Dementia in rugby: Brain Health Clinic for former Scotland rugby players launched in hope of tackling disease early

A clinic for former international rugby players to have their brains assessed in the hope of preventing or slowing down dementia in later life has been launched by the Scottish Rugby Union.

Gordon Bulloch (former Scotland player), Professor Craig Ritchie (Director, Brain Health Scotland), Dr James Robson (Chief Medical Officer, Scottish Rugby) and Jilly McCord (former Scotland player)  at the launch of the Brain Health Clinic at BT Murrayfield,. (Photo by Ross Parker / SNS Group)
Gordon Bulloch (former Scotland player), Professor Craig Ritchie (Director, Brain Health Scotland), Dr James Robson (Chief Medical Officer, Scottish Rugby) and Jilly McCord (former Scotland player) at the launch of the Brain Health Clinic at BT Murrayfield,. (Photo by Ross Parker / SNS Group)

The pilot scheme will be used to identify risk factors and initiate preventative steps ahead of similar services being available to the general public through the NHS.

The driving forces behind the project are Dr James Robson, the SRU’s chief medical officer, and Professor Craig Ritchie, Chair of the Psychiatry of Ageing and Director of the Centre for Dementia Prevention at the University of Edinburgh.

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Prof Ritchie, who is also the director of Brain Health Scotland, is hopeful that in 10 to 20 years’ time dementia will be a “very, very rare condition”.

Professor Craig Ritchie at the launch of the Brain Health Clinic at BT Murrayfield. (Photo by Ross Parker / SNS Group)
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Described as providing a ‘brain health MOT’, the clinic will invite ex-Scotland internationals to be assessed for possible risks to future brain health. The group being targeted are capped male and female players, mainly in the 40 to 60 age bracket.

Gordon Bulloch, the former Scotland and Lions hooker, is one of the first to sign up. He said: “Brain health and physical health go hand in hand and the more we can understand this area the more support we can give players of earlier generations and those who are playing now in the future.”

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Those taking part will undertake a three-stage investigation phase involving health/lifestyle interviews, blood testing and brain scanning and which will help build a picture of how the clinicians can best support the individual with a brain health plan.

The aim is to help manage future health through help and advice on key lifestyle factors such as physical exercise, sleep, diet, drinking, sociability and keeping mentally active.

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Former Scotland hooker Gordon Bulloch is supporting the brain health initiative.

The spark for the clinic idea was what Dr Robson describes as “a seminal paper” in The Lancet which looked at factors you could modify in mid life to influence the outcome in later life.

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It’s a collaborative project which Dr Robson and Prof Ritchie hope will provide a blueprint for tackling dementia.

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“Brain health is pertinent to everybody,” said Dr Robson. “It’s more pertinent to the younger people perhaps because you can effect a bigger change earlier in life to protect yourself in later life.”

Brain Health Scotland, Alzheimer Scotland, the University of Edinburgh and World Rugby have all contributed time, expertise and resources to the scheme which is being funded and hosted by the SRU.

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Dementia is a burning issue in sport and a new study launched this week will investigate ways to reduce risk of the disease in former footballers. Research has found that ex-professionals are three and a half times more likely to die of dementia than the general population. No such data is available in rugby but the sheer ferocity of some of the collisions has heightened concerns about the effect of brain injuries in later life.

The moving testimony this week of Steve Thompson, England’s 2003 Rugby World Cup-winning hooker, laid bare the grim reality for some.

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Thompson is only 43 but was diagnosed with early-onset dementia in 2020. He was placed on suicide watch as his struggle with dementia took him to the brink. He cannot remember large parts of his career and at times forgets the names of his wife and children.

World Rugby has taken steps to limit the amount of contact training permitted in the sport and modified tackling but the threat of legal action from former players continues to hang over the sport’s governing bodies.

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A presentation by Brain Health Scotland to the Rugby Players Association caught the attention of Dr Robson and was key to the SRU’s Brain Health Clinic.

“We are looking at people who have recently retired from the game and who are maybe in their forties, fifties, sixties even,” said Prof Ritchie. “We do a very detailed risk analysis, using techniques like brain imaging, cognitive testing, blood-based biomarkers, to see if there is any evidence of brains changing already in that direction.

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“And then intervene with risk factor modification, maybe get involved with trials and maybe, in the near future, hopefully some pharmacological interventions.

“I’m genuinely hopeful that in 10 to 20 years’ time dementia will be a very, very rare condition if we do this well in this preclinical early stage.”

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Historically, medics had to wait until the emergence of symptoms such as memory and behaviour impairment before they could treat dementia. Now the disease can be tackled earlier.

“What we know is that those changes in the brain are taking place at least in your 40s and 50s,” added Prof Ritchie. “So if the brain changes are taking place this early is there something we can do to intervene to change the course of the illness?”

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The ex-players will be sent a detailed questionnaire about their health and lifestyle.

“I’ll have a look at it and I’ll be able to identify whether there might be some issues,” said Prof Ritchie. “Is there a sleep problem, is there a mood problem, a problem with social isolation, alcohol etc?

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“In the clinic I’ll go through their history with them, do some cognitive tests and then we’ll refer them for a brain scan and blood testing.

“There are probably things we can do immediately but it is also a really good baseline. Alzheimer’s disease is all about change and we’ll be seeing those people again in two, three, four years’ time.”

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While genetics and family history are also key factors in dementia, the professor believes that identifying certain behaviours early can help tackle the disease.

“There are probably 12 modifiable risk factors for dementia,” he said. “In theory, they are modifiable: diet, exercise, lifestyle, other medical conditions like hypertension, diabetes etc. So if we can identify those risk factors before the disease develops symptoms then we should be able to intervene and work with the person to modify the factors. It’s like reducing your risk of cancer by stopping smoking.”

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