In unadjusted analyses, the three-or-more-concussion group had worse average scores on all four health measures: subjective cognitive quality of life, depressive symptoms, general mental health and life satisfaction. These players were also more likely than athletes with no concussions or one to two concussions to exceed clinical screening thresholds for adverse cognitive quality of life, depressive symptoms and general mental health. Life satisfaction did not differ significantly by concussion group.

Years of football participation were not associated with any of the four outcomes in the study. The researchers analyzed post-graduation questionnaires completed between 2018 and 2021 by former varsity football players recruited from 26 United States universities between 2014 and 2020. Participants were surveyed within five years of leaving their institutions.

Their mean age at follow-up was 25.0 years, with a standard deviation of 1.7, and they had accumulated an average of 11.4 years of football experience. Overall, 56.9% reported at least one lifetime concussion. The sample was 60.6% White, and 62.7% competed in Division I; the remainder represented Division II or III programs.

Four validated questionnaires assessed different aspects of psychosocial health. The Quality of Life in Neurological Disorders cognitive domain, or Neuro-QoL, measured self-reported cognitive quality of life, with higher scores indicating better functioning. The Mental Component Summary of the 12-item Short Form Health Survey, or SF-12 MCS, assessed general mental health, while the Satisfaction with Life Scale, or SWLS, measured life satisfaction.

Clinically adverse thresholds were defined as a Neuro-QoL or SF-12 MCS t-score below 40, a PHQ-9 score of at least 10, or an SWLS score below 20. Ordinary least-squares regression models estimated the relationships between football exposure and questionnaire scores while accounting for alcohol use, athletic identity, resilience, sleep quality, race, salary, athletic division, graduate degree status, bodily pain and physical functioning. Missing covariate information was handled through multiple imputation, with estimates pooled using Rubin’s rules.

Interaction terms tested whether the relationship between concussion history and an outcome differed according to playing position. The researchers applied Benjamini–Hochberg procedures to control the false discovery rate across multiple tests, while separate analyses compared the proportions of participants exceeding clinical thresholds. After adjustment for the prespecified covariates, athletes with three or more concussions had significantly higher PHQ-9 scores than those with none.

The estimated difference was 1.53 points, with a standard error of 0.52 and a p-value of 0.014, which the authors classified as a medium-to-large effect. Their SF-12 MCS scores were also an estimated 2.32 points lower than those of players with no concussions, with a standard error of 1.01 and a p-value of 0.022, although that association was no longer statistically significant after false-discovery-rate correction. A Type III test for concussion history as a variable in the PHQ-9 model returned p = 0.003.

Playing position produced less consistent results. In unadjusted analyses, line players reported more depressive symptoms than special-teams players, while line and hybrid players had lower general mental-health scores than special-teams players. A total of 17.8% of line players crossed the PHQ-9 threshold, compared with 8.6% of hybrid players and 2.3% of special-teams players.

A position-by-concussion interaction appeared for Neuro-QoL scores: the change from zero to one or two concussions differed between hybrid and agility players, with an estimated coefficient of 4.57, a standard error of 1.60 and a p-value of 0.018. The effect was small, however, and the researchers said its clinical significance was likely limited. Clinical-threshold results provided additional context.

Overall, 11.8% of the sample had a PHQ-9 score of at least 10, compared with 14.3% in a cited reference sample of American men aged 20 to 39; 12.6% scored below the Neuro-QoL threshold, and 17.6% fell below the SF-12 MCS threshold, broadly near the approximately 16% expected from normative scoring. Just over 10% of participants crossed at least one adverse threshold. The group-level figures therefore appeared broadly similar to the available population references, even though the three-or-more-concussion subgroup consistently showed more adverse outcomes on three of the four measures.

The authors cautioned that the normative references were not stratified by age or sex, which may limit the comparison. These results do not establish that concussions caused the reported symptoms. The study used self-reported concussion counts and self-reported health outcomes, and its post-graduation analysis was cross-sectional, with exposure and health status assessed at the same time.

