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What Is CTE And How Bad Is It?

Courtesy of "Clinicopathological Evaluation of Chronic Traumatic Encephalopathy in Players of American Football". Jesse Mez, MD, MS1,2; Daniel H. Daneshvar, MD, PhD1,3; Patrick T. Kiernan, BA1,2; et al. JAMA, 2017.

Yesterday, the Journal of the American Medical Association (JAMA) published a troubling report on the relation between chronic traumatic encephalopathy (CTE) and football players ( The unfortunate truth is that CTE has been a well-known fact for a couple years, so why is the media blasting the story, now? In the media, it is widely reported that the JAMA investigation suggests that 110 out of 111 brains that belonged to former NFL football players had some level of CTE, which is just part of the study.

First, what is CTE? JAMA describes it as a “progressive neurodegeneration associated with head trauma". In other words, it is a chronic medical condition in which the brain is damaged as a cumulative result of repeated hits to the head. Since several professional football players have played the game since childhood, some have been experiencing hits to the head for about 20 years. The damage caused by such hits to the head is increasingly catastrophic in professional football because players are bigger, stronger and faster than ever before; therefore, the impact from player collisions is far greater than during their youth football experience.

The study of 202 brains from men with football experience, ranging from youth football to the NFL, in which 177 indicated signs of CTE. There are four stages of CTE, where Stage I is the mildest and Stage IV is the most severe. Of the 110 brains that belonged to NFL players, 95 demonstrated severe CTE and 15 were mild. Comparing that to collegiate-level players, 48 brains were studied, where 21 had mild cases of CTE and 27 had severe cases. This may be because individuals who played in the NFL were involved in more head-to-head collisions for a longer period of time. CTE is not like an acute disease, such as Ebola, where just a little bit of exposure could lead to sudden death; instead, CTE, like many chronic medical conditions, arises from cumulative head collisions.

Some symptoms from CTE can range from impulsivity, depression, apathy, anxiety, memory loss, suicidal thoughts, dementia, gait instability, slowness of movement and substance abuse. When CTE is in a more severe stage, those symptoms are magnified, particularly for NFL players. Additionally, suicide was the cause of death for 27% of those with mild CTE, while neurodegenerative complications were cited as the cause of death for 48% of those with severe CTE.

However, while this study is predominately focused on football players, CTE is also found in military veterans, particularly those with war experience. In fact, 45 brains in the study belonged to men who served in the military, in which, 5 had mild CTE and 40 had severe CTE; it is unclear how much military experience and football playing experience contributed to the severity of CTE. Nevertheless, it is possible that CTE may be a point of interest for the Defense Department when reviewing troop readiness, much like post-traumatic stress disorder (PTSD) has recently been a hot topic.

Presently, football is the most popular sport in America, and we have yet to find out if the NFL’s new concussion protocols and rule changes may have a substantial effect in reducing the threat of CTE for players. With studies, such as JAMA’s, gaining widespread coverage in the media, it may prompt parents to be more cautious about signing up their kids to play football and, possibly, opt to sign them to sports with less contact, which may affect the NFL 20 or 30 years into the future. However, as it stands, current NFL players must continue to play and accept that they may develop CTE, or the possibility that they may already have it. There is already an increasing trend of NFL players that are retiring early because of brain-related issues, such as concussions and constant headaches; although, not all have cited concern for CTE as their reason, as more research is conducted, the trend may continue to grow.

To learn more about CTE, watch the PBS Frontline documentary, “League of Denial”, by following the link

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