Frontline report: 87 of 91 former NFL player brains have tested positive for brain disease

[soxhop411]

@jbrezlow: 87 of 91 ex-NFL players have tested positive for the brain disease CTE at one of the nations leading brain banks. http://t.co/kfu3o0hkH7

@jbrezlow: Thats 96 percent of NFL players who were tested for CTE. For all players, the rate was 79 percent: http://t.co/kfu3o0hkH7
 

 
https://twitter.com/frontlinepbs/status/644886997157453824 

 

[Marciano490]

How expansive a term is CTE? Like we all have degenerative discs, but that can range dem normal to highly disruptive. Can you test positive for CTE and still be near completely normal and functional?

 

[StupendousMan]

The statistic is meaningless unless we are given the corresponding stastistic for a set of non-NFL players with the same distribution of ages and body sizes and other factors.

 

[DennyDoyle'sBoil]

I don't think this is anything new.  These are just updated numbers.  The numbers a year ago were 76 of 79, so I guess this means another 12 were added and the trend remains consistent.  http://www.pbs.org/wgbh/pages/frontline/sports/concussion-watch/76-of-79-deceased-nfl-players-found-to-have-brain-disease/
 
I think the most important caveat is that the brains that were studied had been those of people who donated them for research, because they suspected they had CTE.  But I think even with that caveat, it's thought to be a statistically significant number or at least trending that way.

 

[Devizier]

How expansive a term is CTE? Like we all have degenerative discs, but that can range dem normal to highly disruptive. Can you test positive for CTE and still be near completely normal and functional?

 
Good question; without primary literature, I can't give you an exact answer on what these researchers are calling "CTE". However, based on a linked article on the PBS website, "stage one" is determined by the presence of tau plaques, even in asymptomatic subjects. So the answer to your second question is a (qualified) yes. Anyways, I recommend the link because it has informative visuals regarding their scoring system. 

 

[crystalline]

The statistic is meaningless unless we are given the corresponding stastistic for a set of non-NFL players with the same distribution of ages and body sizes and other factors.

Point taken that control groups are essential.

However pathologists have been looking at human brains under the microscope and staining for tau for decades. In this case, the field has a decent general sense of a normal person's baseline level of tau expression and of gray matter degeneration.

I do think the NFL tau numbers might be inflated, due both to selection (demented players more likely to submit brain tissue than non-demented) and lack of a paired control. But I don't question the conclusion that ex NFL players have higher rates than the general public of both brain degeneration and neurological symptoms.

 

[ifmanis5]

If only ESPN would partner with Frontline to air a major special on the subject. Oh wait.

 

[E5 Yaz]

Not to be outdone, I'm sure ESPN will assign a crack investigative team to dig up some new rumors about Spygate and Deflategate.

 
Their crack investigators are busy trying to find any mention of this story on their website
 
edit: Now, it's up

 

[TheYaz67]

How expansive a term is CTE? Like we all have degenerative discs, but that can range dem normal to highly disruptive. Can you test positive for CTE and still be near completely normal and functional?

 
It is a pretty specific condition (regarding folded tau proteins), and it cannot be tested for (currently, although folks are working on it) absent being able to dissect the brain after death.  Of course a retired football player who is 50 years old and has significant memory, cognitive and/or anger issues can be pretty reliably diagnosed as having CTE without cutting open their brain, but absolute confirmation requires looking at the brain under a powerful microscope....

 

[mauf]

I don't think this is anything new.  These are just updated numbers.  The numbers a year ago were 76 of 79, so I guess this means another 12 were added and the trend remains consistent.  http://www.pbs.org/wgbh/pages/frontline/sports/concussion-watch/76-of-79-deceased-nfl-players-found-to-have-brain-disease/
 
I think the most important caveat is that the brains that were studied had been those of people who donated them for research, because they suspected they had CTE.  But I think even with that caveat, it's thought to be a statistically significant number or at least trending that way.

 
"Statistically significant" proof of what? At best, the data shows that most former football players who think there's something seriously wrong with their brain do, in fact, have something seriously wrong with their brain. That's not nothing, but we're a long way from being able to assess the risk associated with being an NFL player, and farther still from being able to assess the risk of playing football at lower levels.

 

[Jnai]

 
"Statistically significant" proof of what? At best, the data shows that most former football players who think there's something seriously wrong with their brain do, in fact, have something seriously wrong with their brain. That's not nothing, but we're a long way from being able to assess the risk associated with being an NFL player, and farther still from being able to assess the risk of playing football at lower levels.