Recall bias was possible, including the possibility that athletes experiencing more symptoms were more likely to report additional concussions. Players with poorer health may also have been more likely to participate in follow-up, while some instruments used relatively short recall periods and may not have captured longer-term well-being. Other unmeasured injuries, changes in athletic identity after leaving college, possible professional participation, and concussions occurring after college could also have influenced the findings.

The researchers lacked comprehensive helmet-sensor measurements across participants’ careers, so playing position and years of participation served as proxies for head-impact exposure. The study’s practical implication is that a history of three or more concussions may help identify former collegiate football players who warrant attention as they leave organized sport, the authors said. Screening was proposed as a way to detect problems during the transition, not because the study demonstrated that screening improves health outcomes.

The findings apply specifically to recently retired collegiate football players and may not extend to professional players, high-school athletes or participants in other sports. Within those limits, the study identifies a group with measurably poorer self-reported psychosocial health at a consequential career transition and supports targeted monitoring and support for athletes with substantial concussion burden.

Subject of Research: Associations between lifetime concussion history and self-reported mental and cognitive health among recently retired collegiate football players

Article Title: Cognitive and Mental Health in Recently Retired Collegiate Football Players: Findings from the CARE Consortium

Article References: Syrydiuk, R. A., Brett, B. L., Varangis, E. M. L., Wiebe, D. J., Pasquina, P. F., McCrea, M. A., McAllister, T. W., Broglio, S. P., CARE Consortium Investigators, Hoy, A., Kelly, L., Ortega, J., McDevitt, J., D’Lauro, C., Cameron, K., Susmarski, A., Benjamin, H., Kamisnki, T., Buckley, T., … Morath, B. (2026). Cognitive and Mental Health in Recently Retired Collegiate Football Players: Findings from the CARE Consortium. Sports Medicine – Open, 12(1), Article 157. https://doi.org/10.1186/s40798-026-01126-6

Image Credits: AI Generated

DOI: 10.1186/s40798-026-01126-6

Keywords: collegiate football, concussion history, mental health, depressive symptoms, cognitive health, athletic retirement, CARE Consortium, self-reported health, Cognitive, Mental, Health, Recently

The paper, authored by researchers at the University of Illinois Chicago, the University of Chicago, and the University of Miami Health System, proposes a lifespan framework for women’s health in sickle cell disease that stretches from menarche through menopause and into healthy aging. Its central claim is provocative: while fertility and pregnancy have received increasing attention as patients survive longer, menopause remains an underexplored and underrecognized phase of the disease trajectory, one that may shape pain, cognition, bone strength, cardiovascular risk, iron burden, and quality of life for decades.

To understand why menopause matters so much in this population, it helps to revisit the biology. Sickle cell disease stems from a single nucleotide substitution in the beta-globin gene that produces hemoglobin S. Under low-oxygen conditions, this hemoglobin polymerizes, forcing red blood cells into rigid, crescent shapes. These sickled cells are less deformable, stick to the vascular endothelium, and clog small vessels, producing the hallmark vaso-occlusive pain crises. Repeated sickling also damages cell membranes, driving chronic hemolysis, which in turn depletes nitric oxide, fuels oxidative stress, and sustains endothelial dysfunction and inflammation. The result is a multisystem disorder in which overlapping mechanisms inflict cumulative organ injury beginning in childhood.

That cumulative injury has led some researchers to describe sickle cell disease as a form of accelerated biological aging. The lungs are vulnerable to acute chest syndrome, pulmonary embolism, and pulmonary hypertension. Kidney damage can begin with tubular dysfunction in childhood and progress to chronic kidney disease in adolescence and adulthood. Cerebrovascular injury, from silent cerebral infarction to overt stroke, erodes cognition and quality of life. Against this backdrop, the authors argue, reproductive aging is not a separate process but another manifestation of aging that deserves a place alongside the rest.

