Multiple concussions linked to slightly worse health in former college athletes

In former college athletes, having had three or more concussions was associated with slightly worse physical, mental, behavioral and cognitive health five years after graduation, according to an article published March 11, 2026, in Neurology^®, the medical journal of the American Academy of Neurology.

Concussions are prevalent among young athletes participating in contact and collision sports. While many studies have examined the effects of concussion immediately after injury or decades later, our study examined the effects in athletes five years after college graduation, a time when early interventions may be more helpful to lessen any long-term effects."

Steven Broglio, PhD, study author, University of Michigan Concussion Center, Ann Arbor

The study involved 3,910 former college athletes, with nearly half being female. Athletes participated in 20 sports including football, soccer, volleyball, lacrosse, rowing, swimming, tennis and golf, with 73% participating at a National Collegiate Athletic Association (NCAA) Division 1 school.

All athletes had a baseline concussion evaluation at the time of study enrollment, typically before starting their college sport, with 77% never having been diagnosed with a concussion. Athletes were evaluated again within five years of college graduation.

During both evaluations, athletes reported their concussion history and completed medical health questionnaires. They also completed two tests that measured the presence and severity of concussion symptoms. At the second evaluation, they completed nine more tests.

Researchers grouped participants based on the number of concussions, with 213 athletes reporting three or more concussions, 1,203 reporting one or two concussions, and 2,494 reporting zero. They then compared athletes in those groups based on their scores on the 11 tests.

For example, one test measured how many of 22 concussion-related symptoms participants had, athletes with three or more concussions had an average of five symptoms compared to an average of three symptoms for athletes with zero concussions.

After adjusting for factors like scores on a test of how much pain affects their daily life, researchers found athletes with three or more concussions had worse scores than those with no concussions on seven tests that measured anxiety, depression, psychological distress, sleep quality, concussion-related symptoms as well as health and well-being.

Athletes with one to two concussions also had worse scores than those with no concussions on tests of psychological distress, quality of life, anxiety, depression, sleep quality, concussion-related symptoms as well as health and well-being.

"While the effect sizes of our findings are quite small, the study participants are still young adults in their 20s, so we don't know if or how these effects might change throughout their lives," said Broglio. "It is also important to note that despite the associations, the vast majority of athletes remained within normal clinical levels for brain health. Continuing to follow these athletes may help determine if these associations become more or less apparent and meaningful over time."

A limitation of the study was that 76% of athletes were white people, so the results may not be the same for people of other races and ethnicities.

The study was supported by the NCAA and the Department of Defense.