Long-term effects of traumatic brain injury in athletes: The most common clinical manifestations

Introduction. Traumatic brain injury (TBI) is a pressing issue in high-performance sports. Although most sports-related TBIs are classified as mild, their frequent occurrence and resulting cumulative effect can negatively impact an athlete’s health. Furthermore, this impact may not become apparent until several years after the injury, and sometimes only after the athlete has retired from the sport.

Objective. To identify the most frequent clinical manifestations associated with the long-term effects of traumatic brain injury in active and retired athletes from various sports.

Materials and methods. In order to assess the prevalence of symptoms associated with various TBI consequences, a total of 902 active and former athletes from Russian national teams were surveyed anonymously using a secure online platform, LimeSurvey, with a proprietary domain. The participants included 662 (73.4%) adult and 240 (26.6%) minor athletes. The study methodology was based on a questionnaire and did not include objective instrumental examinations. The questionnaire presented to the athletes contained questions clarifying anamnestic data and the presence of symptoms that could serve as clinical manifestations of the long-term effects of intracranial injuries. The entire sample of athletes was divided into groups according to age at the time of the survey (adults and minors). The group of adult athletes was also subdivided based on the number of TBIs in their history, the presence of contact/impacts during training (contact and non-contact sports), and age (18–30 years; 31–40 years; 41–50 years; ≥ 51 years). Statistical data analysis was performed using IBM SPSS Statistics 23.0 software.

Results. The prevalence of concussion among the adult athletes was statistically significantly higher than among the minors (15.3% vs. 2.5%, p < 0.001). The most common issues reported by the adult athletes with a history of concussion were sleep (36.6%) and visual disturbances (23.8%), as well as cognitive (25.7%), behavioral (22.8%), and affective (27.7%) disturbances. The aforementioned abnormalities were statistically significantly more frequent in the athletes participating in contact sports (p < 0.05). The athletes aged 18–30 years most commonly noted affective disturbances and changes in sleep, while visual disturbances were more prevalent in older age groups.

Conclusions. The most common clinical manifestations of TBI consequences in athletes consist of a complex of affective, cognitive, and behavioral disturbances, as well as impaired sleep and vision. Most consequences of intracranial injuries present with non-specific symptoms. Therefore, a crucial approach to optimizing the biomedical support system for athletes with a history of TBI consists in continuous monitoring of their health status post-injury. This involves developing screening protocols, followed by the formation of risk groups and early identification of impairments, which will help prevent or slow their progression.

1. Golub VM, Reddy DS. Post-traumatic epilepsy and comorbidities: advanced models, molecular mechanisms, biomarkers, and novel therapeutic interventions. Pharmacological Reviews. 2022;74(2):387–438. https://doi.org/10.1124/pharmrev.121.000375

2. Mele C, Pingue V, Caputo M, Zavattaro M, Pagano L, Prodam F, et al. Neuroinflammation and Hypothalamo-Pituitary Dysfunction: Focus of Traumatic Brain Injury. International Journal of Molecular Sciences. 2021;22(5):2686. https://doi.org/10.3390/ijms22052686

3. Cantu RC, Bernick C. History of Chronic Traumatic Encephalopathy. Seminars in Neurology. 2020;40(4):353–8. https://doi.org/10.1055/s-0040-1713622

4. Malec JF, Ketchum JM, Hammond FM, Corrigan JD, Dams-O’Connor K, Hart T, et al. Longitudinal effects of medical comorbidities on functional outcome and life satisfaction after traumatic brain injury: an individual growth curve analysis of NIDILRR traumatic brain injury model system data. The Journal of Head Trauma Rehabilitation. 2019;34(5):E24–35. https://doi.org/10.1097/HTR.0000000000000459

5. Maas AIR, Menon DK, Manley GT, Abrams M, Åkerlund C, Andelic N, et al. Traumatic brain injury: progress and challenges in prevention, clinical care, and research. The Lancet Neurology. 2022;21:1004–60. https://doi.org/10.1016/S1474-4422(22)00411-2

6. Patricios JS, Schneider KJ, Dvorak J, Ahmed OH, Blauwet C, Cantu RC, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport–Amsterdam, October 2022. British Journal of Sports Medicine. 2023;57(11):695–711. https://doi.org/10.1136/bjsports-2023-106898

7. Cunningham J, Broglio SP, O’Grady M, Wilson F. History of Sport-Related Concussion and Long-Term Clinical Cognitive Health Outcomes in Retired Athletes: A Systematic Review. Journal of Athletic Training. 2020;55(2):132–58. https://doi.org/10.4085/1062-6050-297-18

