We have written before about how we are learning how poorly the brain responds to being hit.

This is not to say an occasional bump on the head causes harm, there is no evidence for this.

But pound the head with sufficient force a sufficient number of times, and some very strange and very, very catastrophic changes happen.

Even if the force does not cause symptoms at the time.

We are learning that with the right level of pounding, just being hit on the head frequently enough will spark a tangle of inflammation in the brain that will permanently change the way a person will live their lives.  Sometimes with profound and very dangerous mood disorders, sometimes with dementia, that is loss of the ability to think.

This is catastrophic.

The New Disease:  What is CTE?

It was not all that long ago that Dr. Omalu noted very bizarre tissue findings in the brain of a star of the Pittsburgh Pirates.  His findings created a firestorm of reaction, from fans and the NFL, creating quite the drama, which can be viewed in the 2015 movie Concussion.

Since that time, a pattern of findings, related to head injury, have been established.

That is, if you look at someone’s brain under the microscope, if their brain has been sufficiently battered, a quite striking set of changes is seen, and often.  These changes are only seen in the setting of head trauma, and they are increasingly being related to two very, very horrible set of symptoms.

The findings are only visible under the microscope, you cannot see the changes on MRI, or CT scan, or with an ultrasound or X-ray.

That means no one  can no if the findings are present until after you die, or if for some reason brain tissue is removed for some urgent reason, such as removal of a tumor.  But really, for nearly everyone, you can’t know for sure if you have these changes while you are living.

The Changes in the Tissue of the Brain Seen After Repeated and Significant Force Applied

1. Tau protein accumulation.  There is a special protein in every brain called tau.  It’s job is to help stabilize the internal structures of cells in the brain.  In many dementias, this protein stops working, and accumulates, gumming up the works.  Normally you can’t see tau proteins in healthy brain cells, they are very, very small.   But if piles of tau protein accumulate they can form tangles.  And large accumulations of tau tangles are visible under the microscope.   Tangles of tau proteins are a hallmark of Alzheimer’s, but very strangely, appear after repeated head trauma,too.
2. Amyloid accumulation.  Amyloids are glops of proteins folded in a way that lets them aggregate into patches of sticky goop.  In the brain these patches are called amyloid plaques, and these plaques too are very, very characteristic of Alzheimer’s, but are also found, very strangely, after repeated head trauma, too.

Together, the appearance of tau protein tangles, and amyloid plaques after head trauma is now known as Chronic traumatic encephalopathy (CTE).

Questions raised by finding Alzheimer’s like material in the brains of young people after injury.

Early observations found tau tangles and amyloid plaques in the brains of NFL players at autopsy.

This raised a firestorm of reaction and a flood of questions.

Does football do this to a lot of people, or are there 1 in a million whose brains change after playing football?

Do other brain injuries cause these findings to appear?

Does everyone with findings like this have symptoms?

Can injury really cause changes similar to Alzheimer’s to start appearing?

How much injury does it take to get this process going?

The New Study from Football Players:  Middle School through the NFL

Over the last few years evidence mounts and mounts that hitting your head frequently, be it by football, or domestic violence, or war, triggers devastation inside the brain.

To see if some of the questions above can be answered, a group of scientists in Boston set up a Brain Bank.  The group of scientists included doctors from Boston University, from the Boston and Bedford VA’s, and a group now called the Concussion Legacy Network.

Together, in 2008, they announced to the nation that any person who had exposure to repetitive brain injury (including contact sports, military service, domestic violence) and who had died, could donate their brain to see if more could be learned about brain injury and CTE.

The group received 202 deceased brain donors, all qualified by having played football, the only form of repetitive brain injury in the 202 samples.

The study then went back to the surviving families to construct the story of each of the 202, their medical history, their injury history, data relating to their ability to think and the nature of their moods.

The group examined every one of the 202 brains under a microscope, looking for abnormalities, including the accumulation of tau tangles and amyloid plaques.