Female physiology adds further layers of complexity. Although the disease arises from a single mutation, its severity is modified by genetics, including variants regulating fetal hemoglobin such as those affecting BCL11A, co-inherited alpha-thalassemia, APOL1 kidney risk variants, and pathways involved in oxidative stress and inflammation. Environmental exposures such as air pollution, secondhand smoke, and psychosocial stress worsen outcomes. And female-specific states modulate disease directly: menstruation can precipitate vaso-occlusive pain episodes beginning at menarche, hormonal fluctuations across the cycle influence vascular tone and inflammatory balance, hormonal contraceptives may alter thrombotic risk, and pregnancy, with its increased oxygen demand and prothrombotic state, amplifies the underlying vasculopathy.

Historically, clinical attention to reproduction in sickle cell disease has clustered around two moments: preserving fertility and managing pregnancy. Both matter. Hypoxic-ischemic injury, chronic inflammation, and gonadal exposure to disease-modifying therapies or transplant conditioning can diminish ovarian reserve. Pregnancy carries heightened risks of vaso-occlusive complications, acute chest syndrome, thromboembolism, preeclampsia, and medically indicated preterm delivery, and treatment decisions during pregnancy remain hampered by gaps in evidence. But the authors contend that this framing treats reproductive health as a series of isolated episodes rather than a continuous life course, and that the continuum does not end with pregnancy. It transitions into midlife, where the evidence is thinnest.

What evidence exists suggests that menopause arrives early. A Brazilian cohort reported menopause roughly five years earlier than expected in the general population, at approximately 46 to 48 years of age, and more recent observational studies from U.S. cohorts have similarly reported mean ages in the mid-to-late forties. These findings come with heavy caveats: small samples, single-center designs, and retrospective data collection that invites recall bias. Larger prospective studies are needed to determine whether reproductive aging is consistently accelerated, and whether timing differs by genotype, disease severity, or treatment exposure. Still, the signal is strong enough that the authors argue menopause should be treated as a critical component of comprehensive sickle cell care.

The midlife picture is more complicated than a simple worsening. In one cohort, up to 80 percent of women reported a reduction in vaso-occlusive pain frequency after menopause, raising the possibility that hormonal changes influence pain pathways, though the authors caution this should not be read as evidence that menopause consistently improves disease-related pain. Meanwhile, vasomotor symptoms, sleep disturbance, mood changes, anxiety, and fatigue may emerge or intensify during the transition, and because many of these overlap with core manifestations of sickle cell disease, menopause-related morbidity risks being misattributed entirely to the underlying condition, leading to underdiagnosis and undertreatment.

Treatment raises its own unresolved questions. Menopausal hormone therapy is the most effective treatment for vasomotor symptoms and has established indications for women with premature or early menopause, but there are currently no adequately powered clinical trials evaluating its safety, efficacy, or optimal formulation and duration in women with sickle cell disease. Because the disease is characterized by endothelial dysfunction, inflammation, and a prothrombotic state, thrombosis is an obvious concern, yet the authors stress that whether hormone therapy adds clinically meaningful thrombotic risk in this population has not been established; it is an important clinical question, not a demonstrated contraindication. Genitourinary syndrome of menopause, with its vaginal dryness, dyspareunia, and urinary symptoms, is another likely under-recognized burden, and low-dose vaginal estrogen, which has minimal systemic absorption, has not been evaluated in these patients.

Beyond symptoms, menopause may intersect with organ systems already compromised by the disease. Estrogen decline accelerates bone resorption, compounding skeletal vulnerability from chronic inflammation, marrow hyperplasia, vitamin D deficiency, and delayed puberty. Cessation of menstruation eliminates a physiologic route of iron loss, and emerging observations suggest iron indices may rise after menopause even after accounting for transfusion history, a particular concern for women with transfusion exposure. Cognitive health presents perhaps the most striking intersection: women with sickle cell disease may enter the menopausal transition carrying pre-existing neurovascular vulnerability from chronic anemia, cerebral hypoxia, and silent infarcts, so midlife hormonal changes unfold under far higher neurological risk than in the general population. Frailty and functional decline, the authors hypothesize, may likewise accelerate when menopause-related changes land on decades of disease-related physiologic stress.