8. Manley G, Gardner AJ, Schneider KJ, Guskiewicz KM, Bailes J, Cantu RC, et al. A systematic review of potential long-term effects of sport-related concussion. British Journal of Sports Medicine. 2017;51(12):969–77. https://doi.org/10.1136/bjsports-2017-097791

9. Butler MLMD, Pervaiz N, Breen K, Calderazzo S, Ypsilantis P, Wang Y, et al. Repeated head trauma causes neuron loss and inflammation in young athletes. Nature. 2025;647:228–37. https://doi.org/10.1038/s41586-025-09534-6

10. Smolensky AV, Shevelev OA, Tarasov AV, Menzhurenkova DN. Epidemiology of sports traumatic brain injury. Exercise Therapy and Sports Medicine. 2024;2:25–31 (In Russ.). EDN: JIMMAS

11. Makdissi M, Critchley ML, Cantu RC, Caron JG, Davis GA, Echemendia RJ, et al. When should an athlete retire or discontinue participating in contact or collision sports following sport-related concussion? A systematic review. British Journal of Sports Medicine. 2023;57(12):822–30. https://doi.org/doi:10.1136/bjsports-2023-106815

12. Sarmiento K, Donnell Z, Bell E, Tennant B, Hoffman R. A qualitative study of barriers and opportunities for concussion communication and management among parents of youth sports athletes. Journal of Concussion. 2019:1;3:10.1177/2059700219861863. https://doi.org/10.1177/2059700219861863

13. Longworth T, McDonald A, Cunningham C, Khan H, Fitzpatrick J. Do rugby league players under-report concussion symptoms? A cross-sectional study of elite teams based in Australia. BMJ Open Sport Exercise Medicine. 2021;7(1):e000860. https://doi.org/10.1136/bmjsem-2020-000860

14. Lovyagina AE, Khvatskaya EE, Volkov DN. Injury rate factors in extreme sports athletes with different mental self-regulation types. Human. Sport. Medicine. 2019;19(1):117–23 (In Russ.). https://doi.org/10.14529/hsm190116

15. Beidler E, Bogar K, Wallace J, McAllister-Deitrick J, Anderson M, Schatz P. The burden of unsubstantiated messaging: collegiate athletes’ chronic traumatic encephalopathy mechanism beliefs. Brain Injury. 2021;35(10):1259–66. https://doi.org/10.1080/02699052.2021.1972146

16. Baugh CM, Meehan WP, Kroshus E, McGuire TG, Hatfield LA. College Football Players Less Likely to Report Concussions and Other Injuries with Increased Injury Accumulation. Journal of Neurotrauma. 2019;36(13):2065–72. https://doi.org/10.1089/neu.2018.6161

17. Chrisman SPD, Lowry S, Herring SA, Kroshus E, Hoopes TR, Higgins SK, et al. Concussion Incidence, Duration, and Return to School and Sport in 5- to 14-Year-Old American Football Athletes. The Journal of Pediatrics. 2019;207:176–84. https://doi.org/10.1016/j.jpeds.2018.11.003

18. Chandran A, Boltz AJ, Morris SN, Robison HJ, Nedimyer AK, Collins CL, et al. Epidemiology of Concussions in National Collegiate Athletic Association (NCAA) Sports: 2014/15-2018/19. The American Journal of Sports Medicine. 2022;50(2):526–36. https://doi.org/10.1177/03635465211060340

19. Pierpoint LA, Collins C. Epidemiology of Sport-Related Concussion. Clinics in Sports Medicine. 2021;40(1):1–18. https://doi.org/10.1016/j.csm.2020.08.013

20. Prien A, Grafe A, Rössler R, Junge A, Verhagen E. Epidemiology of Head Injuries Focusing on Concussions in Team Contact Sports: A Systematic Review. Sports Medicine. 2018;48(4):953–69. https://doi.org/10.1007/s40279-017-0854-4

21. Ntikas M, Stewart W, Ietswaart M, Hunter AM, Maas AIR, Menon DK, et al. Contrasting Characteristics and Outcomes of Sports-Related and Non-Sports-Related Traumatic Brain Injury. JAMA Network Open. 2024;7(1):e2353318. https://doi.org/10.1001/jamanetworkopen.2023.53318

22. Manzanero S, Elkington LJ, Praet SF, Lovell G, Waddington G, Hughes DC. Post-concussion recovery in children and adolescents: A narrative review. Journal of Concussion. 2017;1. https://doi.org/10.1177/2059700217726874

23. Davis AR, Charles SD, Papesh MH, Gerson J, Shen J. Memory outcomes and interventions after sports-related traumatic brain injuries in pediatric and young adult athletes: a scoping review. Journal of Pediatric Psychology. 2025;jsaf075. https://doi.org/10.1093/jpepsy/jsaf075

