“Look football is great but I ain’t dying for this s―t. Lol”
That’s a tweet by the National Football League’s (NFL) Marcellus Bennett, the Green Bay Packers tight end. He was reacting to comments made the day after an NFL press conference held in July, in which New York Jets rookie Jamal Adams claimed he loves the game so much that if he had “a perfect place to die” it would be on the football field.
Thus, an already controversial topic, chronic traumatic encephalopathy (CTE) among professional football players, became even more contentious.
CTE is a condition characterized by brain degeneration and is associated with repeated head trauma. (Encephalopathy is a general term meaning disorder or disease of the brain.) It has led to behavioral and health problems, as well as death, among a number of players in the NFL. Subsequent lawsuits by players have resulted in what are expected to be millions of dollars in payouts by the NFL.
The current controversy began with the release of findings from a new study on the topic. A two-page spread in the front section of The New York Times only emphasized the drama. It featured a headshot of each deceased NFL player diagnosed with CTE and images of their brains following an autopsy.
The study was originally published on Tuesday, July 25 in The Journal of the American Medical Association. It found that among 202 deceased former football players, whose median age at death was 66 years old, CTE was diagnosed in 177. Most publicized was the deaths of those who were NFL players; it was determined that 110 of 111 of those players, or 99 percent, had various levels of CTE. It should be noted that the NFL players’ brains that were studied were not randomly selected. They were donated by families of those players who probably suffered from symptoms, indicating researchers were more likely to discover they had CTE.
The study was conducted by Dr. Ann McKee, a neurobiologist at the Boston University’s Chronic Traumatic Encephalopathy (CTE) Center. McKee has previously admitted there’s no way to truly know the prevalence of CTE without a means of testing living players. At this stage, determining CTE can only be done posthumously.
Media and public perception sometimes fail to give significant attention to the limits of these studies. This study duplicates others that have been done by McKee and her team of researchers at Boston University. They state in this paper, “Estimates of prevalence cannot be concluded or implied from this sample.” Therefore, despite what the public might conclude about the widespread nature of CTE, the study does not determine the number of players in the general NFL population who likely have the disease.
In addition, CTE is prevalent in more than just the NFL. In addition to football players, others with evidence of CTE include hockey players, soccer players and soldiers or others exposed to bombings. And even among athletes, CTE is not limited to professionals. It has been found in those who played college and even high school football.
What is CTE?
In addition to being controversial, CTE is a complex topic. It’s no wonder, considering the key functionality and remarkably intricate structure of the brain.
CTE, a progressive degenerative brain disease, is often found in athletes with a history of repetitive brain trauma. That trauma can be both symptomatic concussions, as well as subconcussive (asymptomatic) hits to the head. CTE was first recognized in boxers as far back as the 1920s and termed dementia pugilistica. From that derived the term punch drunk.
A feature of CTE is that it is triggered by the build-up of tau, naturally-occurring proteins that have become defective, and can be seen as tangles or bundles. This tau build-up leads to brain cell death, a similar phenomenon to Alzheimer’s disease. Uncommonly, but still a feature of CTE, are deposits of beta-amyloid, also a protein and characteristic of Alzheimer’s.
Thus, there is evidence of a link between moderate and severe traumatic brain injuries to a higher risk of developing other brain conditions, such as Alzheimer’s disease.
Symptoms of CTE include:
Aggression
Confusion
Depression or apathy
Impulse control issues
Memory loss
Movement problems (e.g., tremors and stiffness)
Personality changes
Progressive dementia
Substance abuse
Suicidal tendencies
The Prognosis
Despite increasing evidence clearly linking CTE to head trauma, there is much unknown about the disease. One thing is certain though: there is currently no cure for it.
While CTE is most likely to develop following numerous traumatic brain injuries (even without loss of consciousness), and/or a smaller number of severe traumatic brain injuries, there is no evidence that one concussion increases the risk of developing CTE. And even among those with a history of multiple concussions, not every one of them will eventually develop CTE.
It appears that regardless of the current findings and the questions surrounding CTE, some NFL players are not waiting to find out what could be in their future. According to NFL reporter Adam Schefter of ESPN, 14 players age 30 or younger have already retired from the NFL during the 2017 preseason. Twenty players retired at the same age during the 2016 season. Increasingly, the stated reason for “hanging up the helmet” is the fear of CTE.