The equity dimensions are hard to ignore. Sickle cell disease disproportionately affects populations in sub-Saharan Africa, the Middle East, India, and parts of the Americas, precisely the regions where access to comprehensive chronic disease management, reproductive health services, and menopause care is most variable. Even in resource-rich settings, care is fragmented between hematology, obstetrics, gynecology, and primary care; menopause may fall outside hematologists’ traditional scope, while menopause clinicians may have little experience with the disease. In low- and middle-income settings, structured menopause care may be entirely absent from routine services, meaning women enter midlife without any systematic assessment of symptoms or surveillance for bone, cardiovascular, cognitive, and functional decline.

The authors’ prescription is a coordinated lifespan model: routine screening for menstrual changes, vasomotor symptoms, sleep, mood, fatigue, genitourinary symptoms, and sexual health as women approach midlife; careful attribution of new or changing symptoms to both disease and menopause rather than defaulting to the disease alone; individualized hormone therapy decisions weighing genotype, prior venous thromboembolism, and vascular risk; and referral pathways connecting sickle cell specialists with menopause expertise. They also call for research priorities spanning prospective cohorts tracking age at menopause, genotype-stratified analyses, trials of menopause therapies, cognitive and neuroimaging studies, and implementation research adapted to local resources rather than assuming one multidisciplinary model fits all settings.

The stakes extend beyond any single clinic. As survival improves, the measure of success for a lifelong genetic disease can no longer be simply keeping children alive; it must be whether those children grow into adults who age well. Integrating reproductive aging into clinical practice, research agendas, and health policy, the authors argue, is an opportunity to strengthen women-centered care and advance health equity for the millions of women worldwide living with sickle cell disease. Menopause, long invisible in the sickle cell literature, may turn out to be one of the most consequential frontiers in the field.

Subject of Research: Menopause and reproductive aging in women with sickle cell disease across the lifespan

Article Title: From menarche to menopause: a lifespan perspective on women's health in sickle cell disease

Article References: Farooqui, M., Christmas, M., Goba, G., & Hsu, L. (2026). From menarche to menopause: a lifespan perspective on women's health in sickle cell disease. Frontiers in Epidemiology, 6, Article 1931488. https://doi.org/10.3389/fepid.2026.1931488

Image Credits: AI Generated

DOI: 10.3389/fepid.2026.1931488

Keywords: sickle cell disease, menopause, women's health, reproductive aging, menopausal hormone therapy, vaso-occlusive pain, health equity, bone health, cognitive health, iron overload, cardiovascular risk, lifespan care

The effort sits within SMRUTHI-India, short for Strategic Multimodal Intervention in at-risk Elderly Indians for Prevention of Dementia, an ongoing cohort study spanning four zones of the country: Himachal Pradesh in the north, Rajasthan in the west, Tripura in the east, and Karnataka in the south. In a paper published in Frontiers in Dementia, researchers led by teams at the All India Institute of Medical Sciences in New Delhi describe how they constructed, validated, and pilot-tested the CBM as both a printed booklet and a series of animated videos in Hindi, Kannada, and Bengali. The work is registered as a clinical trial, and its results offer an early but encouraging signal that culturally tailored, multidomain prevention can work far from the urban hospital.

The design philosophy draws on the Finnish FINGER study, the first long-term trial to show that multidomain lifestyle interventions could improve cognition in at-risk older people, and on successors such as U.S. POINTER. Those trials, however, were conducted in Western settings where the authors note the effectiveness of such programs may be underestimated because usual care is already so good. The Indian team set out to fill a different gap: pragmatic, culturally appropriate materials that address modifiable risks like diet, physical inactivity, vascular disease, and substance use within the constraints of rural primary care, where participants often have limited literacy and few dedicated resources.

