the US for some time. Whilst the UK experience to date is largely focused on road traffic accidents (RTA) and single trauma head injuries, there is a growing appetite by claimant firms to expand into sports concussion owing to the increased media coverage. Looking to the US is, therefore, a valuable exercise for potential UK compensators.
The increasing focus in the UK has confirmed that data on the long-term neurological consequences of contact sport are limited and conflicting. However, the UK lags behind the US in investigating the impact of head trauma in professional footballers on long-term neurocognitive function and dementia risk, compared to non-players.
The announcement by The Football Association and the Professional Footballers’ Association in November 2017 that it will co-fund a new study, ‘Football’s Influence on Lifelong Health and Dementia Risk (FIELD)’ has, therefore, been welcomed. The study, which is scheduled to start in January 2018, will look into the incidence of degenerative neurocognitive disease such as dementia in ex-professional footballers.
Initial results from the FIELD study are expected within the next two to three years.
A US perspective
Class action and mass tort litigation involving various sports bodies has been prominent in the US since 2011, when the first lawsuit was filed against the National Football League. Nevertheless, despite the growing body of expertise that has arisen as a result, decades of research and investigations by the top US neuro experts have failed to establish a direct causal link between head trauma and dementia.
Despite the lack of a scientifically-proven causal link, claimant lawyers in the UK are already seeking to pursue claims for compensation – both within the sports world and the wider claims arena. Attempts are being made to link a single traumatic head injury, such as that suffered following a fall or a RTA with an increased risk of dementia. The claim typically relates to a potential decline in a claimant’s mental well-being resulting in a need for increased care, case management and accommodation costs in later life. We are already seeing the alleged increased risk of dementia being pleaded in the form of provisional damages, stepped/variable periodical payment orders and lump sum contingency funds.
Research to date
One of the theories advanced by claimant lawyers is that dementia may be caused by an immune reaction (inflammation) that occurs following a head injury. Such inflammation may potentially lead to the formation of toxic clumps of the amyloid and tau proteins that are hallmarks of dementia conditions such as Alzheimer's disease.
Whilst a 2013 University of California study found an increase level of the tau protein in a small sample of former football players, it could not determine a direct causal link as opposed to coincidence.
The most comprehensive research has been compiled by The International Concussion in Sport Group (CISG). CISG has gathered since 2001 to discuss research on concussion in sport and develop return-to-play guidelines among other standards. The group is made up of the world’s leading neuro experts. CISG’s General Consensus statement in 2016 states that there is no scientifically proven connection between sports concussion and long term neurocognitive conditions.
A condition of unknowns
The inconclusive evidence to date is compounded by uncertainty into the exact cause of dementia. Dementia is not a single disease. Rather, it is a term used to describe the symptoms that occur when there is a decline in brain function. Several different diseases can cause dementia and many are associated with an abnormal build-up of proteins in the brain. Such symptoms are also thought to be due to a mixture of genetic and environmental factors. Genetic factors include high blood pressure, diabetes or vascular disease. Environmental factors include air pollution, smoking, drug and alcohol abuse, exposure to pesticides and lack of vitamin D.
In addition to the causative uncertainty surrounding dementia, research into the impact of head trauma also has to take into account the fact that individuals differ in how they respond to head trauma.
At this stage, the only aspect that can be offered with certainty is that head trauma is not required for the development of dementia.
Despite the lack of a scientifically-proven link between head trauma and dementia, compensators should stay alive to the developing body of research and litigation threat. Should a claim be intimated or advanced – arising from a sports injury or otherwise – there is a clear and pressing need for instructed medical experts to be fully aware of the latest and imminent research, in order to successfully refute dementia causation arguments.
In addition, due to the genetic and environmental factors impacting dementia, investigations which may reveal competing risk factors should be considered carefully in relation to the claimant’s lifestyle, family history, and medical history. DNA profiling may even need to be considered in certain circumstances.
For now, we await the findings of the FIELD study with interest in the hope that a clearer light is shone on the influence of contact sports participation on lifelong health and dementia risk.