This prospective longitudinal cohort study compared male adolescent soccer players (n=82, mean age 14.8 years) with noncontact sport athletes (n=47, mean age 14.7 years) across one competitive season at three European centers, assessing cognition, behavior, balance, brain MRI metrics, and plasma biomarkers at preseason, postseason, and 2 months later.
No significant between-group differences were found in cognition, behavior, balance, cortical thickness, brain volumes, white-matter microstructure, or functional connectivity. However, soccer players had higher preseason tNAA, GFAP, and NfL than controls, and tNAA declined in soccer players while rising in controls (β=0.047, 95% CI 0.020–0.074, P=.001), converging by postseason. Heading exposure within soccer players was not significantly associated with any outcome change.
- Single-season follow-up limits detection of cumulative, long-term RHI effects. - Male-only sample restricts generalizability to female athletes. - Self-reported heading exposure is an imprecise measure of actual RHI dose.
One season of youth soccer was not associated with detectable deficits in cognition or brain structure, but subtle biomarker signals (GFAP, NfL, tNAA) warrant monitoring. Clinicians and coaches should be aware that current evidence supports continued play while underscoring the need for longer-term surveillance studies before drawing firm safety conclusions.
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