The theoretical backbone is the Health Behaviour Model, which explains health actions through people’s beliefs and attitudes. The module therefore aims to raise awareness of dementia, sharpen the perceived severity of its symptoms, highlight the advantages of managing risk, and strengthen confidence in the ability to change. Building on this framework, neurologists, a neuropsychiatrist, a neuropsychologist, psychologists, a dietitian, and physiotherapists combed the literature on PubMed, JSTOR, and EMBASE to identify major content themes, drafted a booklet in English, and then subjected it to a gauntlet of stakeholder review and expert scoring.

The validation numbers are striking. The initial draft achieved an average item-level content validity index of 0.933, with individual items ranging from 0.6 to 1.0; after experts flagged five weaker sections, revisions pushed the scale-level average to 0.977, and multi-rater agreement improved from fair to excellent on nineteen of twenty-one items. The booklet’s readability on the SMOG index came out at 10.07, meaning it sits near a tenth-grade reading level, deliberately accessible for a lay audience. When 83 cohort members rated the printed material with the Patient Education Material Assessment Tool for print, between 70 and 96 percent judged the booklet understandable and actionable, with many awarding perfect scores.

For participants who cannot read, the team converted the booklet’s themes into ten animated videos of four to eight minutes each. The storylines follow a relatable older adult in an Indian village developing early signs of dementia, with voice-overs, characters, and settings drawn from the communities themselves. A behavioural science expert reviewed the videos and pushed for caricatures, clearer behavioural-change messaging, less medical jargon, and key takeaway messages at the end of each clip. Ratings from 86 viewers were similarly strong, and qualitative feedback showed that illiterate participants engaged far more readily with the videos than with the printed booklet.

To test whether the module could actually change behaviour, the researchers ran a pilot feasibility study using a cohort multiple randomised controlled trial design at the central hospital site and a pre-post design at peripheral rural sites, enrolling people aged 55 and older with elevated dementia risk on the CAIDE score but normal cognition at baseline. The primary outcome was the LIBRA index, a validated composite of lifestyle-related dementia risk factors. After six months, the intervention group at the central site improved significantly, with the median LIBRA score falling from −3.0 to −4.6, while the control group’s improvement did not reach statistical significance. At the peripheral sites, the index dropped from 0.55 to −1.0, a change the authors report as highly significant.

Feasibility metrics revealed an instructive split between settings. At the central hospital, only 42.4 percent of participants completed the six-month follow-up, largely because travelling to another state, extreme weather, and the stressful hospital environment made repeat visits difficult; many participants were caregivers accompanying patients rather than local residents. In the rural periphery, by contrast, retention reached 85 percent, and adherence was remarkably high: every participant engaged in cognitive activities, 88.2 percent in physical activity, and 70.6 percent in dietary changes. More than half monitored vascular risk, and among those with addictions, 62.5 percent reported reducing their dependence. Overall, 80 to 100 percent of rural participants said they wanted to continue the intervention beyond the trial.

Adherence translated into target achievement. At the central site, all intervention participants reached the MIND diet score goal of at least eight, 87.5 percent exceeded 600 metabolic equivalent task-minutes of weekly physical activity, and 75 percent achieved blood pressure control below 140/90 mmHg. Rural participants met the diet target as well, with 70.6 percent hitting the activity goal and 58.8 percent achieving blood pressure control. Cognitive test scores improved in both arms but not significantly, an outcome the team attributes to the small pilot sample and short follow-up rather than a failure of the approach, noting that pilots of this size are designed to generate preliminary estimates, not definitive efficacy.

The researchers are candid about limitations: heavy reliance on psychoeducation, attrition that may have introduced nonresponse bias, small numbers, and use of the original LIBRA index, which they plan to culturally adapt. Even so, the module’s low cost and its reliance on existing rural health infrastructure rather than new facilities make it a candidate for scale, and the team is planning a larger multicentric trial that will enlist ASHA community health workers to extend reach and sustainability. If those larger trials confirm what this pilot suggests, the path to delaying dementia in one of the world’s fastest-ageing populations may run through a booklet, a set of cartoons, and the trusted hands of village health workers.