 
I haven't read the paper so I am commenting somewhat blindly, but the way it's being reported also sounds like there's something slightly more specific: most former players who think there's something seriously wrong with their brain do in fact have the same thing wrong with their brain. Now, it may be the case that CTE is being used as a sort of umbrella term for a bunch of loosely aggregated conditions that all result in the same neurological / histological symptoms, but the fact that they've all got some variant of the same thing seems important here.

 

[OCST]

Point taken that control groups are essential.

However pathologists have been looking at human brains under the microscope and staining for tau for decades. In this case, the field has a decent general sense of a normal person's baseline level of tau expression and of gray matter degeneration.

I do think the NFL tau numbers might be inflated, due both to selection (demented players more likely to submit brain tissue than non-demented) and lack of a paired control. But I don't question the conclusion that ex NFL players have higher rates than the general public of both brain degeneration and neurological symptoms.

 
Is it a conclusion yet?

 

[Devizier]

 
I haven't read the paper so I am commenting somewhat blindly, but the way it's being reported also sounds like there's something slightly more specific: most former players who think there's something seriously wrong with their brain do in fact have the same thing wrong with their brain. 

 
Exactly right, and not only that, the quoted statement could be applied to anything: "Smokers who think something is wrong with their lungs happen to have something wrong with their lungs". It's a meaningless critique. Obviously, it's very hard to come up with anything resembling statistical certainty in any study that requires human subjects, particularly *dead* human subjects.

 

[DennyDoyle'sBoil]

 
"Statistically significant" proof of what? At best, the data shows that most former football players who think there's something seriously wrong with their brain do, in fact, have something seriously wrong with their brain. That's not nothing, but we're a long way from being able to assess the risk associated with being an NFL player, and farther still from being able to assess the risk of playing football at lower levels.

 
Is it possible that a significant proportion of former bakers or teachers or cobblers would (a) all think they have something so wrong with their brains that they would be willing to submit them for post-mortem research, and (b) would turn out at a rate of around 95 percent percent to be correct, and (c) all would have CTE?
 
Yeah, absolutely.  It’s possible.  And guessing isn’t science and "statistically significant" is not a good word choice by me when trying to compare one population to another that may never have been tested.  I’ll admit that.  But I’ll still take the under.

 

[Devizier]

 
Is it a conclusion yet?

 
In some studies, yes.

 

[Jnai]

It's also worth pointing out how extremely difficult it is to get consent for this study. Donating organs even for really good medical uses is still icky to a lot of people, and the patients in this study are probably right at the ethical boundary of being able to consent even if they're still alive.

Until there's a non histological test, research is going to be severely limited.

 

[troparra]

This author (McKee) did a previous study with controls - from 2013: http://www.ncbi.nlm.nih.gov/pubmed/23208308?dopt=Abstract
 

A total of 85 brains from former athletes, military veterans or civilians with a history of repetitive mild traumatic brain injury were comprehensively evaluated. Eighteen additional brains from cognitively intact individuals without history of mild traumatic brain injury were obtained from the Boston University Alzheimer’s Disease Center Brain Bank that included some subjects from the Framingham Heart Study. Next of kin provided written consent for participation and brain donation
 

 
68 of 85 (80%) of those with history of repetitive mild traumatic brain injury had signs of CTE.  Zero of 18 controls had signs of CTE.  
The data presentation is quite transparent, in Table 2 they list info for each individual subject. 
 
Usual caveats apply - small sample, deceased subjects, selection bias, association not causation, etc.
 
Pretty solid evidence for such a study.  Unless you believe they fabricated results Exponent style.  

 

[EricFeczko]

Point taken that control groups are essential.

However pathologists have been looking at human brains under the microscope and staining for tau for decades. In this case, the field has a decent general sense of a normal person's baseline level of tau expression and of gray matter degeneration.

I do think the NFL tau numbers might be inflated, due both to selection (demented players more likely to submit brain tissue than non-demented) and lack of a paired control. But I don't question the conclusion that ex NFL players have higher rates than the general public of both brain degeneration and neurological symptoms.

I always thought it was about the phosphorylation of tau (i.e. the present of "tangles" in the brain), not the expression, that was the biomarker of dementia.
The problem is that tau phosphorylation is not specific to any form of dementia. Tangles also occur in Alzheimer's, Lewy-body, and fronto-temporal dementia.
Whether CTE is even a real disorder, or is simply cases related to already existing dementias, remains questionable.

