The age of first exposure to American football and the effect on cognitive resilience

Millions of young Americans set out to play football each year, and as we come to understand more about the effects of repetitive head impacts (RHI) on the developing brain, the mitigation of these effects become increasingly important. It is well understood the relationship between RHIs and later life cognitive decline, however, not much is known about why some former players exhibit worse symptoms than others. One proposed reason for these differences is resiliency, the ability of the brain to resist pathological changes, most commonly referred to as cognitive reserve (CR). To help us better understand cognitive reserve and how it is impacted by the age of first exposure to American football, we propose the Chronic Traumatic Encephalopathy-Cognitive Reserve (CTE-CR) score which we define as the difference between clinical neuropsychological presentation and expected pathological burden. The CTE-CR score is unique in that it defines CR not in its traditional way through proxies, but as a quantifiable and measurable score. This score can be used to further research CR, while the results of our proposed study will aid in the research of CTE pathogenesis and help influence the future of age restrictions in American tackle football