By: Jack Hussey
American football has reigned supreme in the U.S. sports market for decades, bringing in billions of dollars of annual revenue at the professional, college, and even high school levels. While many love the sport and make it a large part of their daily lives, many are skeptical of its borderline violent nature and avoid the sport because of this. This sentiment was further compounded by a 2005 study that revealed the presence of chronic traumatic encephalopathy (CTE) in the brain of a retired NFL player who had recently passed (Omalu et al. 2005). Since the original study was published, media coverage and general apprehension over the dangers of concussions in contact sports, especially football, has increased greatly. These factors have pushed even more resources and researchers toward the study of CTE and the effects it has on contact athletes in the long term. In 2008, researchers from a group of American institutions created a brain bank to study the effects of consistent head trauma on former football players. A study conducted by the American Medical Association aimed to find both the neurological and clinical features of CTE in deceased former football players (Mez et al. 2017). Their research would provide more clarity on the varying degrees of CTE’s effects and how it may have led to the deaths of those afflicted.
Researchers conducted both a clinical and neurological evaluation of the 202 brain donors, with the clinical evaluation being conducted by a behavioral neurologist, neuroscientist, or neuropsychologist who obtained a history of cognitive, behavioral, mood, and motor symptoms. The researcher conducted comprehensive interviews with a family member of the deceased player to learn more about their specific symptoms and afflictions. The neurological evaluations used selected samples of proteins and tissues found in the brain to make the diagnosis, the criteria for which was determined by a panel of neuropathologists at a conference in 2015 (McKee et al. 2016). The diagnoses had been previously classified into four stages, with stages I and II being considered mild and stages III and IV being considered severe (McKee et al. 2013).
Among the 202 brain donors, 177 (87%) of them were neuropathologically diagnosed to have some form of CTE, with 22% of the donors having a mild form of the disorder and 66% having a severe form of the disease. Those who were diagnosed with a mild form of the disorder had a lower median age of death of 44, while those with more severe cases had a median age of death of 71. The patients with mild cases were more likely to pass from things like suicide or an accidental overdose, with suicide notably being the cause of death for over a quarter of patients with a stage I/II diagnosis. Conversely, almost 50% of the athletes with severe cases of CTE passed from a neurodegenerative condition, which is defined as a dementia-related or parkinsonian-related cause of death. The data on age and cause of death implies a relationship between mild cases of CTE and short-term mental health issues, which would explain the increase in suicides and overdoses compared to severe cases. The same could be said for the relationship between severe cases and long-term neurological issues, as the age of death is much later and the causes of death are more long-term issues (Mez et al. 2017). Severe cases seem to eat away at the patient’s brain as their life progresses, while mild cases can cause severe mental strife in the short term and lead to earlier deaths for those afflicted (Mez et al. 2017).
There was also a correlation between the duration that the athletes played football for and the severity of their conditions. Patients who were diagnosed with a severe case of CTE played football for three more years on average than the patients with mild cases. Almost 50% of patients with mild cases didn’t play football past the college level, while 80% of patients with severe cases played some form of professional football after college, which implies that the severity of a case of CTE is connected to the amount of time that the patient played football for (Mez et al. 2017).
The study design seems very well thought out and there aren’t any major blind spots in their research and tests. The study cites previous discoveries and experiments well and takes their findings into account, such as using the new criteria for diagnosis that were finalized two years prior. The article also includes a section for conflict-of-interest disclosures for the experts involved as well as a disclaimer that the funders of the study were not involved in its design or execution, ensuring that the study had no corporate or political motives behind it. There isn’t much else that can be added to a study like this, but improving medical technologies could improve the brain imaging and reveal more about the disease and how it manifests physically. The data set will continue to grow in the future as the brain bank grows and medical technology improves.
The information that the AMA study brings to the table puts the sport of football, and especially the NFL, in a very precarious situation. A poll by the Barrow Neurological Institute in Arizona showed that Arizona parents’ willingness to let their children play football decreased by around 20% from 2016 to 2020, echoing the growing anti-football sentiment stemming from more accurate research on concussions and conditions like CTE (Barrow Media Relations 2021). This causes the talent pool to thin and creates a larger long-term problem for the NCAA and the NFL. While the NFL’s revenue has constantly increased since the discovery of CTE and further research into the disorder, they have had to use more resources because of it. The league has strengthened medical protocols for on-field concussions and pledged over $100 million in support of education and independent research into CTE and other trauma-induced disorders (NFL 2017). They have also done an overhaul to the concussion protocol to be sure that players have fully recovered before they return to the field.
References
Barrow Media Relations. 2021. Concussion poll: AZ parents see football as riskier than contact sports. https://www.barrowneuro.org/about/news-and-articles/press-releases/concussion-poll-az-parents-see-football-as-riskier-than-contact-sports/#
McKee AC, Cairns NJ, Dickson DW, et al. 2016. The first NINDS/NIBIB consensus meeting to define neuropathological criteria for the diagnosis of chronic traumatic encephalopathy. Acta Neuropathol. https://pubmed.ncbi.nlm.nih.gov/23208308/
McKee AC, Stern RA, Nowinski CJ, et al. 2013. The spectrum of disease in chronic traumatic encephalopathy. Brain. https://pubmed.ncbi.nlm.nih.gov/26667418/
Mez J, Daneshvar DH, Kiernan PT, et al. 2017. Clinicopathological evaluation of chronic traumatic encephalopathy in players of american football. JAMA. https://www.proquest.com/docview/1923746784/A4B410B024354E2BPQ/1?accountid=14244&parentSessionId=c0RM5kiUGixjZdlyvPMMYIdW3LVG1%2BhoVos49RHB69E%3D
NFL issues response to CTE research report. 2017. NFL. https://www.nfl.com/news/nfl-issues-response-to-cte-research-report-0ap3000000822159
Omalu BI, De Kosky ST, Minster RL, Kamboh MI, Hamilton RL, Wecht CH. 2005. Chronic traumatic encephalopathy in a National Football League player. Neurosurgery. https://pubmed.ncbi.nlm.nih.gov/15987548/
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