CTE almost universal among ex-NFL football players

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FocusFootballinjury13A study of the brains of 202 former American football players found that 87% showed signs of chronic traumatic encephalopathy (CTE), a degenerative brain disease linked to repeated blows to the head. The Boston University study found that 110 of the 111 brains from ex-NFL players were diagnosed with CTE.

A recent study of former American football players’ brains does not bode well for professional players’ long-term brain health. US News reports that Dr Ann McKee, chief of neuropathology at the VA Boston Healthcare System at Boston University, examined 202 donated brains from the families of deceased football players. Of those, 177 – 87% – showed signs of chronic traumatic encephalopathy, or CTE, a degenerative brain disease linked to repeated blows to the head.

Further, while researchers examined brains of former American football players across all levels of play and all positions, 110 of the 111 brains from ex-NFL players – 99% – were diagnosed with CTE. The study is the largest published CTE case series to date.

“There’s no question that there’s a problem in football. That people who play football are at risk for this disease,” McKee said. “And we urgently need to find answers for not just football players, but veterans and other individuals exposed to head trauma.”

CTE can only be diagnosed posthumously. Symptoms usually emerge years later and include memory loss, confusion, difficulty with balance, depression and dementia, according to the Brain Injury Research Institute.

Forty-four of the 110 ex-NFL players’ brains determined to have CTE – 40% – were former linemen, who are the players most likely to be knocking heads on the field.

McKee, who also serves as the director of the CTE Centre at Boston University, warned that the study had selection limitations as most of the donated brains were from concerned family members who witnessed their loved ones showing symptoms of CTE. The 177 brains found to have had CTE belonged to players who competed on the field for an average of 15 years.

“Obviously, this doesn’t represent the prevalence in the general population, but the fact that we’ve been able to gather this high a number of cases in such a short period of time says that this disease is not uncommon,” McKee said. “In fact, I think it’s much more common than we currently realize. And more importantly, this is a problem in football that we need to address and we need to address now in order to bring some hope and optimism to football players,” she continued.

Jeff Miller, the NFL’s senior vice president for health and safety policy, admitted there is a link between football and degenerative brain disorders during a round table discussion in Washington in March 2016.

Importance: Players of American football may be at increased risk of long-term neurological conditions, particularly chronic traumatic encephalopathy (CTE).
Objective: To determine the neuropathological and clinical features of deceased football players with CTE.
Design, Setting, and Participants: Case series of 202 football players whose brains were donated for research. Neuropathological evaluations and retrospective telephone clinical assessments (including head trauma history) with informants were performed blinded. Online questionnaires ascertained athletic and military history.
Exposures: Participation in American football at any level of play.
Main Outcomes and Measures: Neuropathological diagnoses of neurodegenerative diseases, including CTE, based on defined diagnostic criteria; CTE neuropathological severity (stages I to IV or dichotomized into mild [stages I and II] and severe [stages III and IV]); informant-reported athletic history and, for players who died in 2014 or later, clinical presentation, including behavior, mood, and cognitive symptoms and dementia.
Results: Among 202 deceased former football players (median age at death, 66 years [interquartile range, 47-76 years]), CTE was neuropathologically diagnosed in 177 players (87%; median age at death, 67 years [interquartile range, 52-77 years]; mean years of football participation, 15.1 [SD, 5.2]), including 0 of 2 pre–high school, 3 of 14 high school (21%), 48 of 53 college (91%), 9 of 14 semiprofessional (64%), 7 of 8 Canadian Football League (88%), and 110 of 111 National Football League (99%) players. Neuropathological severity of CTE was distributed across the highest level of play, with all 3 former high school players having mild pathology and the majority of former college (27 [56%]), semiprofessional (5 [56%]), and professional (101 [86%]) players having severe pathology. Among 27 participants with mild CTE pathology, 26 (96%) had behavioral or mood symptoms or both, 23 (85%) had cognitive symptoms, and 9 (33%) had signs of dementia. Among 84 participants with severe CTE pathology, 75 (89%) had behavioral or mood symptoms or both, 80 (95%) had cognitive symptoms, and 71 (85%) had signs of dementia.
Conclusions and Relevance: In a convenience sample of deceased football players who donated their brains for research, a high proportion had neuropathological evidence of CTE, suggesting that CTE may be related to prior participation in football.

Jesse Mez; Daniel H Daneshvar; Patrick T Kiernan; Bobak Abdolmohammadi; Victor E Alvarez; Bertrand R Huber; Michael L Alosco; Todd M Solomon; Christopher J Nowinski; Lisa McHale; Kerry A Cormier; Caroline A Kubilus; Brett M Martin; Lauren Murphy; Christine M Baugh; Phillip H Montenigro; Christine E Chaisson; Yorghos Tripodis; Neil W Kowal; Jennifer Weuve; Michael D McClean; Robert C Cantu; Lee E Goldstein; Douglas I Katz; Robert A Stern; Thor D Stein; Ann C McKee


National Football League (NFL) player reaction to the study was mixed, says a CBS Chicago report.

Baltimore Ravens’ offensive lineman John Urschel retired two days after the study was released. Pittsburgh quarterback Ben Roethlisberger has suffered many concussions in his 14 NFL seasons. He calls the study “alarming” but decided to play another season.

Retired Bears linebacker Lance Briggs admits he has been battling symptoms consistent with CTE. During a recent talk show, Briggs stated that he believes every football player has the disease. “You get worried. I get concerned for myself,” Briggs said in a web series with Sqor. “And even though I’ve never had any suicidal thoughts, or anything like that. For it to happen to some great men and great football players, I know that I can’t separate myself from that crowd.”

The report says Dave Duerson, former Chicago Bears Super Bowl champion, ended his life with a gunshot wound to the chest in 2011. Duerson who had been struggling with mental illness, asked that his family donate his brain for research on CTE.

McKee confirmed in examinations that the concussions and periodic hits to the head Duerson sustained during his NFL career led to him developing the disease

The report says the NFL spent years denying the link between blows to the head and brain disease. However, as studies like these continue to provide more evidence of a correlation, the NFL has acknowledged the link. The NFL settled lawsuits in 2016 with thousands of retired players. The lawsuits allege that the NFL attempted to hide the connection with hits to the head and permanent brain damage. The NFL reportedly paid out $1 billion to these athletes.

Dr. Michael Alosco, a neuropsychology fellow at Boston University researching CTE and Alzheimer’s disease, helped with McKee’s findings by interviewing the families of the deceased football players and assisting with the clinical diagnoses.

“We’re at the forefront of a new disease,” Alosco is quoted in the report as saying. “You can date it back to the 1920s when we found it in boxers, but really it’s only now when we’re really understanding what it is and what it can do.”

CTE can also occur in other sports that involve repeated hits to the head and is now being detected in student athletes who may have never played college or professional sports. “It’s sad to see its effect,” Alosco said, “But it’s exciting to see this new disease and learn more about it and ultimately figure out a way to treat and prevent it down the road.”

US News report
JAMA abstract
CBS Chicago report

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