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Lehman et al.1 reported an increased risk of death from amyotrophic lateral sclerosis (ALS) and AD among retired National Football League players, especially among players in speed positions. A 40-fold higher prevalence rate for ALS was reported in football players who played after 1960.2 There was no risk of ALS in high school students who played football from 1946 to 1956, when headgear was less protective than today.3 I am surprised that Lehman et al. discussed only the causal hypothesis of recurrent traumatic brain injuries or concussions whereas other possible etiologic factors were not mentioned (i.e., intense physical activity, use of drugs, exposure to neurotoxins).1 In Italy, a 12-fold higher risk of death from ALS in professional soccer players was observed but not from AD or Parkinson disease.4 In 6 of 8 subjects, age at death was younger than 59 years.4 The risk of ALS was also significantly increased for midfielders but not for other positions.5 Lehman et al. found a different pattern of risk of death for ALS and AD vs Parkinson disease1 so this may indicate a different origin for these diseases. It might be important to know the mean age at death of players deceased from ALS and AD in this study.1 Further cohort studies in professional players of different sports should be conducted with particular attention to the position of players because this could supply important etiologic cues.

Neurodegenerative causes of death among retired National Football League players