24. Nesterovskiy YuE. Cognitive and psycho-emotional disorders in children after traumatic brain injuries: Causes, clinical picture and therapy. Medical Council. 2025;12:142–52 (In Russ.). https://doi.org/10.21518/ms2025-305

25. Meehan WP, Taylor AM, Proctor M. The pediatric athlete: younger athletes with sport-related concussion. Clinics in Sports Medicine. 2011;30(1):133–44. https://doi.org/10.1016/j.csm.2010.08.004

26. Pfister T, Pfister K, Hagel B, Ghali WA, Ronksley PE. The incidence of concussion in youth sports: a systematic review and meta-analysis. British Journal of Sports Medicine. 2016;50(5):292–7. https://doi.org/10.1136/bjsports-2015-094978

27. Misquitta K, Dadar M, Tarazi A, Hussain MW, Alatwi MK, Ebraheem A, et al. The relationship between brain atrophy and cognitive-behavioural symptoms in retired Canadian football players with multiple concussions. NeuroImage. Clinical. 2018;19:551–8. https://doi.org/10.1016/j.nicl.2018.05.014

28. McKee AC. The Neuropathology of Chronic Traumatic Encephalopathy: The Status of the Literature. Seminars in Neurology. 2020;40(4):359–69. https://doi.org/10.1055/s-0040-1713632

29. Meysami S, Raji CA, Merrill DA, Porter VR, Mendez MF. MRI Volumetric Quantification in Persons with a History of Traumatic Brain Injury and Cognitive Impairment. Journal of Alzheimer’s Disease. 2019;72(1):293–300. https://doi.org/10.3233/JAD-190708

30. Morissette MP, Prior HJ, Tate RB, Wade J, Leiter JRS. Associations between concussion and risk of diagnosis of psychological and neurological disorders: a retrospective population-based cohort study. Family Medicine and Community Health. 2020;8(3):e000390. https://doi.org/10.1136/fmch-2020-000390

31. Sicard V, Harrison AT, Moore RD. Psycho-affective health, cognition, and neurophysiological functioning following sports-related concussion in symptomatic and asymptomatic athletes, and control athletes. Scientific Reports. 2021;11(1):13838. https://doi.org/10.1038/s41598-021-93218-4

32. Leng Y, Byers AL, Barnes DE, Peltz CB, Li Y, Yaffe K. Traumatic Brain Injury and Incidence Risk of Sleep Disorders in Nearly 200,000 US Veterans. Neurology. 2021;96(13):e1792–9. https://doi.org/10.1212/WNL.0000000000011656

33. Cross NE, Carrier J, Postuma RB, Gosselin N, Kakinami L, Thompson C, et al. Association between insomnia disorder and cognitive function in middle-aged and older adults: a cross-sectional analysis of the Canadian Longitudinal Study on Aging. Sleep. 2019;42(8):zsz114. https://doi.org/10.1093/sleep/zsz114

34. Taskina D, Zhu C, Schwab N, Hazrati LN. Brain pathology and symptoms linked to concussion history: beyond chronic traumatic encephalopathy. Brain Communications. 2024;6(2):fcad314. https://doi.org/10.1093/braincomms/fcad314

35. Katz DI, Bernick C, Dodick DW, Mez J, Mariani ML, Adler CH, et al. National Institute of Neurological Disorders and Stroke consensus diagnostic criteria for traumatic encephalopathy syndrome. Neurology. 2021;96(18):848–63. https://doi.org/10.1212/WNL.0000000000011850

36. Theadom A, Mahon S, Hume P, Starkey N, Barker-Collo S, Jones K, et al. Incidence of Sports-Related Traumatic Brain Injury of All Severities: A Systematic Review. Neuroepidemiology. 2020;54(2):192–9. https://doi.org/10.1159/000505424

37. Ledreux A, Pryhoda MK, Gorgens K, Shelburne K, Gilmore A, Linseman DA, et al. Assessment of Long-Term Effects of Sports-Related Concussions: Biological Mechanisms and Exosomal Biomarkers. Frontiers in Neuroscience. 2020;14:761. https://doi.org/10.3389/fnins.2020.00761

38. Mason SJ, Davidson BS, Lehto M, Ledreux A, Granholm AC, Gorgens KA. A Cohort Study of the Temporal Stability of ImPACT Scores Among NCAA Division I Collegiate Athletes: Clinical Implications of Test-Retest Reliability for Enhancing Student Athlete Safety. Archives of Clinical Neuropsychology. 2020;35(7):1131–44. https://doi.org/10.1093/arclin/acaa047