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By the time retired Chicago Bears star Dave Duerson took his own life in February of 2011, he’d spent months complaining about headaches, blurred vision, and deteriorating memory. The last line of his suicide note read, “Please, see that my brain is given to the NFL’s brain bank.” He then shot himself in the chest, presumably to keep his brain sufficiently in tact for future study.
A few months later, researchers at Boston University’s Center for the Study of Traumatic Encephalopathy confirmed what Duerson had suspected – that he had the telltale signs of chronic traumatic encephalopathy (CTE), a brain disease that at that point a handful of retired NFL players had also been diagnosed with.
Fast forward four years and while significant off-the-field coverage of pro football revolves around domestic violence, countless studies of deceased and retired NFL players – as well as current and former players of several high contact sports, including soccer and hockey – continue to pile up showing that the continuous hits to the head many athletes take have a serious compound effect. In the week prior to Sunday’s Super Bowl, Seattle Seahawks defensive lineman Michael Bennett was not shy about calling out NFL Commissioner Roger Goodell about the way the league has treated players who have dealt with health issues as the result of CTE and other injuries.
“The consensus is that getting hit in the head over and over again or really hard is bad for your brain, and with new types of tests we find new types of abnormalities that we didn’t know existed,” Chris Nowinski, a former wrestler and cofounder of the Sports Legacy Institute in Boston, told me. “The research is exploding. There’s been more money dedicated to concussion research in the last two or three years than in the history of time. There is a new study every week.”
Because no two concussions are exactly alike, and many neurological effects are difficult to see right after a hit, there’s no one diagnostic tool that catches all concussions – though one eye-tracking technique may catch up to 90 percent. “An immediate, 100 percent accurate concussion test is elusive and will be very, very difficult,” Nowinski said.
Instead, much of the cutting-edge imaging research focuses on finding biomarkers in the brain that reveal abnormalities, and then sorting out what those abnormalities will likely mean functionally for an individual down the road. One key here is being able to do this in vivo, while people are still alive and treatment is still possible, as CTE is currently only diagnosed post mortem. (The National Institutes of Health is funding a big study out of Boston University, DETECT, to do just that.)
“I would argue that there is never going to be a single tool that will be effective across all concussions, because each concussion has a different trajectory based on the risk factors of the individual, the kind of hit taken, etc.,” Dr. Anthony Kontos, a researcher at the University of Pittsburgh’s Sports Medicine Concussion Program, said.
“The field right now from a neuroimaging perspective is driven by a couple things. One is that we want to see if we can match up what we see clinically and functionally with what we see in neuroimaging. And number two is can we do this in a cost-effective, accurate, and potentially portable way.”
While fMRI and PET scans tend to be the go-to imaging tools in concussion research, Kontos and colleagues have been taking a different approach, something called functional near-infrared spectroscopy. Because the technique involves shining light that penetrates 5 to 8 millimeters into the cortical area of the brain to look at blood flow, it’s noninvasive, less expensive than big scanners like MRI, and portable.
“What we found is the concussed folks will be essentially less efficient,” Kontos said. “They were worse on the performance of the cognitive tests, with slower reaction times and processing speeds, worse on memory recall, and in addition their brain activation wasn’t the same as controls. Those individuals who were concussed weren’t activating the same parts of the brain in the same way.”
The findings sit atop a huge heap of results reaching similar conclusions. In the past year alone, researchers have reported on:
- Translocator protein “hotspots” seen using PET and MRI
- Neuroinflammation and brain atrophy in former NFL players
- One type of functional connectivity as a potential biomarker
- Reduced working memory accuracy in youth who play tackle football
- Impaired cerebrovascular reactivity as a potential biomarker
- Using diffusion tensor imaging to assess white matter fiber tracts
- Hippocampal volume and surrounding white matter pathways corresponding to cognitive deficits
The damage already done
Beyond imaging advances and neurological discoveries, researchers are finding signs of CTE in many former athletes. In one recent study, 76 of 79 deceased NFL players had the brain disease, according to Frontline’s Concussion Watch. Meanwhile, significant cognitive deficits are being found in still living retired NFL players, who may or may not benefit from a class-action lawsuit that would offer medical exams for retired NFL players, monetary awards when certain brain diseases are diagnosed, and greater education around safety.
Given football is not the only high-contact sport where former athletes have been found to have CTE (think wrestling, hockey, and soccer), I asked Nowinski whether he thought the sport is being unfairly singled out.
“Football is not getting a bad rap – it’s getting a well-deserved rap,” he said. “It’s the only sport that encourages hitting kids in the head before 10 years old on purpose. And in the US you’ve got 1 in 8 boys playing, so it’s a huge issue and it’s facing an existential crisis because the world has moved past football in the sense that we all agree it’s a bad idea to hit kids on the head on purpose.”
From a practical standpoint, many contact sport governing bodies – at all levels of play – are being forced to grapple with the question of when to take someone who’s been hit in the head out and when to let that person back in again. “Return to play will be partially controlled by how much we feel people can lose before people feel comfortable,” Nowinski said.
While he plans to watch the Super Bowl, Nowinski clarifies that it’s mainly for research: “I’m OK with grown men playing a risky game as a job if they’re compensated appropriately and have a full understanding of the risks. I’m never going to tell a fireman he can’t go into a burning building. So I can enjoy watching it, but I don’t enjoy watching a bad sideline test and a guy getting put back in, and I don’t like the fact that to get there these guys all played as children for 10 years for free.”
“I think we do a lot better job of that today than we did 5 or 10 years ago,” added Kontos, who has played soccer his whole life and loves to watch pretty much all sports, including football’s main event. “But there’s always room for improvement.”