A JAMA study examined 202 deceased football players and found CTE in 110 of 111 former NFL players. Severe cases appeared progressive and more common in older players, with an average career length of 15 years. The findings raise questions about football's safety and whether youth and professional policies need to change.
202
Approximately 15 years
110
Well, sometimes you just pick up something and it just changes your life immediately. And I have to admit my caveat is I'm a football fan and in fact I played high school football. But this news today that just appeared in the Journal of the American Medical association is totally sobering and I think causes all deep reflection on this whole thing of CTE which is described in this JAMA paper today that evaluates chronic traumatic encephalopathy in football players is pretty much strong, strong evidence that this sport has some serious problems. And as you probably recall, we had this movie with Will Smith, Concussion that really talked about Dr. Bennett Omalu, a neuropathologist who was the first to kind of bring this concept of CTE to the fore and was criticized and ran into all sorts of problems. I don't need to review the movie, but you know the story. And then the question was could we really do the proper kind of science to demonstrate that CTE was a real clinical condition associated with the playing of a sport, football. This paper entitled Clinical Pathological Evaluations of the Chronic Traumatic Encephalothe and Players of American Football in which it analyzed the neuroanatomy and biochemistry of 202 deceased former football players, starting with some in high school, college, semi pro and pro. It's pretty airtight, I believe. And there are some important takeaways from this. I think for all of us. The first thing we can say is the prevalence of the appearance of CTE of, of what are called grade three and four, which are the really clinically most severe forms, was truly unbelievable. And the neuroanatomy of the brain pathologies as described in the article and as seen in this recent paper, that just article that just appeared in the New York Times is again it's position specific. They go through the different positions in football and talk about the individuals whose brains were donated after their death for this analysis. And the percentage of individuals that have grade 3 and 4 CTE with all sorts of signs anatomical of brain damage and then looking at things like alpha syneclin and phosphorylated tau protein and the things that we use clinically to assess neuropathology in Alzheimer's is, and the recognition that this was a progressive condition, that the stage three and four were seen most likely and often in those individuals of mean average age of 70, whereas the lower grade CTE was seen in individuals of younger age, meaning it is undoubtedly progressive because the mean duration of playing football in this group was what was it specifically? It was 15 years of football, on average, that they had played out of their whole life. So this progression of pathology that occurs by the initiation or triggering of this cascade of events that leads to ultimate recognition of the neuropathology and the neuroanatomical changes is quite irrefutable. They also suggest that the duration of injury, and you cannot directly interrelate the injury as it relates to concussion injury versus non concussion injury. With the progression of this condition, it raises some very interesting questions. Are there certain genotypes that might be more sensitive to concussion injury or to the CTE than others? We will have to look at all sorts of other types of data going forward because as you know, this was kind of a self selected volunteer of the individuals donating their brains when they were deceased for this evaluation. So the question could be, you know, are these people that had more inclination to believe that they had been injured? And so you have a weighting towards greater injury. But I think that certainly the data is strong enough that it really brings to our recognition that our environment, in this case the traumatic environment of a head injury, plays a very important role in sequencing for a cascade of events that ultimately leads to neurodegeneration. So how this ultimately plays its way through the regulations of the sport of football and into things as it pertains to children, both boys and girls, playing this sport and other concussive injury related sports, I think remains to be seen. But this certainly is a very, very powerful wake up call when you have 202 deceased individuals who have donated their brains for evaluation, who all have signs and symptoms of CTE. In fact, 110 of the 111 national football players were demonstrated to have very demonstrable grading of cte. So stay tuned. But certainly this is a new day that opens up all sorts of new explanations and understanding of neurodegeneration and its relationship to motion gravity related injuries, what we call traumatic concussive injuries.