 

[EricFeczko]

Regardless of the specific diagnosis, the fact that mild traumatic brain injury (mTBI, also known as a concussion with loss of consciousness) is associated with dementia has been known for a long time (see here for a recent review, or PM me if you want a lecture). This knowledge has been established by large-scale epidemiological studies on thousands of subjects.

 

[mauf]

 
Is it possible that a significant proportion of former bakers or teachers or cobblers would (a) all think they have something so wrong with their brains that they would be willing to submit them for post-mortem research, and (b) would turn out at a rate of around 95 percent percent to be correct, and (c) all would have CTE?
 
Yeah, absolutely.  It’s possible.  And guessing isn’t science and "statistically significant" is not a good word choice by me when trying to compare one population to another that may never have been tested.  I’ll admit that.  But I’ll still take the under.

To Jnai's point, if you had 91 bakers, teachers or cobblers who thought there was something seriously wrong with their brain, it's unlikely that you would find that nearly all of them suffer from the same disorder (or at least closely related disorders).

I don't think there was much doubt that some former NFL players have brain disease caused by impacts during their playing days. The important questions still aren't answered -- but knowing that most of these players suffer from the same or similar disorders will guide the effort to find those answers.

 

[crystalline]

I always thought it was about the phosphorylation of tau (i.e. the present of "tangles" in the brain), not the expression, that was the biomarker of dementia.

 
Yes.  Tau is a protein associated with microtubules that is present in many nervous system cells.  The "tau tangles" seen in many forms of disease are hyper-stable aggregates of many strands of over-phosphorylated tau.  The tangles (often called neurofibrillary tangles or NFT) can be seen easily in histology.  What's discussed above is the presence of tau tangles.  
 
Edit: it's not known whether sick cells make tau tangles, or whether tangles make normal cells sick.

 

[StupendousMan]

This author (McKee) did a previous study with controls - from 2013: http://www.ncbi.nlm.nih.gov/pubmed/23208308?dopt=Abstract

 
Thank you very much.  I am a scientist, but not a biologist or medical doctor, let alone a brain specialist.  You and other posters here are providing expert advice and information far more quickly than I could find it on my own.

 

[OCST]

Acknowledging all of the problems with the difficulty of doing these studies, of defining CTE in the first place, etc. etc. - if it's true that a very high % of former players will end up with severe dementia, we could be looking at the end of football as we know it.

 

[E5 Yaz]

ESPN.com has now removed the report from its Top Headlines ... but kept the Buffalo deflate jokes there

 

[StupendousMan]

Acknowledging all of the problems with the difficulty of doing these studies, of defining CTE in the first place, etc. etc. - if it's true that a very high % of former players will end up with severe dementia, we could be looking at the end of football as we know it.

 
I don't want to diminish the severity of the problem, but there are a few professions which are known to lead to serious health problems, yet still exist.  Coal miner, for example.  As long as some people are willing to accept good wages now in exchange for the possibility of sickness later, they will continue to sign up.
 
I guess the big difference between coal mining and football is that more ordinary members of society are likely to quit watching football in protest than to stop using electricity.

 

[McBride11]

I would argue that an everyday joe schmoe wouldnt be an adequate control.
High end athletes all ready have numerous physiological changes that an average person doesnt have. Any of these other factors could contribute to increased tau desposition in the brain. (steroids/hgh, high intensity weights/exercise, increased metabolic rates, extreme protein intake, etc).
Maybe bodybuilders or baseball players or some other pro athletes with less mTBI would be a better control group.
All we appear to have is an observational studyt with a biased sample at this point.
Troparra's cited study appears a little more robust since it include military and civilians as well.
So the current study makes a nice headline but says really very little.

 

[nighthob]

I don't want to diminish the severity of the problem, but there are a few professions which are known to lead to serious health problems, yet still exist.  Coal miner, for example.  As long as some people are willing to accept good wages now in exchange for the possibility of sickness later, they will continue to sign up.
 
I guess the big difference between coal mining and football is that more ordinary members of society are likely to quit watching football in protest than to stop using electricity.

The problem isn't finding adults to play the sport, the problem is the skill level of those players once the federal government bans full contact football for minors.

