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It’s All In Your Head

One of the most characteristic sounds associated with football, whether it’s high school, college, or pro, is the sound made when two helmets make contact. From the sidelines, it’s easy to not think about the fact that brain injury and a devastating disease called CTE (chronic traumatic encephalopathy) could be in the making with every blow to the head.

Parents of football players, read on…
A relationship between head trauma such as blows to the head from playing football or hockey or from boxing, and cognitive impairment and dementia has been the subject of much research in recent years. Now a new study from Boston experts sheds more light on the topic.

Briefly, investigators evaluated post-mortem brains from 85 individuals (age range, 17-98 years) who had a history of repetitive mild traumatic brain injury. Here’s what they found:

- Sixty-eight of the brains, all from men, showed signs of chronic traumatic encephalopathy
Of these 68 men, 64 had been athletes, 21 military veterans (86% of whom had also been athletes), and one had self-inflicted head-banging injuries
Among the men with CTE, 50 had played football (33 in the National Football League)
- Other men with signs of CTE included 6 high school football players, 9 college football players, 7 professional boxers, and 4 National Hockey League players
Brains from 17 of the 85 individuals who had a history of repetitive mild traumatic brain injury did not show signs of CTE.
CTE was the only diagnosis in 43 cases (63%), while 8 others also were diagnosed with motor neuron disease, 7 with Alzheimer’s disease, and 15 with other types of dementia.
Seven deaths were from suicide and 6 from overdose, while the most common causes of death were respiratory failure (most of which were associated with CTE), heart disease, and dementia
The results of this four-year study, which was conducted by researchers at the Boston University Center for the Study of Traumatic Encephalopathy and the Veterans Affairs Boston Healthcare System, along with the Sports Legacy Institute, should give pause to parents whose children don a football players uniform.

What is CTE?
CTE is a progressive neurodegenerative disease that can be triggered by repetitive mild traumatic brain injury. These repeated assaults to the brain cause deposits of a protein called hyperphosphorylated tau (p-tau) to accumulate in various areas of the brain as neurofibrillary tangles.

If these terms sound familiar, that’s because they are associated with Alzheimer’s disease, the most common form of dementia. Although CTE and Alzheimer’s disease share some characteristics, they are not the same disease, as experts have observed differences in brain atrophy (shrinkage) and other structural abnormalities between the two conditions.

Symptoms of CTE include aggression, confusion, depression, impaired judgment, impulsivity, irritability, short-term memory loss, and an increased tendency for suicide that typically begin nearly a decade after the brain injuries start. As time goes on, other symptoms can develop, including difficulties with speech, dementia, problems with walking, and parkinsonism.

More from the study
While the results of this study provide critical information about repetitive head injuries and CTE, it does not identify what percentage of football players are likely to develop the disease. To get a better idea of that statistic, researchers need to examine the brains of former players who do not show symptoms of the disease, and families are less likely to donate the brains of these individuals for research.

Perhaps the most important information for parents from this study is the following. In a recent New York Times article, Robert Cantu, co-director of the encephalopathy center and one of the study’s co-authors, noted that “Parents have become paranoid about concussions and connecting the dots with CTE, and that’s wrong. The dots are really about total head trauma.”

His words can be stated another way, as the study’s authors concluded. “This study clearly shows that for some athletes and war fighters, there may be severe and devastating long-term consequences of repetitive brain trauma that has traditionally been considered only mild.”

If football is here to stay, then we need to pay more attention to blows to the head, brain injury, and ways to prevent CTE and similar diseases.

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