Protocol for an Observational Study on the Effects of Early-Life Participation in Contact Sports on Later-Life Cognition in a Sample of Monozygotic and Dizygotic Swedish Twins Reared Together and Twins Reared Apart

A large body of work links traumatic brain injury (TBI) in adulthood to the onset of Alzheimer's disease (AD). AD is the chief cause of dementia, leading to reduced cognitive capacity and autonomy and increased mortality risk. More recently, researchers have sought to investigate whether TBI experienced in early-life may influence trajectories of cognitive dysfunction in adulthood. It has been speculated that early-life participation in collision sports may lead to poor cognitive and mental health outcomes. However, to date, the few studies to investigate this relationship have produced mixed results. We propose to extend this literature by conducting a prospective study on the effects of early-life participation in collision sports on later-life cognitive health using the Swedish Adoption/Twin Study on Aging (SATSA). The SATSA is unique in its sampling of monozygotic and dizygotic twins reared together (respectively MZT, DZT) and twins reared apart (respectively MZA, DZA). The proposed analysis is a prospective study of 660 individuals comprised of 270 twin pairs and 120 singletons. Seventy-eight (11.8% individuals reported participation in collision sports. Our primary outcome will be an indicator of cognitive impairment determined by scores on the Mini-Mental State Examination (MMSE). We will also consider several secondary cognitive outcomes including verbal and spatial ability, memory, and processing speed. Our sample will be restricted to individuals with at least one MMSE score out of seven repeated assessments spaced approximately three years apart. We will adjust for age, sex, and education in each of our models.