The FOCUS study was commissioned by The Football Association [The FA] and the Professional Footballers' Association [PFA] in 2018, with the University of Nottingham appointed to conduct an independent research study into the long-term brain health of former professional footballers.
The study, which was led by Weiya Zhang at the Versus Arthritis Centre for Sport, Exercise and Osteoarthritis, was commissioned as part of The FA and the PFA’s ongoing commitment to building a greater understanding of any possible link between football and dementia.
The first findings from the FOCUS study, published in June 2023, examined:
Cognitive Impairment and Self-Reported Dementia in UK Retired Professional Soccer Players
The second set of findings from the FOCUS study have analysed:
Heading frequency and risk of cognitive impairment in retired male professional soccer players
The findings from the second part of the FOCUS study suggest that the former professional footballers who took part in the research study were more likely to demonstrate cognitive impairment if they recalled that they had headed the ball more often in matches and training. This follows the results of a cognitive status assessment with a cohort of former professional footballers.
The former professional footballers who took part in the study were asked to recall how many times they headed the ball per typical match and per typical training session; 0-5, 6-15 and over 15 times.
From the study group, those who recalled that they typically headed the ball 6-15 times in a match were found to be 2.71 times more likely to score below the test threshold in the cognitive status assessment, than the former professional footballers in the study who recalled that they typically headed the ball 0-5 times.
The former professional footballers in the study who recalled that they typically headed the ball in a match more than 15 times were 3.53 times more likely to score below the test threshold, than the former professional footballers in the study who recalled that they typically headed the ball 0-5 times.
The second part of the FOCUS study also showed that former professional footballers who had reported that they suffered concussion with a memory loss were found to be 3.16 times more likely to score below the test threshold.
The second part of the FOCUS study adds to the research in this area although limitations are recognised within paper.
The FA has led the way in taking steps to help understand potential risk factors within the game whilst ongoing research continues in this area. This includes establishing industry-leading concussion guidelines, introducing the world’s most comprehensive heading guidance at every level of the professional and amateur game in England, and implementing the second year of a trial to remove deliberate heading in football matches across U12 level and below.
Mark Bullingham, FA Chief Executive, said: "This study is another step in understanding any potential link between neurogenerative disorders and former professional footballers. Since funding the FIELD study, we have continued to invest in research to gain a greater understanding of the area and potential risk factors. More research is required to fully understand the issues and we welcome a global approach to do that."
"As we work to gain a greater understanding of the medical research, we will continue to take a leading role as the governing body in reviewing the safety of our game and addressing potential risk factors which may be associated with football. These include the removal of heading from training for primary school age children and recommendations on limits for all ages. We are also trialling the complete removal of heading in U12 football."
"Additionally, we continue to review our concussion protocols, which are regarded as world-leading. In football, as with other sports, the issue of concussion management needs to be understood."
“Whilst there is no doubt of the overall benefit to health of playing football, by addressing potential risk factors whilst we continue to invest in medical research, we will ensure that millions can continue to enjoy our national sport."
Maheta Molango, PFA CEO said: “The FOCUS study supports existing evidence highlighting footballers' increased vulnerability to cognitive decline in their later years."
“The study, commissioned by the PFA and the FA, provides valuable insights that build on the FIELD study's findings and has further explored the link between professional football, the long-term effects of heading and cognition."
“It will continue to be vitally important to build the knowledge base and understanding of this relationship so that effective action and interventions can take place. That means real-world changes in training practices and matchday protocols to protect the wellbeing of players, but also the ways in which former players can be supported."
“This needs a collective approach from right across football.”
The findings of the FOCUS study will be shared with both FIFA and UEFA, and The FA has reiterated its support for further research from across the wider game to help build a better understanding of players’ brain health and wellbeing.
If you have any questions or concerns specifically related to Dementia or Alzheimer’s, please contact the helplines at Alzheimer's Society on 0333 150 3456
Support is also available to former professional footballers who have concerns about their brain health. This includes the Advanced Brain Health Clinic [insert link], which is funded by The FA and provides confidential specialist assessment and advice for retired, elite, male and female football players.
Steps taken by The FA to improve safety in football:
The FA’s Concussion Guidelines and Online Courses can be found HERE.
The game-wide Heading Guidance can be found HERE.
The latest update on The FA’s Youth Heading Trial can be found HERE.