• Concussions and Dementia

    CTE — Chronic Traumatic Encephalophathy

    I have a confession to make. I know very little about the game of football. In fact, I know very little about hockey or wrestling, or any other contact sports for that matter. I have started to pay attention when at the beginning of the 2009 football season additional attention was being brought to the issue of football–related head injuries, both in the media and by the public. The New York Times ran 18 separate articles on the subject during the month of October alone. Many in–depth stories were run in high profiles media outlets, including the New Yorker, and an episode of 60 Minutes. Public interest increased as well.

    Why am I paying attention? Simply because what I do know about, and what I have studied for over two decades is Alzheimer’s disease and related dementia. And the contact sports aforementioned are being discussed in connection with the individuals having a very high probability of acquiring Chronic Traumatic Encephalopathy.

    When the autopsy of Owen Thomas, a co–captain of the University of Pennsylvania football team who committed suicide last April, it set off a national media firestorm. His autopsy revealed the same brain disease found in a number of deceased N.F.L. players, moving the issue of head injury in football from the professional ranks to an urgent concern facing both amateur and professional athletes, and their families, across the nation.

    The disease gaining national attention is chronic traumatic encephalopathy (CTE), a neurodegenerative disorder that, according to the National Institutes of Health, is linked to repetitive trauma to the brain, such as concussions, over a long period of time. CTE involves a key brain protein called tau that eventually kills brain cells and is involved in other neurodegenerative diseases, including Alzheimer’s disease and frontotemporal dementia. CTE, although its own distinct condition, shares some of the same key features with these other types of diseases. It is a form of dementia with mainly neurobehavioral symptoms such as poor decision making, impaired memory, erratic behavior, use of drugs and alcohol, depression and suicide.

    CTE is not a new disorder; it had been known since the 1920’s as dementia pugilistica, which is Latin for fighter, because it was thought to be isolated to boxers. Since, scientists have identified it in the brains of players of other contact sports, including football.

    Eleanor Perfetto’s worker’s compensation claim on behalf of her husband, Ralph Wenzel, asserted that his early–onset dementia was an occupational hazard of his seven seasons as a lineman in the N.F.L. Having heard league officials say for years that high rates of dementia in former players either did not exist or could not be ascribed to football, Perfetto, who has a Ph.D. in public health, said she wanted to end all doubt in the courts.

    A study commissioned by the National Football League reports that Alzheimer’s disease or similar memory–related diseases appear to have been diagnosed in the league’s former players vastly more often than in the national population – including a rate of 19 times the normal rate for men ages 30 through 49. The N.F.L. has long denied the existence of reliable data about cognitive decline among its players. These numbers would become the league’s first public affirmation of any connection, though the league pointed to limitations of this study.

    So even though nobody believes for one second, today, that football in America could be in any kind of jeopardy, we have to wonder what could happen in 10 years when parents have an additional decade of research detailing the effects of cognitive issues confronting another generation of former football players. If a sportswriter and former NFL player steer their sons clear of organized football, what might that say long–range about the game’s viability? What happens in 20, 25 years when the research on brain injuries at the youth football level piles so high parents simply can’t ignore it?

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