 

[crystalline]

I would argue that an everyday joe schmoe wouldnt be an adequate control.
High end athletes all ready have numerous physiological changes that an average person doesnt have. Any of these other factors could contribute to increased tau desposition in the brain. (steroids/hgh, high intensity weights/exercise, increased metabolic rates, extreme protein intake, etc).
Maybe bodybuilders or baseball players or some other pro athletes with less mTBI would be a better control group.

Yes, fair point. However we know that tau tangles in the brain are strongly associated with brain degeneration in other diseases. For example in Alzheimer's, advancing disease and worsening dementia is correlated with more tau tangles. https://en.m.wikipedia.org/wiki/Tauopathy

Also the microscopic pathology of CTE appears to be consistent and different from dementias like Alzheimer's. For example CTE but not Alzheimer's patients have tau deposition in astrocytes. I just found this article, which says CTE but not Alzheimers has tau pathology in white matter, where damage often occurs in head injury (as with diffuse axonal injury.)

So the exact cause of CTE has not been nailed down, but there's a lot of suggestive facts that neurodegeneration is present in ex-football players with mental health issues.

So the current study makes a nice headline but says really very little.

No question that this particular study isn't a big advance. The big step was showing that a lot of football players had neurodegeneration. There's lots of work to be done.

 

[Devizier]

Yes, fair point. However we know that tau tangles in the brain are strongly associated with brain degeneration in other diseases. For example in Alzheimer's, advancing disease and worsening dementia is correlated with more tau tangles. 

 
Another consideration is that the hypothesis is sound from a common sense perspective. That's not to say that a correct hypothesis has to make intrinsic sense -- just ask Stanley Prusiner -- but it helps. And active duty military isn't necessarily a "control group" per se, but another experimental group. CTE in blast-exposed veterans is probably even better studied than in former NFL players.

 

[McBride11]

crystalline excellent cites and research. I agree long term that tau will likely found to be the culprit and that mTBI plays a large role, scientifically we just arent there yet. It is interesting that tau does occur in different areas in the CTE types. That piece I had not known

And ya Devizier I had meant vets are another experimental group more similar to average joe controls in overall physiology (less confounders then). Thanks for clarifying.

 

[Smokey Joe]

The problem isn't finding adults to play the sport, the problem is the skill level of those players once the federal government bans full contact football for minors.

     The feds won't need to step in.  All it will take is the first multi-million dollar settlement against a school district and it will be over.

 

[nighthob]

     The feds won't need to step in.  All it will take is the first multi-million dollar settlement against a school district and it will be over.

 
I don't think it's even going to get there, there's already a movement afoot in New Hampshire to make 16 the legal age to participate in full contact football, it's going to succeed sooner rather than later. These studies are piling up quickly, a few years ago I figured that full contact football would end at the youth levels in my lifetime. Now I'm pretty sure it will be gone before I turn 60.

 

[ishmael]

I wonder if ESPN will so much as make a peep when this movie comes out on Christmas Day?
 
 
 
https://www.youtube.com/watch?v=Qk-1TLVUPZk

 

[SumnerH]

 
I wonder if ESPN will so much as make a peep when this movie comes out on Christmas Day?
 
 
 
https://www.youtube.com/watch?v=Qk-1TLVUPZk
 

 
Being discussed over here.
 
Including this story:

In dozens of studio emails unearthed by hackers, Sony executives; the director, Peter Landesman; and representatives of Mr. Smith discussed how to avoid antagonizing the N.F.L. by altering the script and marketing the film more as a whistle-blower story, rather than a condemnation of football or the league.
...
“We’ll develop messaging with the help of N.F.L. consultant to ensure that we are telling a dramatic story and not kicking the hornet’s nest.”
...
Another email on Aug. 1, 2014, said some “unflattering moments for the N.F.L.” were deleted or changed, while in another note on July 30, 2014, a top Sony lawyer is said to have taken “most of the bite” out of the film “for legal reasons with the N.F.L. and that it was not a balance issue.”

 

[Ed Hillel]

Star HS player in NJ dies after taking a hit during a game. The article isn't clear, but it looks like a brain injury:
 

He was taken from the field after a Summit interception and subsequent return, Tapinto.net reported Saturday. He was carted off the field in an ambulance, the website said.
The player felt “woozy” after the play but tried reassuring his teammates he would be fine as he was lifted on a gurney and rushed to the hospital, the News reported, citing witnesses.

 
http://www.foxnews.com/us/2015/09/26/nj-high-school-star-quarterback-dies-after-suffering-injury-during-game/?intcmp=hpbt1