News reports this week confirm the danger of severe long-term brain injury to football players, including those who played in high school and college. Earlier studies had indicated that boys who start playing tackle football before the age of 12 face a higher risk of neurological deficits as adults. The American Psychiatric Association reported the following this morning:
Small Study Finds 87 Out Of 91 Deceased NFL Players Had CTE.
NBC Nightly News (9/18, story 10, 0:35, Holt) reported on “troubling news tonight about the long-term dangers of head injuries while playing football.” According to PBS Frontline, a small study by the “VA in Boston University showed the brains of 87 out of 91 former deceased NFL players tested positive for “chronic traumatic encephalopathy, or “CTE in the latest study of traumatic brain injuries. That is 96 percent of deceased NFL players examined and they’ve also founded CTE in the brains of 79 percent of all deceased football players tested, including those who played in high school and college.”
The AP (9/18) added that the brains were examined by researchers with the Department of Veterans Affairs and Boston University. According to the report, many of the players who donated their brains to research suspected they had CTE, “which therefore skews the population of brains being examined.” CTE is linked to repeated brain trauma and is associated with symptoms including “memory loss, impaired judgement, depression, and, eventually, progressive dementia.”
The Washington Post (9/18, Bonesteel) noted that researchers wrote that the high rate of CTE in the players’ brains “supports past research suggesting it’s the repeat, more minor head trauma that occurs regularly in football that may pose the greatest risk to players,” instead of just the “sometimes violent collisions that cause concussions.”
In following this story, I was reminded that in January 2015 the journal Neurology, reported the study of cognitive impairment in NFL players who had begun playing before age 12. A good summary is from HealthDay news January 30, 2015 (note the emphasis on the dangers of repetitive hits rather than just concussions):
Boys who start playing tackle football before the age of 12 may face a higher risk for neurological deficitsas adults, according to research published online January 28 in Neurology.
In 2011, investigators recruited former National Football League (NFL) players to participate in an ongoing study called DETECT. The players’ average age was 52, and all had played at least two years in the NFL and 12 years of “organized football.” All had sustained a comparable number of concussions throughout their careers. All had a minimum six-month history of mental health complaints, including problems with thinking clearly, behavior, and mood. All underwent a standardized battery of neurological testing to assess learning, reading, and verbal capacities, as well as memory and planning skills.
All the players performed below average on several of the assessments. But by many measures, the overall mental functioning of those who started playing before age 12 registered roughly 20% below that of those who started at age ≥12. For example, the early start group performed worse in terms of immediate and delayed verbal-recall tests, and were deemed less mentally “flexible” than the 12-and-up group. The study authors pointed out that, on average, children who play football between the ages of 9–12 experience between 240–585 head hits per season, with a force that is comparable to that experienced by high school and college players.
“Now I want to be clear that we’re not talking about the impact of concussions here,” study coauthor Robert Stern, PhD, a professor of neurology, neurosurgery, anatomy, and neurobiology at Boston University’s School of Medicine, told HealthDay. Stern is also the director of the Alzheimer’s Disease Center Clinical Core and director of clinical research at the Chronic Traumatic Encephalopathy Center at the university. “I know that the emphasis of late has been on concussions. But what I’m more concerned about are all of those repetitive hits that we refer to as sub-concussive trauma.”
Neurofeedback is not a treatment for chronic traumatic encephalopathy, but is a reliable treatment for many post-concussion and closed-head injury syndromes. We recommend waiting at least a month after an acute injury before beginning neurofeedback. Remarkably, the treatment can be effective many years after an injury to reduce fogginess, attention difficulties and other cognitive sequelae of old head injuries.