Whether you’re a football fan or not, there’s a good chance that you’ve heard rumblings about lawsuits directed towards the NFL, concussions, and something called CTE. So what exactly is CTE and what’s all the controversy about? CTE is the abbreviation for a neurological condition called Chronic Traumatic Encephalopathy. Despite what you might think, CTE is not a “new” disease. It has been described in one form or another for nearly 100 years now, albeit usually in reference to boxers whose head injuries are perhaps more obvious and dramatic. The symptoms of CTE can vary considerably based on a number of factors. However, it is thought that the driving force behind the development of this disease stems from the accumulation of damage resulting from repeated blows to the head.
Studies indicate that over time, and due to these repeated head injuries, inflammation and bruising take place in the brain that causes a common protein called tau to become defective. This defective protein subsequently triggers the neurons in an affected brain to misfire and the surrounding tissue to atrophy. The result looks similar to what one might expect in the brain of an individual who has Parkinson’s or even Alzheimer’s disease- Diseases that are typically associated with old age. The fact that this type of brain damage is being discovered in much younger individuals, and to an extent that it appears to develop in a relatively short period of time, is one of the aspects of CTE that has surprised and concerned so many scientists. Common sense tells us that repeated blows to the head simply can’t be healthy for your brain. But how many blows? And how hard do the blows have to be before you should worry about CTE?
There are many questions about CTE that remain unanswered. Right now, CTE can only be definitively confirmed via autopsy. That’s because there are too many symptom presentations possible in order to identify a process that can be strictly attributed to CTE while someone is still living. Here’s an example of what I mean. If your doctor were to evaluate a person with suspected Alzheimer’s disease, (s)he would expect to see signs of memory loss, difficulty with complicated tasks such as balancing a checkbook, and atrophy in certain areas of the brain on an MRI scan. In regards to CTE, however, the location of the head injuries could not only be anywhere, but relatively mild injuries are unlikely to cause any overt structural damage to the brain. While one person might demonstrate memory loss, another person could have problems with attention, and yet a third person could display mood swings and impulsivity. In other words, there isn’t a clear x, y, and z currently available to indicate a specific diagnosis. That being said, ongoing research studies are aiming to solve this conundrum by utilizing state-of-the-art neuroimaging techniques to identify abnormal tau protein deposits in the living.
Now let’s get back to football. Some of the controversy regarding concussions and football, specifically, is related to pre-existing factors and other variables that could prevent a doctor from forming a clear-cut diagnosis. Let me explain. I want you to try and remember a few characteristics of the stereotypical football player from your high school. Did he appear to be more physically developed than the other boys in your class? Was he more likely to take risks and less likely to shy away from challenges? While these characteristics certainly aren’t true of every football player, these are the types of variables that must be addressed as well. How much of the disease process is directly related to head injuries? Or could the disease process potentially be induced by a combinationof factors including repetitive head injuries, high testosterone levels, a genetic predisposition to dementia, underlying mental health conditions, etc.?
So... should you let your son play football??? Better yet, should you allow your daughter to play soccer? After all, research suggests that female soccer players suffer concussions at a higher rate than do football players! The truth of the matter is that any sport or activity that places a person at higher risk of repeated injury is subject to the possibility of future brain dysfunction. Since you will probably agree that banning all contact sports is not a great solution, it seems that other changes such as behavior modification, the strict enforcement of rules and regulations, and the use of high-quality safety equipment must be implemented. It appears that professional sports organizations, university athletics teams, and even peewee coaches are attempting to do just that. In the meantime, health education and risk management are key.
Stay tuned for my upcoming blog posts about Sports-Related Head Injuries when I will discuss the signs, symptoms, and treatments for Concussions and Sub-Concussive hits.