Here is What They Found

The brain exams found:

1. The more football, the more CTE, and the trend starts early:
   • For middle school players, neither of the 2 brains, 0%,  examined at this age had any signs of CTE (0 of 2)
   • For high school players, 21% had signs of CTE  (3 of 14)
   • For college players, 91% had signs of CTE (48 of 53)
   • For semi-professional players,  64% had signs of CTE (9 of 14)
   • For Canadian Football League Players, 88%had signs of CTE (7 of 8)
   • For NFL players, 99% had signs of CTE (110 of 111)
2. With the sole exception of semi-professional players, the risk of developing CTE went up and up and up with age.
3. CTE first appears in high school football.  If these numbers reflect real proportions, then 1 out of 5 of our kids playing football in high school could develop the clumps of protein in their brains suggestive of devastating disability and early death.
4. CTE is nearly universal in college players.  Over 90% had signs of the material accumulating that could lead to early death from suicide from mood agonies, and/or dementia in middle age.
5. CTE was found in nearly every brain from the NFL.

The symptom exams found, on the 111 whose families could complete a symptom evaluation:

Brains with CTE were from kids and young adults who had three types of symptoms:

1. A devastating destruction of normal mood function, causing impulsivity, depression, apathy, hopelessness, explosive outburts, violence, and suicide.

Some mix of these symptoms of mood and behavior changes were seen in 96% of those with mild CTE, and 89% of those with severe CTE on their brain exams.

27% of all those with mild CTE were so miserable, that their cause of death was suicide.

2. A devastating loss of the ability to think.  Examples of symptoms in this category include trouble with memory, executive function (getting something done, and attention, as well as loss of normal language function.

Some mix of these symptoms of loss of normal thinking ability, showed up in 85% of those with mild CTE, and 95% of those with severe CTE.

25% of those with severe CTE were diagnosed with dementia prior to death, 85% were on autopsy.

3. Loss of normal ability to move was present as well, including loss of normal gait, and slowed speed of moving.  Abnormalities of moving appeared in 66% of mild CTE cases, and 50% of severe CTE cases.

Curiously, the chances of having these various horrifying symptoms was the same whether the abnormality in the brain was CTE only or CTE and some other abnormality.  CTE was all it took.

Every one of the 202 people with CTE had symptoms, every one.

The most common cause of death in the group of 202 was brain dysfunction:

Mood problems alone for 33%

Thinking problems alone for 55%

Both mood and thinking for 38%

To add more agonies to those with mood troubles, 2/3 became addicted, half became suicidal.

BOTTOM LINES

1. This study is simply terrifying, and catastrophic.
2. From now on, everyone must know that playing football not only can, but usually causes truly disabling and deadly lifelong brain damage.
3. In this study, the brain damage that looks like Alzheimer’s begins to appear IN HIGH SCHOOL, and rises to nearly everyone in COLLEGE and later.
4. This study DID NOT relate concussions to these tragedies.  It remains very possible, indeed likely, that even without any concussions occurring, CTE may flower in the brains of our youth who play football.
5. This study only could examine the brains of people who had died.  Obviously this means it will likely find more problems than in those so much  more mildly affected they are alive.
6. Even with this caution, the alarm is now sounded loud and clear.  The burden of proof now shifts dramatically, to those who want to or want their kids to play football.  Seeing changes that look like Alzheimer’s disease and are highly associated with very deadly mood malfunction, and loss of the ability to think in over 20% of high school football players and 90% ofcollege football players, and nearly every NFL football player must make every one of us just stop.

It is time to stop.  Time to stop playing football after 8th grade, and more to the point all together, so that high school and college kids are not drawn to it.

It is time to stop when such a massive proportion of those examined had terrible symptoms and shocking findings on autopsy.

Perhaps a day will come when we can, with confidence, say that there is a group in high school and college and beyond that will not suffer the devastation of CTE, perhaps that turns out to be a very large number of kids.

But until we know how to play the game without 20% of high schoolers, 90% of college kids, and nearly 100% of NFL players showing us signs of CTE, and high proportions committing suicide or succumbing to dementia, I think it is only common sense to stop.

It took a long time, but eventually people began to ask, is boxing so much fun we must subject our kids to brain damage?

Football is not much different.

The last point this article really brought to my attention is that repetitive physical force to the brain, mild enough to not cause any obvious injury at the time, can trigger a cascade of abnormality that lasts and can engulf a lifetime.  Clearly this is an issue in football, but also will likely be seen wherever heads are hit many times:  war, and physical abuse in the home, come to mind.

To your health,
Dr. Arthur Lavin