Background: Adverse long-term effects of playing football due to repetitive head impact exposure on neurocognition and mental health are controversial. To date no studies have evaluated such effects in women. Aims: To (a) compare neurocognitive performance and mental health in retired elite female football players with retired elite female non-contact sport athletes, and to (b) assess whether findings are related to his-tory of concussion and/or heading exposure. Methods: Neurocognitive performance, mental health and cognitive symptoms were assessed using computerized tests (CNS-VS), paper pen tests (Category fluency, TMT, Digit Span, PASAT), questionnaires (HADS, SF-36), and a symptom checklist. Heading exposure and concussion history were self-re-ported in an online survey and in a clinical interview, respectively. Lin-ear regression was used to analyse the effect of football, concussion and heading exposure on outcomes adjusted for confounders. Results: Female football players (n=66) performed similar on neurocognitive tests when compared to non-contact sport controls (n=45), except for significantly lower scores on verbal memory (MD=-7.038, 95%CI=-12.98,-0.08, p=.038) and verbal fluency tests (MD=-7.534, 95%CI=-13.75,-0.46, p=.016).Among football players weaker verbal fluency performance was significantly associated with =2 concussions (MD=-10.36, 95%CI=-18.48,-2.83, p=.017), while weaker verbal memory performance was significantly associated with frequent heading (MD=-9.166, 95%CI=-17.59,-0.123, p=.041). The depression score differed significantly be-tween study populations and was significantly associated with frequent heading but not with history of concussion. Conclusion: The clinical relevance of above findings is questionable. Future studies should investigate whether these associations point to a causal link between repetitive head impacts and verbal memory/fluency or mental health.
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