Wednesday, January 28, 2009

Traumatic Brain Injury and Football

Almost exactly two years ago, I posted a sports rant focusing on the effects of repeated concussions on football players. Here it is Superbowl time again, and another story has surfaced on the topic. (Also see here.) I assume these stories are released at Superbowl time to get more play.

The study of the brains of former NFL players is being conducted by the Center for the Study of Traumatic Encephalopathy at Boston University School of Medicine. Credits are as follows. I added the parenthetical clarification of the acronyms:
CSTE (Center for the Study of Traumatic Encephalopathy) is a collaboration between SLI (Sports Legacy Institute) and USM (Boston University School of Medicine). SLI was founded by former Harvard football player and WWE pro wrestler Chris Nowinski, and neurosurgeon and concussion expert Robert Cantu, MD, chief of Neurosurgery and director of Sports Medicine at Emerson Hospital in Concord, Mass, and clinical professor Neurosurgery at BUSM. The work at BUSM is being led by McKee, an associate professor of Neurology and Pathology, director of the Neuropathology Core of the BU Alzheimer's
Disease Center, and the director of the brain banks of the Framingham Heart Study and the Bedford VA Medical Center, and Robert Stern, PhD, associate professor of Neurology and co-director of the BUSM Alzheimer's Disease Clinical and Research Program. The CSTE received initial funding for their research from BUSM and subsequently received a $100,000 grant from the National Institute on Aging to support their work. This past week, the group of researchers learned that they received a $250,000 grant from the National Operating Committee on Standards for Athletic Equipment (NOCSAE).
According to the story, players have been asked to donate their brains for study under the "88 Plan," named for John Mackey who wore jersey 88 for the Colts and now has severe dementia. So far, 7 NFL players have been evaluated, an 6 have been diagnosed with chronic traumatic encephalopathy. Trauma refers to damage. Encephalopathy refers to brain pathology. Hence, traumatic encephalopathy is a technical term for brain damage caused by head injury.

One can diagnose encephalopathy through brain imaging, psychological tests, and by clinical signs and symptoms. However, in this case, the diagnosis was made the most reliable way, by autopsy, so there is no mistaking the severity of the problem. Interestingly, the players' brains had some similarities to Alzheimer's patients. Most of the players showed signs of memory loss, impaired thinking, depression, and impulsive behavior. They also may have abused substances. Two died of suicide and a third died of a self-inflicted gunshot wound ruled accidental.

This is pretty scary data, but I want to add two cautions to interpreting the data. First, these are people who have died early, between 25 and 50, so they had severe and repeated injuries. If we examined players who lived a full life, we would certainly see a different picture. This is why the authors have carefully avoided claiming that most NFL athletes have brain injury.

Second, the players with traumatic encephalopathy played at a time when concussions weren't taken seriously. The NFL has developed procedures for managing concussions and when to allow a concussed athlete back onto the field. The NCAA has supported studies of concussions. The American Academy of Family Physicians has a nice summary of how to manage concussions in high school athletes. As mentioned above, the quality of the equipment is also being evaluated. So, now that concussions are being taken more seriously, the pervasiveness of traumatic encephalopathy should be declining. But we don't know that for sure.

As someone who spends most of his time in his head and others', I question why we accept this risk at all. Remember the old commercial, "A mind is a terrible thing to waste"? When a child or a young adult athlete is concussed, the rest of their life is at risk. And for what?


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