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Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disorder that has been identified after repetitive traumatic brain injury. In brains with CTE, deposition of hyperphosphorylated tau (p-tau) within neurofibrillary tangles is seen in the depths of the cerebral sulci. Nevertheless, not all individuals subjected to repetitive brain trauma (RBT) develop CTE. Additional risk factors, including genetic ones like apolipoprotein E ℇ4, may increase susceptibility to CTE.
The objective of this study was to determine the clinicopathologic features of 202 deceased former football players (median age at death, 66 years; mean 15 years of participation) whose brains were donated for research. Researchers conducted retrospective, blinded clinical assessments via an online questionnaire and telephone interviews with informants, including head trauma, athletic, and military histories.
CTE was neuropathologically diagnosed in 177 players (87%), less commonly in those who only played football in high school (3 of 14) or before (0 of 2) compared with those who played in college (48 of 53), semiprofessionally (9 of 14), and professionally in the Canadian Football League (7 of 8) or National Football League (110 of 111). Among football players with the highest level of play, 101 (86%) had severe pathology. Nearly all individuals with CTE pathology (regardless of its severity) had cognitive symptoms and behavioral or mood disorders; in addition, 33% of those with mild CTE pathology and 85% of those with severe CTE pathology had signs of dementia.
Mez J et al. Clinicopathological evaluation of chronic traumatic encephalopathy in players of American football. JAMA 2017 Jul 25; 318:360. (http://jamanetwork.com/journals/jama/article-abstract/2645104)
Rabinovici GD.Advances and gaps in understanding chronic traumatic encephalopathy: From pugilists to American football players. JAMA 2017 Jul 25; 318:338. (http://dx.doi.org/10.1001/jama.2017.9353)
Comment
In this excellent study, CTE is shown as a condition associated with repetitive traumatic brain injury. Football players and sports physicians need to be aware of these findings as well as of the potential selection bias of this convenience sample of former players who donated their brains, possibly out of concern for their own brain health. Large cohorts need to be studied to explore the potential genetic risk and exposure factors such as duration, level of play, and nature of impacts that may play a role in CTE pathology, symptoms, and syndromes in association with American football.