Subject of Research: Development and validation of a multimodal health education intervention for dementia prevention in at-risk rural Indian elderly

Article Title: Development of a multimodal health education module for dementia prevention in at-risk rural Indian elders: a SMRUTHI INDIA initiative

Article References: Sharma, K., Dubey, A., Gupta, S., Fulara, K., Narzari, H., Nilima, N., Sneha, Kamini, Sharma, S., Sharma, V., Chaudhary, S., Vastrad, P., Priya Darshanraj, N., Bhattacharjee, S., Datta, P., Shekhawat, G. S., Verma, A., Harshath Ajay, V., Sandesh, J. R., … Padma Srivastava, M. V. (2026). Development of a multimodal health education module for dementia prevention in at-risk rural Indian elders: a SMRUTHI INDIA initiative. Frontiers in Dementia, 5, Article 1914082. https://doi.org/10.3389/frdem.2026.1914082

Image Credits: AI Generated

DOI: 10.3389/frdem.2026.1914082

Keywords: dementia prevention, rural India, SMRUTHI-India, multimodal intervention, LIBRA index, health education, animated videos, care bundle module, lifestyle intervention, cognitive health, PEMAT, elderly

The study harnessed longitudinal data spanning multiple years, following large cohorts of older adults to chart cognitive changes alongside their involvement in paid labor. Unlike cross-sectional studies that provide snapshots, this methodology allowed the team to observe dynamic cognitive trajectories, offering unprecedented insight into how continued work influences brain health as individuals advance in age.

Technically, the research implemented robust cognitive assessment tools standardized for the Chinese population, assessing domains such as memory, executive function, and processing speed. By correlating these cognitive metrics with work participation data—including employment status, hours worked, and job type—the study disentangles the complex relationship between occupational engagement and cognitive resilience.

Crucially, the findings suggest that older adults who remain engaged in paid employment exhibit slower rates of cognitive decline compared to their non-working peers. The protective effect of work on cognitive function appears not only statistically significant but also sustained over time, suggesting that the mental stimulation and social interaction inherent in many jobs might confer neuroprotective benefits.

The mechanistic underpinnings of these results are thought to reflect both cognitive reserve enhancement and increased neural plasticity driven by complex work-related tasks and ongoing mental challenges. The study posits that continued employment helps maintain synaptic connectivity and functional brain networks, mechanisms critical to preserving cognition in later life.

Furthermore, the research highlights socioeconomic and health-related variables as modulating factors. For example, individuals engaged in physically demanding labor or with existing chronic conditions showed different cognitive trajectories, emphasizing the need to consider the quality and nature of work in aging policies.

This evidence arrives amid global demographic shifts, where aging populations present escalating challenges for health systems and economies. Understanding how paid labor interfaces with aging brain function offers a promising avenue to extend cognitive healthspan, potentially reducing the burden of dementia and other neurodegenerative conditions.

Experts suggest that policy adjustments encouraging flexible, meaningful employment opportunities for older adults could harness these cognitive benefits. Such strategies might include part-time roles, vocational retraining, and ergonomic job designs tailored to this demographic.

As the study unfolds a multifaceted picture of aging, work, and brain health, it underscores the importance of continued research to explore causality and to develop targeted interventions. This pioneering work adds a vital piece to the complex puzzle of how purposeful activity can shape cognition throughout the lifespan, offering hope for healthier, more engaged aging populations worldwide.

Subject of Research: Paid work participation and cognitive function trajectories in older adults

Article Title: Paid work participation and cognitive function trajectories among older adults in China: evidence from a longitudinal study

Article References:
Zhao, Z., Xu, S., Jiang, J. et al. Paid work participation and cognitive function trajectories among older adults in China: evidence from a longitudinal study. BMC Geriatr (2026). https://doi.org/10.1186/s12877-026-07979-6

Image Credits: AI Generated