Sekretnyi V., Nekhanevych O.


About the author:

Sekretnyi V., Nekhanevych O.



Type of article:

Scentific article


Contact sports (football, hockey, boxing, mixed martial arts, rugby and American football) are sports with high frequency of traumatic brain injuries (TBI). But a significant part of sports related concussions (SRC) are below the level of clinical diagnosis of SRC or are unnoticed. The most severe cumulative consequence of SRC is chronic traumatic encephalopathy (CTE). CTE is a progressive neurodegenerative disease accompanied by motor, psychological and cognitive disorders. Today, CTE widely resonates in the science world due to suicides among famous athletes. Despite the fact that this disease has been studied for almost 100 years, the diagnosis of CTE can be made only after autopsy. That is why the study of a wide range of clinical manifestations of CTE plays an important role. The aim of the study. To establish long-term cognitive consequences of TBI in ice hockey players. Object and methods of research. Retrospectively, we tested retired 20 ice hockey players (17 men and 3 women). All the players were winners of the Ukrainian Ice Hockey Championship and members of the national teams of Ukraine. The average age is 34 ± 9.4 years, the youngest of them is 21 years old, the oldest is 51 years old. Also, players were divided into age groups: 18-28 years, 29-38 years, 39 and older. All athletes had at least one SRC (7 athletes had 1 SRC, 2 SRC – 3 athletes, 3 SRC – 6 athletes, 4 and more – 4 athletes). 7 hockey players were hospitalized after having had SRC (which indicates the severity of SRC). All athletes completed a questionnaire with their team doctor, which included: passport part, sports history, history of SRC, a mini mental scale evaluation (MMSE) and «the clock drawing test». Results. Dividing athletes into groups according to the number of SRC received during their professional career, we compared their MMSE result. The results of the analysis showed a statistically significant decrease in the value of MMSE with an increase in SRC more than 1 during a sports career. Thus, in the group with 1 SRC the value of MMSE was 28.7 (1.38) points, while in the group with 2 or more SMS it was equal to 26.7 (1.15) points (p <0.05). While analyzing the level of MMCE, depending on the sports specialization in hockey, statistically significant differences were found. Therefore, MMSE goalkeepers scored 26.6 (0.6) points, strikers – 27.8 (0.4) points, defenders – 28.2 (0.7) points (p <0.05). In addition, the fact of hospitalization indicates clinically significant severity of a history of SRC. Having retrospectively collected data on hospitalization of hockey players after SRC, there was also a decrease in the value of MMSE in those with a history of hospitalization. Thus, in the group of people with hospitalization MMSE was 27.1 (1.39) points, without hospitalization – 27.9 (1.7). An analysis of the relationship between age groups and the nature of cognitive impairment has also been made. No statistically significant data was found, indicating no relationship between age and severity of cognitive impairment. Significant statistic connection (n = 20, correlation coefficient rs = – 0.40; p <0.05) has been found between the number of SRC and the indicator and MMSE test and between number of SRC and «the clock drawing test» (n = 20, correlation coefficient rs = – 0.10; p <0.05). These data suggests that the amount of SRC affects cognitive functions. Conclusions. Our study has outlined connection between cognitive impairment in ice-hockey players and SRC. Despite the fact that the world literature emphasizes the importance of cognitive testing both to guide athletes before and after SRC, and to assess the long-term effects of SC, there is no one diagnostic protocol and it requires unification and mandatory inclusion in the diagnostic program for the athlete who had SRC.


ice hockey, sports related concussion, chronic traumatic encephalopathy, cognitive impairment.


