If there is anything positive to come out of the rise of concussions in contact sports, it would be the dramatic increase in public awareness. On most levels of competition, the days of "having your bell rung" and getting back into action are over. Certainly, this is beneficial to those involved in potentially dangerous sports.
The other major benefit is the amount of research now being done on sports-related concussions. I recently spoke with Dr. Jeffrey Kutcher, Director of Michigan NeuroSport, Clinical Associate Professor of Neurology at the University of Michigan and a member of the American Academy of Neurology, about some of the advancements in brain research.
As I wrote recently, football may not put our children at an incredible risk of developing chronic traumatic encephalopathy (CTE) and becoming suicidal. Yet head injuries cannot be taken lightly, nor is the potential long-term damage that can be associated with them – especially when those injuries are not necessarily caused by the singular "knockout blow" that is often associated with concussions. Instead, researchers have spent a great amount of time and money investigating how the body reacts to both the smaller, repetitive head injuries and the gut-wrenching blows that get all the attention.
At the core of brain trauma research is a substance called tau, according to Kutcher. Tau is a type of protein that is naturally found in neurons in the brain. As the brain gets damaged, tau is shown to aggregate and clump in the neurons in different states of brain disease. "How these clumps end up in the neurons is still undetermined, but it is an issue of protein management," Kutcher said. He continued, "Researchers are trying to find how tau gets from one place in the brain to another, how to take care of tau clumps, etc."
The issue is that too much tau in the brain creates dysfunction, Kutcher explained. Doctors often describe a patient as having CTE when tau is distributed in the brain. Other diseases seem to have greater influences from other mechanisms, whereas in CTE, tau seems to be the predominant problem. Tau is also distributed differently throughout the brain than other brain diseases, including Alzheimer's disease.
Some months ago, Deadspin.com posted an article about some of the advancements in concussion research, with one of the stated goals to be to prevent future incidents rather than to just "conceptualize death." Kutcher stressed that researchers are working on creating the tools that can be used to identify tau build-up before death, but that that they also have to find out what the tau build-up means in the first place. "We must be clear that a patient who shows tau in the brain, even in abundance, might not be at clinical risk of anything; we need to explain what that means."
Though MRI and PET scans, for example, have dramatically improved the ability to study the brain, researchers still do not know what factors increase risk by a particular percentage. Kutcher asked, "How do we know if an increased risk is only defined by the amount of tau in your brain and not other genetics?" Unfortunately, as Kutcher stated, the only way to truly define the issues in the field, is to have subjects followed over time, where doctors can monitor exposure to impact, brain function, tau and other factors in order to draw a more complete picture. Kutcher concluded: "The vast majority of contact athletes over the last 100 years do not have CTE; obviously, other factors are involved than just contact sports."