CTE found in 99% of former, deceased NFL players’ brains: JAMA study (updated)

click to enlargeUpdated for additional information and analysis at conclusion. In the largest-ever case study published of CTE–chronic traumatic encephalopathyVA Boston Healthcare System (VABHS) and the Boston University School of Medicine’s CTE Center found mild to severe CTE pathology in nearly all of the brains of former football players studied. Jesse Mez, MD, BU Medical assistant professor of neurology and lead author on the JAMA study, said that “The data suggest that there is very likely a relationship between exposure to football and risk of developing [CTE].” The CTE is marked by defective tau (stained red in the brain sample pictures, click to expand), which is also evident in Parkinson’s and Alzheimer’s Disease.

Of the 202 brains donated to the VA-BU-CLF (Concussion Legacy Foundation) Brain Bank:

  • The most dramatic finding is the detection of CTE in 110 of 111 donated former NFL players’ brains (defined as having played one play in a regular NFL season game).
  • In addition, the brains of other football players were studied. CTE was detected in seven of eight Canadian Football League former players (88 percent), nine of 14 semi-professional players (64 percent), 48 of 53 college players (91 percent), and three of 14 high school players (21 percent).
  • The severity increased with length of play, with the majority of former college, semi-professional and professional players having severe pathology. The deceased high school players diagnosed with CTE had mild pathology findings. Age at death ranged from 23 to 89.
  • Player position mattered. Linemen, running backs, defensive backs, and linebackers, who take most of the punishment in football, were the bulk of the donated brains with CTE.

Separately, and with no knowledge of the pathology, backgrounds on each donor were compiled to gather medical history and symptoms. What was striking were the personality changes evident with even mild CTE. Dr. Mez: “We found cognitive, mood and behavioral symptoms were very common, even among players with mild CTE tau pathology. This suggests that tau pathology is only the tip of the iceberg and that other pathologies, such as neuroinflammation and axonal damage, contribute to the clinical symptoms.” 

Preliminary to the current study was UNITE (Understanding Neurologic Injury and Traumatic Encephalopathy), a retrospective analysis of brains donated to the VA-BU-CLF Brain Bank started in 2014 with grants from the National Institute of Neurological Disorders and Stroke and the National Institute of Biomedical Imaging and Bioengineering, both part of the National Institutes of Health (NIH).  The researcher, Ann McKee, a BU Medical professor of neurology and pathology and director of BU’s CTE Center, is a co-author of the current study. The NFL was also supposed to help fund this research through the NIH, but pulled funding in late 2015 due to Dr. Robert Stern of BU’s involvement with the CTE Center [TTA 25 May 16]. (This Editor has reported on Dr. Stern’s pioneering work on CTE twice on his presentations at NYC MedTech and GCRI.).

The limitations of the study are evident. The donor families of players with CTE were far more motivated to donate brains after death into the study. There is no control group, whether normal or from other types of brain trauma. Dr. Stern also has stated previously that we know the outcome, but not the reasons why some get it and others do not (more on this in ‘Brain Games’).  BU Research, BU School of Medicine, NY Times (interactive presentation with histories of players and position analysis).

Why is this research important to healthcare and to technology? First, because repetitive brain trauma–concussive and sub-concussive–now has an even better-documented relationship to significant medical and behavioral conditions. This study is fundamental research to deepen our knowledge about the effects and long term brain outcomes of head trauma, whether from football, other contact sports, combat service (e.g. IED explosions), car accidents, and even repetitive actions by a person who is developmentally disabled. Second, avoiding or minimizing head trauma in sports and warfare, plus correctly diagnosing and treating concussion and sub-concussion, are huge areas for technology about which this Editor has advocated for several years. The message here is not that football is bad, but in the present state is played dangerously–as are high contact sports such as flag football, hockey and rugby–the orthopedist’s gift–and heading the ball in soccer. We need to know more, minimize it now, and health tech should be part of this.

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