Tag Archives: Sport

Diagnosing CTE in Living Patients

Earlier this year our News Blog included a study looking at the brains of former American footballers, which found chronic traumatic encephalopathy (CTE) was present in 110 of 111 footballers who had played in the National Football League (NFL).[1] [2] However, this can only be seen during autopsy, and, at present, we are only able to make a presumptive diagnosis of CTE while the patient is alive. Now a study published in Neurosurgery [3] has found that it may be possible to diagnose CTE in living patients. PET imaging was conducted on the brain of a footballer 52 months prior to this death, and after autopsy, it was found that data from the PET scan (showing the level of binding of a molecular imaging probe) correlated significantly with deposition of tau proteins in the brain (P=0.02). Although this is only a single patient, further investigation is warranted, which could confirm whether PET scanning is a useful diagnostic tool in patients at high-risk of CTE – not only American footballers, but also military personnel.

— Peter Chilton, Research Fellow

References:

  1. Lilford RJ. Two Hundred and Two Ex-(American) Footballers’ Brains Analysed After Death – This You Must Read. NIHR CLAHRC West Midlands News Blog. 15 September 2017.
  2. Mez J, Daneshvar DH, Kiernan PT, et al. Clinopathological Evaluation of Chronic Traumatic Encephalopathy in Players of American Football. JAMA. 2017; 318(4): 360-70.
  3. Omalu B, Small GW, Bailes J, et al. Postmortem Autopsy-Confirmation of Antemortem [F-18]FDDNP-PET Scans in a Football Player With Chronic Traumatic Encephalopathy. 2017.
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Another Study on the Hazards of American Football

Head impacts seem to be a common occurrence in American Football, with studies of youth players suggesting they experience around 240-252 impacts per season.[1] [2] In the previous News Blog we looked at research on brain injury in ex-American Football players, which found widespread chronic traumatic encephalopathy.[3] Now a cross-sectional study by Alosco, et al. has looked at the impact playing from an early age has on behaviour, mood and cognition.[4] The authors assessed 214 former amateur and professional football players (who hadn’t played any other contact sport) on a number of psychiatric tests. Multivariate regression analysis showed that those who had begun playing before the age of 12 had at least twice the risk of significant impairments in behavioural regulation, apathy and executive function, and three times the risk for clinically elevated depression, compared with those who were began playing when they were 12 or older. These effects were not linked to age, education or even how long the individual played football for. There were also no differences in the level of play, i.e. those who played professional fared similar to those who only played at high school-level. The authors hypothesise that 12 years old is a critical time for key neurodevelopmental milestones that occur within the hippocampus and amygdala (where clinical functions such as emotion regulation and behaviour are modulated).

— Peter Chilton, Research Fellow

References:

  1. Munce TA, Dorman JC, Thompson PA, Valentine VD, Bergeron MF. Head impact exposure and neurologic function of youth football players. Med Sci Sports Exerc. 2015; 47: 1567–76.
  2. Cobb BR, Urban JE, Davenport EM, Rowson S, Duma SM, Maldjian JA et al. Head impact exposure in youth football: elementary school ages 9-12 years and the effect of practice structure. Ann Biomed Eng. 2013; 41: 246373.
  3. Lilford RJ. Two Hundred and Two Ex-(American) Footballers’ Brains Analysed After Death – This You Must Read. NIHR CLAHRC West Midlands News Blog. 15 September 2017.
  4. Alosco ML, Kasimis AB, Stamm JM, et al. Age of first exposure to American football and long-term neuropsychiatric and cognitive outcomes. Transl Psychiatry. 2017; 7: e1236.

Two Hundred and Two Ex-(American) Footballers’ Brains Analysed After Death – This You Must Read

Who would have thought that American football could be so damaging to the brain? Boxing yes. Here force is targeted at the container for the brain. However, it turns out that other contact sports may also damage the brain according to a recent study of 202 ex-footballers who donated their brains before death.[1] The clinical condition of the patients was recorded and correlated with histopathological finding. The mean age at death is rather young at 66. Hold on to your seat and read on to learn that fully 87% of football players’ brains fulfilled the histopathological criteria for chronic traumatic encephalopathy (a progressive neurodegenerative disorder associated with repetitive head trauma). In fact it was present in 110 of the subsample of 111 footballers who were lucky (unlucky) enough to make the National Football League (NFL). Further, 86% of these NFL players had severe pathology. Yes, brains may be more willingly donated when cognitive deterioration is present than when it is not, leading to inclusion bias. A prospective study is needed. But should we wait the 20-40 years needed for the results? Even if this study has overestimated the effect, the bias could not create so large an association if there were none. Would you encourage your grandchildren to play? If your heart packs up, your lungs fail or your pancreas turns cancerous, you die as yourself. But if your cerebral cortex is damaged you live as someone else.

— Richard Lilford, CLAHRC WM Director

Reference:

  1. Mez J, Daneshvar DH, Kiernan PT, et al. Clinopathological Evaluation of Chronic Traumatic Encephalopathy in Players of American Football. JAMA. 2017; 318(4): 360-70.