Abstract

Background: This study examines the long-term cognitive consequences of repetitive head impact on executive functions in mixed martial arts (MMA) fighters over two years. Methods: Neuropsychological tests assessed executive functions in two groups: competitive (CG; n = 26) and recreational groups (RG; n = 26). Results: A significant interaction between time and group was observed. The CG experienced greater declines in Mental Processing Speed (MPS) after 1 year [4.6 s (3.1; 6.1); p ≤ 0.001] and 2 years [14.6 s (5.1; 24.0); p = 0.003]. Inhibitory control (IC) also declined after 1 year [4.7 a.u. (3.0; 6.2); p ≤ 0.001] and 2 years [10.0 a.u. (11.6; 11.4); p ≤ 0.001]. Cognitive flexibility (CF) showed a pronounced reduction after 1 year [4.8 a.u. (3.0; 6.7); p ≤ 0.001] and 2 years [7.5 a.u. (5.9; 9.1); p ≤ 0.001]. Automatic (AP) and controlled processes (CP), as well as direct (DM) and indirect memory (IM), also showed significant impairments in CG. Conclusions: These findings highlight the detrimental effects of MMA competitions on cognitive function, emphasizing the need for monitoring and interventions to preserve fighters’ health and performance. © 2025 by the authors.