  1. Gallo V, Motley K, Kemp SPT, Mian S, Patel T, James L, et al. Concussion and long-term cognitive impairment among professional or elite sport-persons: a systematic review. J Neurol Neurosurg Psychiatry. 2020;91(5):455-68.
  2. McCrory P, Meeuwisse W, Dvořák J, Aubry M, Bailes J, Broglio S, et al. Consensus statement on concussion in sport-the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51:838-47.
  3. Gardner AJ, Howell DR, Levi CR, Iverson GL. Evidence of concussion signs in national rugby League match play: a video review and validation study. Sports Med – Open. 2017;3:29.
  4. Mez J, Daneshvar DH, Kiernan PT, Abdolmohammadi B, Alvarez VE, Huber BR, et al. Clinicopathological evaluation of chronic traumatic encephalopathy in players of American football. JAMA. 2017;318:360-70.
  5. Carson A. Concussion, dementia and CTE: are we getting it very wrong? J Neurol Neurosurg Psychiatry. 2017;88:462-4.
  6. Mckee AC, Abdolmohammadi B, Stein TD. The neuropathology of chronic traumatic encephalopathy. Handb Clin Neurol. 2018;158:297-307.
  7. Gardner RC, Yaffe К. Epidemiology of mild traumatic brain injury and neurodegenerative disease. Mol Cell Neurosci. 2015;66:75-80.
  8. Pearce N, Gallo V, McElvenny D. Head trauma in sport and neurodegenerative disease: an introduction and review of the epidemiological evidence. Occup Environ Med. 2017;74.
  9. Tartaglia MC, Hazrati L-N, Davis KD, Green RE, Wennberg R, Mikulis D, et al. Chronic traumatic encephalopathy and other neurodegenerative proteinopathies. Front Hum Neurosci. 2014;8:30.
  10. Covassin T, Elbin R, Kontos A, Larson E. Investigating baseline neurocognitive performance between male and female athletes with a history of multiple concussion. J Neurol Neurosurg Psychiatry. 2010;81:597-601.
  11. McKee AC, Cairns NJ, Dickson DW, Folkerth RD, Keene CD, Litvan I, et al. The first NINDS/NIBIB consensus meeting to define neuropathological criteria for the diagnosis of chronic traumatic encephalopathy. Acta Neuropathol. 2016;131.1:75-86.
  12. Fralick M, Thiruchelvam D, Homer C, Tien C, Redelmeier D. Risk of suicide after a concussion. CMAJ. 2016;1887:497-504.
  13. Wortzel HS, Shura RD, Brenner LA. Chronic Traumatic Encephalopathy and Suicide: A Systematic Review. Biomed Res Int. 2013;42:42-80.
  14. Goldstein L, Diaz-Arrastia R. Traumatic Brain Injury and Risk of Suicide. JAMA. 201814;320(6):554-6.
  15. Di Virgilio TG, Hunter A, Wilson L, Stewart W, Goodall S, Howatson G, et al. Evidence for acute electrophysiological and cognitive changes following routine soccer heading. EBioMedicine. 2016;13:66-71.
  16. Tuominen М, Hänninen Т, Parkkari J, Michael JS, Luoto Т, Kannus Р, et al. Concussion in the international ice hockey World Championships and Olympic Winter Games between 2006 and 2015. BJSM. 2016:244-52.
  17. Renton T, Howitt S, Marshall C. Lifetime prevalence of concussion among Canadian ice hockey players aged 10 to 25 years old, 2014 to 2017. J Can Chiropr Assoc. 2019;63(2):80-91.
  18. Howell DR, Osternig L, van Donkelaar P, Mayr U, Chou L-S. Effects of concussion on attention and executive function in adolescents. Med. Sci. Sports Exerc. 2013;45(6):1030-7.
  19. Emery CA, Kang J, Shrier I, Goulet C, Hagel BE, Benson BW, et al. Risk of injury associated with body checking among youth ice hockey players. JAMA. 2010;303:2265-72.
  20. Barth JT, Alves WM, Ryan TV, Macciocchi SN, Rimel RW, Jane JA, et al. Mild Head Injury in Sports: Neuropsychological Sequelae and Recovery of Function. Levin HS, Eisenberg HM, Benton AL, editors. Oxford University Pres: 1989. р. 257-75.
  21. Meehan WP, d’Hemecourt P, Collins CL, Taylor AM, Comstock RD. Computerized neurocognitive testing for the management of sport-related concussions. Pediatrics. 2012;129(1):38-44.
  22. Baugh CM, Kroshus E, Stamm JM, Daneshvar DH, Pepin MJ, Meehan WP. Clinical practices in collegiate concussion management. Am. J. Sports Med. 2016;44(6):1391-9.
  23. Moser RS, Iverson GL, Echemendia RJ, Lovell MR, Schatz P, Webbe FM, et al. Neuropsychological evaluation in the diagnosis and management of sports-related concussion. Arch. Clin. Neuropsychol. 2007;22(8):909-16.
  24. Iverson G. Predicting slow recovery from sport-related concussion: the new simple-complex distinction. Clin. J. Sport Med. 2007;17(1):31-7.
  25. Broglio SP, Macciocchi SN, Ferrara MS. Neurocognitive performance of concussed athletes when symptom free. J. Athl. Train. 2007;42(4):504-8.
  26. Echemendia RJ, Thelen J, Meeuwisse W, Comper P, Hutchison MG, Bruce JM. Testing the hybrid battery approach to evaluating sportsrelated concussion in the National Hockey League: A factor analytic study. Clin Neuropsychol. 2019;28:1-20.
  27. Vartiainen MV, Peltonen K, Holm A, Koskinen S, Iverson GL, Hokkanen L. Preliminary normative study of ImPACT® in Finnish professional male ice hockey players. Appl Neuropsychol Adult. 2019;1:1-7.
  28. Echemendia RJ, Bruce JM, Meeuwisse W, Comper P, Aubry M, Hutchison M. Long-term reliability of ImPACT in professional ice hockey. The Clinical Neuropsychologist. 2016;30(2):328-37.
  29. Hurtubise J, Gorbet D, Hamandi Y, Macpherson А, Lauren S. The effect of concussion history on cognitive-motor integration in elite hockey players. Concussion. 2016;1(3):CNC17.
  30. Esopenko C, Chow TW, Tartaglia MC, Bacopulos A, Kumar P, Binns MA, et al. Cognitive and psychosocial function in retired professional hockey players. J Neurol Neurosurg Psychiatry. 2017;88:512-9.
  31. Ciesielska N, Sokołowski R, Mazur E, Podhorecka M, Polak-Szabela A, Kędziora-Kornatowska K. Is the Montreal Cognitive Assessment (MoCA) test better suited than the Mini-Mental State Examination (MMSE) in mild cognitive impairment (MCI) detection among people aged over 60? Meta-analysis. Psychiatr Pol. 2016;50(5):1039-52.
  32. Trivedi D. Cochrane Review Summary: Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Prim Health Care Res Dev. 2017;18(6):527-8.
  33. Park J, Jeong E, Seomun G. The clock drawing test: a systematic review and meta-analysis of diagnostic accuracy. J Adv Nurs. 2018;74(12):2742-27.
  34. Delnaz Palsetia, G Prasad Rao, Sarvada C Tiwari, Pragya Lodha, Avinash De Sousa. The Clock Drawing Test versus Mini-mental Status Examination as a Screening Tool for Dementia: a clinical comparison. Indian J Psychol Med. 2018;40(1):1-10.

Publication of the article:

«Bulletin of problems biology and medicine» Issue 2 (156), 2020 year, 328-332 pages, index UDK 61:615.81-84:616-009.1-18:616.8-085.82-84:616.831.001.31-34