More than 40 percent of football, soccer, ice hockey, and other contact sport participants under age 30 had signs of the degenerative brain disease, including the first American woman soccer player to be diagnosed
It’s perhaps not especially surprising that after enduring decades of head-thumping collisions on the football field, many NFL veterans spend their retirements grappling with declining brain health. Almost all—92 percent—of ex-NFL players studied have been diagnosed with chronic traumatic encephalopathy (CTE). Worryingly though, a new study from the Boston University CTE Center suggests that it’s not just grizzled old pros who should be concerned about the degenerative brain disease. Researchers found that young, amateur athletes who play some of the most physical contact sports also seem to be at risk, despite their comparatively short, lower-profile playing careers.
After examining the brains of 152 contact sport participants who had died under age 30, they discovered 41.4 percent had signs of CTE. More than 70 percent of those diagnosed were amateur athletes who’d played sports like football, ice hockey, soccer, rugby, and wrestling. The study also included the first American female athlete diagnosed with CTE, a 28-year-old collegiate soccer player whose identity remains private. The results were published in JAMA Neurology.
“It seems to be well accepted now that you can play at a very high level of elite American football or ice hockey and get CTE,” says Ann McKee, director of the BU CTE Center. “But we’re seeing the beginnings of this disease in young people who were primarily playing amateur sports.”
For parents, the latest findings present a dilemma. Sports—whether high-contact like ice hockey or largely collision-free like basketball—are important for kids and young people, keeping them moving and socializing and teaching them a range of life skills. But if the price of playing certain sports is an increased risk of permanent and devastating damage to developing brains, is it worth it?
CTE Starts Early; Head Injuries Can Cause Depression
The researchers began by scrutinizing brain samples for signs of an abnormal buildup of a protein called tau—a signature of CTE—as well as for damage to the white matter and other brain tissue. All of the samples were pulled from the BU-led UNITE Brain Bank, a repository of more than 1,400 brains donated after death for study, which is run in partnership with the US Department of Veterans Affairs and the Concussion Legacy Foundation.
That neuropathologic examination showed that a majority of the athletes with CTE had a mild, early stage of the disease, but a small number—three—had reached the third of its four stages. (Another recent BU CTE Center study also revealed that playing tackle football at a young age was tied to brain decline in later life.) At the moment, CTE can only be diagnosed after death.
The researchers, who conducted detailed interviews with the donors’ relatives, also determined most of the athletes were suffering from clinical symptoms during their short lives, even if they didn’t have CTE. More than 70 percent of them had apathy and a similar number were depressed, while more than half had difficulty controlling their behavior; many also had issues with substance use.
“Those symptoms might be a result of the head injury itself,” says McKee, a BU Chobanian & Avedisian School of Medicine professor of neurology and pathology, a William Fairfield Warren Distinguished Professor, and a chief of neuropathology at the VA Boston Healthcare System. “The study suggests that some of the symptoms these young athletes are experiencing are not caused by the early tau pathology of CTE. The head impacts themselves might cause damage to the white matter and vascular injury, a breach of the blood-brain barrier.”
She and her team concluded that even just a couple of more years on the field made a big difference. Those diagnosed with CTE played, on average, for an additional 3.8 years more than those without it.
The study didn’t include samples from young people who played noncontact sports—the UNITE Brain Bank mainly takes donations from those who’d been concerned about their brain health during life. McKee says the number of CTE cases found in young contact sport players compared to the general public is startling.
“This study clearly shows that the pathology of CTE starts early,” says McKee. “The fact that over 40 percent of young contact and collision sport athletes in the UNITE Brain Bank have CTE is remarkable—considering that studies of community brain banks show that fewer than 1 percent of the general population has CTE.”
This study clearly shows that the pathology of CTE starts early. The fact that over 40 percent of young contact and collision sport athletes in the UNITE Brain Bank have CTE is remarkable—considering that studies of community brain banks show that fewer than 1 percent of the general population has CTE.