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JAMA. 2017 Jul 25;318(4):360-370. doi: 10.1001/jama.2017.8334.

Clinicopathological Evaluation of Chronic Traumatic Encephalopathy in Players of American Football.

Author information

1
Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts2Department of Neurology, Boston University School of Medicine, Boston, Massachusetts.
2
Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts3Department of Orthopaedic Surgery, Stanford University, Stanford, California.
3
Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts4VA Boston Healthcare System, US Department of Veteran Affairs, Boston, Massachusetts5Department of Veterans Affairs Medical Center, Bedford, Massachusetts.
4
Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts2Department of Neurology, Boston University School of Medicine, Boston, Massachusetts4VA Boston Healthcare System, US Department of Veteran Affairs, Boston, Massachusetts5Department of Veterans Affairs Medical Center, Bedford, Massachusetts.
5
Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts.
6
Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts6Concussion Legacy Foundation, Waltham, Massachusetts.
7
Concussion Legacy Foundation, Waltham, Massachusetts.
8
Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts7Data Coordinating Center, Boston University School of Public Health, Boston, Massachusetts.
9
Interfaculty Initiative in Health Policy, Harvard University, Boston, Massachusetts9Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts.
10
Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts10Department of Biostatistics, Boston University, Boston, Massachusetts11School of Public Health, Boston University, Boston, Massachusetts.
11
Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts2Department of Neurology, Boston University School of Medicine, Boston, Massachusetts4VA Boston Healthcare System, US Department of Veteran Affairs, Boston, Massachusetts12Department of Pathology, Boston University School of Medicine, Boston, Massachusetts.
12
School of Public Health, Boston University, Boston, Massachusetts13Department of Epidemiology, Boston University, Boston, Massachusetts.
13
School of Public Health, Boston University, Boston, Massachusetts14Department of Environmental Health, Boston University, Boston, Massachusetts.
14
Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts2Department of Neurology, Boston University School of Medicine, Boston, Massachusetts6Concussion Legacy Foundation, Waltham, Massachusetts15Department of Neurosurgery, Emerson Hospital, Concord, Massachusetts.
15
Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts2Department of Neurology, Boston University School of Medicine, Boston, Massachusetts12Department of Pathology, Boston University School of Medicine, Boston, Massachusetts16Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts17Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts18Department of Biomedical Engineering, Boston University College of Engineering, Boston, Massachusetts19Department of Electrical and Computer Engineering, Boston University College of Engineering, Boston, Massachusetts.
16
Department of Neurology, Boston University School of Medicine, Boston, Massachusetts20Braintree Rehabilitation Hospital, Braintree, Massachusetts.
17
Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts2Department of Neurology, Boston University School of Medicine, Boston, Massachusetts21Department of Neurosurgery, Boston University School of Medicine, Boston, Massachusetts22Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts.
18
Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts4VA Boston Healthcare System, US Department of Veteran Affairs, Boston, Massachusetts5Department of Veterans Affairs Medical Center, Bedford, Massachusetts12Department of Pathology, Boston University School of Medicine, Boston, Massachusetts.
19
Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts2Department of Neurology, Boston University School of Medicine, Boston, Massachusetts4VA Boston Healthcare System, US Department of Veteran Affairs, Boston, Massachusetts5Department of Veterans Affairs Medical Center, Bedford, Massachusetts12Department of Pathology, Boston University School of Medicine, Boston, Massachusetts23Boston University School of Medicine, Boston, Massachusetts.

Abstract

Importance:

Players of American football may be at increased risk of long-term neurological conditions, particularly chronic traumatic encephalopathy (CTE).

Objective:

To determine the neuropathological and clinical features of deceased football players with CTE.

Design, Setting, and Participants:

Case series of 202 football players whose brains were donated for research. Neuropathological evaluations and retrospective telephone clinical assessments (including head trauma history) with informants were performed blinded. Online questionnaires ascertained athletic and military history.

Exposures:

Participation in American football at any level of play.

Main Outcomes and Measures:

Neuropathological diagnoses of neurodegenerative diseases, including CTE, based on defined diagnostic criteria; CTE neuropathological severity (stages I to IV or dichotomized into mild [stages I and II] and severe [stages III and IV]); informant-reported athletic history and, for players who died in 2014 or later, clinical presentation, including behavior, mood, and cognitive symptoms and dementia.

Results:

Among 202 deceased former football players (median age at death, 66 years [interquartile range, 47-76 years]), CTE was neuropathologically diagnosed in 177 players (87%; median age at death, 67 years [interquartile range, 52-77 years]; mean years of football participation, 15.1 [SD, 5.2]), including 0 of 2 pre-high school, 3 of 14 high school (21%), 48 of 53 college (91%), 9 of 14 semiprofessional (64%), 7 of 8 Canadian Football League (88%), and 110 of 111 National Football League (99%) players. Neuropathological severity of CTE was distributed across the highest level of play, with all 3 former high school players having mild pathology and the majority of former college (27 [56%]), semiprofessional (5 [56%]), and professional (101 [86%]) players having severe pathology. Among 27 participants with mild CTE pathology, 26 (96%) had behavioral or mood symptoms or both, 23 (85%) had cognitive symptoms, and 9 (33%) had signs of dementia. Among 84 participants with severe CTE pathology, 75 (89%) had behavioral or mood symptoms or both, 80 (95%) had cognitive symptoms, and 71 (85%) had signs of dementia.

Conclusions and Relevance:

In a convenience sample of deceased football players who donated their brains for research, a high proportion had neuropathological evidence of CTE, suggesting that CTE may be related to prior participation in football.

PMID:
28742910
PMCID:
PMC5807097
DOI:
10.1001/jama.2017.8334
[Indexed for MEDLINE]
Free PMC Article

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