A study published on July 25, 2015 in the Journal of the American Medical Association, JAMA has found that CTE, or chronic traumatic encephalopathy, in 99% of deceased NFL players' brains that were donated to scientific research. CTE is an effect of experiencing numerous traumatic brain injuries (TBI), and although the average person is more like to suffer a TBI from an auto accident, TBI's can occur while engaging in sports. In fact, all of the brains in the study were required to have football as their primary exposure to head trauma. The research subjects must have had to experience repetitive head trauma in their lifetimes, but may or may not have exhibited CTE symptoms during their lives.
What Is Chronic Traumatic Encephalopathy?
To explain it more clearly, CTE is pathologically characterized by a buildup of abnormal tau protein in the brain that can disable neuropathways and may lead to a variety of clinical symptoms, such as memory loss, confusion, impaired judgment, aggression, depression, anxiety, impulse control issues, and sometimes even suicidal behavior. CTE is found in individuals that have experienced repeated head trauma, and most cases were diagnosed in veterans and people who played contact sports like American football. The only formal diagnosis of this degenerative brain disease is through an autopsy, meaning that we can't knows if someone has CTE, for sure, until after they die.
The study acknowledges potential bias because relatives of the players may have submitted their brains after noticing clinical symptoms while they were living. It also points out the lack of a comparison group to represent all individuals exposed to college-level or professional football. Without that, the study is unable to provide an overall estimate on the risk of playing football and its effects on the brain.
CNN reports, "Out of 202 deceased former football players total--a combination of high school, college, and professional players--CTE was neuropathologically diagnosed in 177. The disease was identified in 110 out of 111 former NFL players. It was also found in three of the 14 high school players and 48 of the 53 college players."
The NFL told CNN, "The medical and scientific communities will benefit from this publication, and the NFL will continue to work with a wide range of experts to improve the health of current and former NFL athletes...there are still many unanswered questions relating to the cause, incidence, and prevalence of long-term effects of head trauma such as CTE."
The study looked at both the brain pathology, which is the behavior of the disease in the brain, and the clinical history of each participant. It identified four stages of pathological CTE severity among the brains, based on amounts of tau buildup and distribution. Stages one and two are classified as mild and stages three and four are severe.
CNN summarized, "Individuals who were reported to have experienced more behavioral mood symptoms during their lifetime were more likely to have findings indicative of mild disease as opposed to severe. These symptoms occurred in 96% of mild cases and 89% of severe cases. People with a mild buildup and distribution of tau were also more likely to have died by suicide. Those with a severe buildup, on the other hand, were more likely to have experienced cognitive symptoms, such as memory loss."
One of the biggest problems is a lack of encouragement for players to seek treatment. Stereotypes about mental health treatment and studies that emphasize problems stemming from brain trauma, without fully explaining the science behind it, may give athletes the idea that they can't do anything to help themselves. Although CTE can currently only be diagnosed after death, many symptoms of the disease that occur in someone's lifetime, like depression and anxiety, are treatable. It is important for someone experiencing symptoms from a traumatic brain injury to receive an evaluation from a neurologist and work with them to create a treatment plan.
Dr. Jeffrey Kutcher, national director of the Sports Neurology Clinic at the Core Institute, who was not involved in the study, said, "My rule as a physician, as a neurologist, is to protect and promote the brain health of my patients over the course of a lifetime, no question about that. You have to look at the total person though. You have to understand why people play sports. It's an individual decision, everybody gets different things out of it. You also have to understand what the arc of their life is going to be, what their health is going to be at the end of their career."
Kutcher mentions that most of the brains in the study came from players that were on the field decades ago, from the 1950s to the 1990s, with the rest having played more recently. There were not the same brain injury awareness, medical protocols, or equipment back then as there is today.
Dr. Ann McKee, director of Boston University's CTE center, and a coauthor of the study, are currently conducting more research on CTE and its effects. They are examining lengths of exposure to head trauma, the age of first exposure, the lengths of playing careers, and how these relate to the risk of CTE and its pathological severity. They are also using the 177 donated brains with CTE to discover if there are any genetic risk factors of the disease.
"It certainly can be prevented," McKee said, "'That's why we really need to understand how much exposure to head trauma and what type of head trauma the body can sustain before it gets into this irreversible cascade of events."
Additionally, in a statement commenting on the study, the league said, "The NFL is committed to supporting scientific research into CTE and advancing progress in the prevention and treatment of head injuries. In 2016, the NFL pledged $100 million in support for independent medical research and engineering advancements in neuroscience related topics. This is in addition to the $100 million that the NFL and its partners are already spending on medical and neuroscience research."
The Michigan Law Firm, PLLC Blog previously discussed that the NFL settled a class action with ex-football players who had suffered from brain injuries, potentially paying out $4 million, to those who suffered from CTE.
The start of fall means that football season is here, and football season means cleats on turf and helmets against helmets. As spirited at American become during this time of year, it's important to remember that repetitive head trauma caused by playing football may lead to CTE or other brain injuries. It should also be noted that traumatic brain injuries can be caused by experiencing a blow to the head in a motor vehicle accident. If you or someone you know has experienced a traumatic brain injury from a car crash, contact The Michigan Law Firm, PLLC at 844.4MI.FIRM for a free legal consultation. Let us take care of your legal trouble while you focus on improving your health.
