Football, concussion and brain damage

Two articles in recent days have focused my attention on this subject. CNN reports:

Until recently, the best medical definition for concussion was a jarring blow to the head that temporarily stunned the senses, occasionally leading to unconsciousness. It has been considered an invisible injury, impossible to test -- no MRI, no CT scan can detect it.

But today, using tissue from retired NFL athletes culled posthumously, the Center for the Study of Traumatic Encephalopathy (CSTE), at the Boston University School of Medicine, is shedding light on what concussions look like in the brain. The findings are stunning. Far from innocuous, invisible injuries, concussions confer tremendous brain damage. That damage has a name: chronic traumatic encephalopathy (CTE).

On Tuesday afternoon, researchers at the CSTE released a study about the sixth documented case of CTE in former NFL player Tom McHale, who died in 2008 at the age of 45, and the youngest case to date, an 18-year-old multi-sport athlete who suffered multiple concussions.

While CTE in an ex-NFL player's brain may have been expected, the beginnings of brain damage in an 18-year-old brain was a "shocking" finding, according to Dr. Ann McKee, a neuropathologist at the Veterans Administration Hospital in Bedford, Massachusetts, and co-director of the CSTE.

"We think this is how chronic traumatic encephalopathy starts," said McKee. "This is speculation, but I think we can assume that this would have continued to expand."

CTE has thus far been found in the brains of six out of six former NFL players.

"What's been surprising is that it's so extensive," said McKee. "It's throughout the brain, not just on the superficial aspects of the brain, but it's deep inside."

CSTE studies reveal brown tangles flecked throughout the brain tissue of former NFL players who died young -- some as early as their 30s or 40s.

McKee, who also studies Alzheimer's disease, says the tangles closely resemble what might be found in the brain of an 80-year-old with dementia.

"I knew what traumatic brain disease looked like in the very end stages, in the most severe cases," said McKee. "To see the kind of changes we're seeing in 45-year-olds is basically unheard of."

The damage affects the parts of the brain that control emotion, rage, hypersexuality, even breathing, and recent studies find that CTE is a progressive disease that eventually kills brain cells.

. . .

So far, around 100 athletes have consented to have their brains studied after they die.

Ted Johnson was one of the first to sign up. He said he believes that concussions he suffered while playing football explain the anger, depression and throbbing headaches that occasionally still plague him.

Johnson said he played through concussions because he, like many other NFL athletes, did not understand the consequences. He has publicly criticized the NFL for not protecting players like him.

"They don't want you to know," said Johnson. "It's not like when you get into the NFL there's a handout that says 'These are the effects of multiple concussions so beware.' "
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In a statement, the NFL indicated that their staffs take a cautious, conservative approach to managing concussions.

While they support research into the impact of concussions, they maintain that, "Hundreds of thousands of people have played football and other sports without experiencing any problem of this type and there continues to be considerable debate within the medical community on the precise long-term effects of concussions and how they relate to other risk factors."

The NFL is planning its own independent medical study of retired NFL players on the long-term effects of concussion.

There are more details in the full article. Recommended reading - particularly if you have a son who's playing, or wants to play, football at school or college.

What am I bet that the NFL's study will downplay the risks, and emphasize the safety features built into the sport? There's far too much money riding on the game for the NFL to want to risk losing viewers and spectators by changing the rules to minimize the risk of injury. I don't think they'll do anything particularly constructive - their current response is a pretty good indication of this.

The second report is from the BBC.

People concussed in their youth show subtle signs of mental and physical problems even more than 30 years later, say Canadian researchers.

The study, published in the journal Brain, found athletes with a history of concussion had worse physical and mental test scores.

The researchers stressed these minor changes did not affect day-to-day life.

Experts said minor head injury recovery could be slow, but this was the first hint of a longer-lasting effect.

The small-scale study involved just 40 former athletes aged between 50 and 60, 19 of whom had a history of one or more concussions in their youth.

The researchers from Montreal University carried out a battery of tests, covering everything from short-term memory and the ability to follow simple verbal and written commands, to motor control.

The previously concussed volunteers had poorer performance in the memory tests, delayed responses to unpredictable events, and were unable to complete the hand control tests as quickly.

Dr Louis de Beaumont, who led the study, said: "This study shows that the effects of sports concussions in early adulthood persist beyond 30 years post-concussion, and that it can cause cognitive and motor function alterations as the athletes age.

"Athletes should be better informed about the cumulative and persistent effects of sports concussion on mental and physical processes so they know about the risk associated with returning to their sport."

The Canadian study would seem to corroborate the findings of the Boston University investigation.

I'm guessing the pressure to keep football as a high-stress contact sport will be very high - after all, with so much money involved, those getting rich from it won't want any changes that might affect that! Still, if I had a son, there's no way I'd allow him to play football in high school - not with this sort of evidence piling up.

Peter