Devasting Effects of Chronic Traumatic Encephalopathy
As the numbers of current and former National Football League (NFL) players commit violent acts on others and/or take their own lives continues to rise, we just received word that 43-year-old Junior Seau, a 20-year veteran of the NFL had chronic traumatic encephalopathy (CTE). Seau's family donated his brain to the National Institutes of Health (NIH) after he took his own life in May of 2012. Seau's brain was examined by five different experts, who at first didn't think his brain looked suspicious, but after closer examination detected CTE.
This past December, yet another NFL player committed two acts of violence - killed his girlfriend who was the mother of his daughter and then turned the gun on himself. After a night of reported drinking, Kansas City Chiefs linebacker Jovan Belcher, who was 25- years-old, argued with his girlfriend, shot her multiple times, then drove to the team's field house and took his own life in front of head coach Romeo Crennel and general manager Scott Pioli. The autopsy results were just released stating his blood alcohol level was .17, well over the Missouri legal limit of .08. Reports have been circulating Belcher was partying in downtown Kansas City the night before, and police discovered him sleeping in his car with the engine running outside an apartment building. The officers suggested he get some rest, so he knocked on an apartment door of two women who let him "sleep it off" for a few hours. Was his recent behavior excessive or different in any way? Was he acting aggressively before he began drinking? Did Belcher show any symptoms of CTE? In addition to Seau, we know NFL players Dave Duerson and Cookie Gilchrist had CTE, as did National Hockey League (NHL) player Derek Boogaard.
CTE is a progressive degenerative disease which can be found in athletes and non-athletes alike who experience repeated blows to the head or receive traumatic brain injury (TBI). It's believed continued TBI's may set off advancing decline of brain tissue, which may include the accumulation of the abnormal protein tau. These differences may begin within months, years or even decades of repeated trauma . CTE is only diagnosed at autopsy and has been found in almost all of the former football players whose brains have been donated for research. However, it's not just football players who are affected by repeated TBI's and possible CTE, but boxers and hockey players as well as servicemen and women who have suffered blast trauma and other head injuries.
A study was recently released in the scientific journal, Brain, indicating there may be more evidence between repeated head trauma and CTE. The study examined 85 brains of people who had a record of repeated TBI's and 18 brains from people who had no history of TBI and were cognitively fine. Researchers discovered 80% of subjects who had a history of repeated TBI had CTE. In addition to the 'healthy' brains, the subjects ages ranged anywhere from 17-years-old to 98-years-old, of which 64 were athletes, 21 military serviceman and one was a person who self injured themselves by head banging. The brains included professional NFL and Canadian football players, college and high school football players, NHL players, professional boxers and wrestlers, in addition to amateur hockey and football players. Military personnel included marines and navy servicemen who served in wars that included: WWII, the Vietnam War, the Iraq War, the Afghan and Gulf War.
CTE is thought to have four stages with various symptoms. The only way to know if CTE symptoms existed is to have conversations with family members and friends seeing as CTE cannot be diagnosed until after death. In the study mentioned above, the subject's brains were examined and separated by stage. Seven brains were reported to have had symptoms of stage I which included headaches, difficulty concentrating, short term memory issues and a tendency to be more aggressive and two were diagnosed with post-traumatic stress disorder. In stage II, 11 of the 14 brains with CTE showed symptoms such as mood swings, depression, headache and short term memory problems along with explosivity. The brains of 12 subjects in stage III had symptoms including problems with executive function (our ability to plan and organize), memory loss, explosivity, issues with attention and concentration, depression, headache, aggression, apathy and suicidal thoughts. The 15 brains that fell into stage IV had problems with memory loss and trouble with executive function which proceeded to major memory loss with dementia. Many had overpowering problems with concentration and attention, aggressiveness, paranoia, depression, trouble walking, and 31 % had at some point, been suicidal.
This study is one that can help lay the foundation for future studies hopefully studies that will help show a way to determine who will develop CTE. To do this, researchers would need to examine the brains of players who showed no symptoms or do not develop CTE and family members seem less apt to donate these brains to research. Even though the study seems to indicate that repeated blows to the head leads to CTE, to truly prove this, researchers will have to figure out why some people get CTE and others do not when the same tasks are completed. In order to do this CTE would have to be recognized in patients who are alive with diagnostic criteria and/or tools. But at this point, it would seem that the few TBI's sustained the better, or at least making sure one is properly healed before getting back into the game.
Belson, K. "Study Bolsters Link Between Routine Hits and Brain Disease." NYTimes. December 3, 2012. http://www.nytimes.com/2012/12/03/sports/study-bolsters-link-between-routine-hits-to-head-and-long-term-brain-disease.html
Belson, K.;Pilson, Mary. "Seau Suffered From Brain Disease." NYTimes. January 10, 2013. www.nytimes.com/2013/01/11/sports/football/junior-seau-suffered-from-brain-disease.html
George, Rachel**. "** Jovan Belcher's blood alcohol content was twice legal limit**."** USA Today. January 14, 2013**. **http://www.usatoday.com/story/sports/nfl/2013/01/14/jovan-belcher-autopsy-kasandra-perkins-kansas-city-chiefs/1833251/
McKee, A.; Stein, T.; Nowinski, C.; Stern, R.; Daneshvar, D.; Alvarex, V.; Lee, H.; Hall, G.; Wojtowicz,; Baugh,C.; Riley, D.; Kubilus, C.; Cormier, K.; Jacobs, M.; Martin, B.; Abraham, C.; Ikezu, T.;Reichard, R.; Wolozin, B.; Budson,A.; Goldstein, L.; Kowall, N.; Cantu, R. "The spectrum of disease in chronic traumatic encephalopathy." Brain. First published online: December 2, 2012.. doi: 10.1093/brain/aws307.
Photo: National Institutes of Health.
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