Researchers have found the hallmarks of chronic traumatic encephalopathy throughout the brain of a 25-year-old former college football player who sustained more than 10 concussions during about 16 years on the gridiron.
The unnamed athlete, described in a report published Monday by the journal JAMA Neurology, is the youngest patient to get a definitive diagnosis of widespread CTE — degenerative brain changes accompanied by a range of neuropsychiatric symptoms that are linked to repeated blows to the head. The condition can be diagnosed only after death because it requires direct examination of tissue throughout the brain.
The report authors noted that the brains of athletes as young as 17 had shown “focal lesions” — limited and isolated spots of clumped proteins — that suggested CTE. But they wrote that “widespread CTE pathology ... is unusual in such a young football player.” Most of the former athletes whose brain autopsies have revealed widespread CTE have been 45 to 80 years old.
The young man died of cardiac arrest resulting from a staph infection of the tissues surrounding the heart. His case is unusual in that before his death, he enrolled in a research study called Understanding Neurological Injury and Traumatic Encephalopathy, part of an effort to recognize the signs of CTE in living people.
As a result, researchers have detailed results of neuropsychological testing performed on the man before his death. Those tests showed that his overall levels of intellectual function were normal and that he was readily able to remember and describe key events from his past. But his short-term memory and some elements of executive function were noticeably impaired.
The tests came in the wake of behavior that closely resembled that seen in several athletes who were found after their deaths to have brains riddled with clumps of tau protein, which is a hallmark of Alzheimer's dementia and chronic traumatic encephalopathy.
The young man, who had a family history of depression and addiction, was described as apathetic and joyless, with sleep problems and a low appetite.
He had been playing contact football since age 6, as a defensive linebacker and a special teams player. He suffered his first concussion at age 8. His played on a Division 1 college football team for three years, including one as a redshirt freshman, and left the team at the beginning of his junior season because he was continuing to suffer headaches, blurry vision, tinnitus, insomnia, anxiety and other post-concussive symptoms.
After he began failing courses, he left college just short of earning a degree and had difficulty maintaining a job. He smoked marijuana daily to relieve his headaches and anxiety, and had become verbally and physically abusive toward his wife.
The authors of the report, led by Boston University neurologist Dr. Ann McKee, noted that it was impossible to discern whether the young man's cognitive profile and his behavior were early signs of CTE or possibly just depression. They were at least consistent with a diagnosis of post-concussive syndrome.
Nevertheless, McKee and her colleagues called the report “instructive.” Along with other cases from the research study, the findings might make it easier to identify early signs of CTE in living individuals who could take action — such as quitting contact sports — before more damage is done.
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