Soccer players are 50 percent more likely to develop dementia, according to new research.
Rates of the memory-robbing condition are higher than in the general population, say scientists.
The finding is based on thousands of players in Sweden's top division. One in eleven were afflicted with dementia.
Lead author Dr. Peter Ueda, of the Karolinska Institute, Stockholm, said: "The overall evidence supports the hypothesis that former elite football (soccer) players are at increased risk of neurodegenerative disease, especially Alzheimer's disease and other dementias."
An alarming nine percent (537 out of 6,007) were diagnosed - compared to six percent (3,485 out of 56,168) of the controls.
It adds to the evidence that heading the ball damages the brain. Goalkeepers were not at increased risk.
Dr. Ueda said: "It has been hypothesized the repetitive mild head trauma sustained and concussions might cause neurodegenerative disease."
He added: "It could be that the difference in neurodegenerative disease risk between these two types of players supports this theory."
The study period spanned 1924 to 2019 - meaning the analysis included amateurs.
Dr. Ueda said: "Male football (soccer) players in the Swedish top division had a 1.5-fold increased risk of neurodegenerative disease compared with population controls who were matched on sex, age and region of residence."
The phenomenon is applied to Alzheimer's and other forms of dementia. Rates of motor neuron disease remained the same, and Parkinson's cases were lower.
Dr. Ueda said: "Unlike outfield players, goalkeepers did not have an increased risk of dementia - supporting the hypothesis mild head impacts sustained when heading the ball could explain the increased risk in outfield players."
A landmark study by Glasgow University found former professional soccer players in Scotland were 3.5 times more likely to get dementia.
Dr. Ueda said: "We found a significantly higher risk of neurodegenerative disease diagnosis and neurodegenerative disease mortality among soccer players than population controls. However, the magnitude of the association was not as large."
It may reflect differences in tactics, practice routines and frequency of play. The game did not turn professional in Sweden until the late 1960s.
Dr. Ueda said: "By the late 1990s, almost all top division players had football (soccer) as their full-time occupation.
"Further research is needed to investigate how exposures associated with health outcomes might differ across populations of elite football (soccer) players."
Children under the age of 12 in England, Scotland and Northern Ireland are now banned from heading footballs (soccer) during practice or training.
Dr. Ueda said: "Importantly, our findings suggest goalkeepers don't have the same increased risk of neurodegenerative disease as outfield players.
"Goalkeepers rarely head the ball, unlike outfield players, but are exposed to similar environments and lifestyles during their football (soccer) careers and perhaps also after retirement."
The study in The Lancet Public Health also found overall mortality rates were slightly lower among soccer players - 40 compared to 42 percent.
Added co-author Professor Bjorn Pasternak: "The lower overall mortality we observed among footballers (soccer players) indicates their overall health was better than the general population, likely because of maintaining good physical fitness from frequently playing football (soccer).
"Physical activity is associated with a lower risk of dementia, so it could be hypothesized the potential risks from head impacts are being somewhat offset by having good physical fitness.
"Good physical fitness may also be the reason behind the lower risk of Parkinson's disease."
Dementia has killed four members of England's World Cup-winning team of 1966.
They include Ray Wilson, Martin Peters, Jack Charlton and Nobby Stiles. Sir Bobby Charlton is suffering from the same condition.
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