There’s been growing concern about the dangers of chronic traumatic encephalopathy, or CTE, among pro athletes who participate in contact sports. A new study in the Journal of the American Medical Association raises questions about the extent of the problem among amateur athletes.
Researchers have found CTE, a degenerative disease linked to repeated blows to the head, in brain donations from former youth, high school and college athletes who died before age 30, according to a new study published in the JAMA.
The study examined the brains of 152 donors who played a variety of contact sports, including wrestling, soccer and football. All donors exhibited clinical symptoms during their lives, such as depression or behavioral and mood disorders. Most were white, male football players. Suicide was the most common cause of death, followed by unintentional overdose.
Though the study found 41% of donors had CTE, Dr. Christopher Bailey, director of University Hospitals' Sports Medicine Concussion Center, cautioned that "brain bank" studies like this focus on a very specific population sample — in this case, those who suffered behavioral impairments. These types of studies, he explained, don't tell doctors how to look for signs of CTE in living patients who aren't experiencing cognitive impairments.
"I think that some of the findings that are associated with this study that are not highlighted by the authors, in some ways, they're actually more interesting findings," Bailey said.
Though all of the study's donors were symptomatic of behavioral and mood disorders, less than half had CTE, Bailey noted. Nearly all of those athletes with CTE had stages I or II, which is considered mild on a four-stage scale.
“The symptoms that we're talking about, things like depression or behavioral problems or suicidality, could not distinguish those who had CTE and those who did not," Bailey said. "It really kind of comes back to that idea that we really don't know what this problem looks like in the living."
A recent systematic literature review of some of the same clinical symptoms, such as depression or behavioral problems found amateur athletes showed no increased risk for those behavioral impairments, Bailey noted.
Since CTE cannot be diagnosed in the living, doctors cannot track how often it occurs. This should spur doctors and researchers to rise to the challenge of learning more, Bailey said. Medicine has made significant strides over the past 20 years in how to manage concussions, but there remains much scientists don't know, he added.
“For me to think about... the athletes that are suiting up to play football on Friday nights, I don’t know that this sample really tells me much about that because the people that were a part of this study were so very impaired and had so many problems just not typical of the normal athletes that we see," Bailey said.
One thing doctors do know about concussions is it's important to identify them as soon as possible, Bailey said. Having trained medical staff on the sidelines at sporting events to watch for possible head injuries is a good first step for preventing injuries, followed by establishing clear concussion protocols, he said.
In 2020, 6.8% of children aged 17 and under had symptoms of a concussion or brain injury at some point in their life, though just 3.9% of children under 17 received an official diagnosis by a health care provider, according to the Centers for Disease Control and Prevention.
The UH Concussion Center tracks the number of concussion cases it receives, though many people who suffer head injuries don't seek formal treatment, Bailey noted.
"We're identifying them as much as we can, but we don't know that we're catching all of them," he said, adding that the number of concussion cases dipped during the pandemic and is starting to return to previous levels.
The UH Concussion Management Program works with professional and amateur athletes to guide them through the recovery process. Most people recover from a concussion within a few days to weeks, but some can experience a prolonged recovery process brought on by other obstacles such as migraines or depression, Bailey said.
Previous concussions can also dictate how prone someone is to them in the future. Past studies have shown patients are twice as likely to suffer another concussion after the first one and are six times more likely to suffer one after that, according to Bailey.
Style of play is also a factor in concussions, Bailey added. For example, a football player who leads with the crown of their head while tackling is more likely to experience concussions. That has everything to do with what the athlete is doing on the field and nothing to do with their brain's vulnerability to injury, Bailey said. He suggests athletes watch film to improve their form and work with coaches to identify potential on-field risks.
