Chronic traumatic encephalopathy
Encyclopedia
Chronic traumatic encephalopathy (CTE) is a progressive degenerative disease
Degenerative disease
A degenerative disease, also called neurodegenerative disease, is a disease in which the function or structure of the affected tissues or organs will progressively deteriorate over time, whether due to normal bodily wear or lifestyle choices such as exercise or eating habits...

 found in individuals who have been subjected to multiple concussions and other forms of head injury
Head injury
Head injury refers to trauma of the head. This may or may not include injury to the brain. However, the terms traumatic brain injury and head injury are often used interchangeably in medical literature....

. A variant of the condition, dementia pugilistica
Dementia pugilistica
Dementia pugilistica is a type of neurodegenerative disease or dementia, which may affect amateur or professional boxers as well as athletes in other sports who suffer concussions...

, is primarily associated with boxing
Boxing
Boxing, also called pugilism, is a combat sport in which two people fight each other using their fists. Boxing is supervised by a referee over a series of between one to three minute intervals called rounds...

. CTE has been most commonly found in professional athletes participating in American football
American football
American football is a sport played between two teams of eleven with the objective of scoring points by advancing the ball into the opposing team's end zone. Known in the United States simply as football, it may also be referred to informally as gridiron football. The ball can be advanced by...

, ice hockey
Ice hockey
Ice hockey, often referred to as hockey, is a team sport played on ice, in which skaters use wooden or composite sticks to shoot a hard rubber puck into their opponent's net. The game is played between two teams of six players each. Five members of each team skate up and down the ice trying to take...

, professional wrestling
Professional wrestling
Professional wrestling is a mode of spectacle, combining athletics and theatrical performance.Roland Barthes, "The World of Wrestling", Mythologies, 1957 It takes the form of events, held by touring companies, which mimic a title match combat sport...

 and other contact sport
Contact sport
Many sports involve a degree of player-to-player or player-to-object contact. The term "contact sport" is used in both team sports and combat sports, medical terminology and television game shows, such as the Gladiators and Wipeout, to certain degrees...

s, who have experienced head trauma, resulting in characteristic degeneration of brain tissue and the accumulation of tau protein
Tau protein
Tau proteins are proteins that stabilize microtubules. They are abundant in neurons of the central nervous system and are less common elsewhere, but are also expressed at very low levels in CNS astrocytes and oligodendrocytes...

. Individuals with Chronic Traumatic Encephalopathy may show symptoms of dementia
Dementia
Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...

 such as memory loss, aggression, confusion and depression which may appear within months of the trauma or many decades later.

Several former NFL players have been diagnosed post-mortem with chronic traumatic encephalopathy. Former Detroit Lions
Detroit Lions
The Detroit Lions are a professional American football team based in Detroit, Michigan. They are members of the North Division of the National Football Conference in the National Football League , and play their home games at Ford Field in Downtown Detroit.Originally based in Portsmouth, Ohio and...

 lineman and eight-time Pro Bowler Lou Creekmur
Lou Creekmur
Louis Creekmur was an NFL left offensive tackle/guard for the Detroit Lions from 1950-59. He was also used as a defensive lineman in critical situations...

, former Houston Oilers
Tennessee Titans
The Tennessee Titans are a professional American football team based in Nashville, Tennessee, United States. They are members of the South Division of the American Football Conference in the National Football League . Previously known as the Houston Oilers, the team began play in 1960 as a charter...

 and Miami Dolphins
Miami Dolphins
The Miami Dolphins are a Professional football team based in the Miami metropolitan area in Florida. The team is part of the Eastern Division of the American Football Conference in the National Football League...

 linebacker John Grimsley
John Grimsley
John Glenn Grimsley was an American linebacker in the National Football League who played for seven seasons for the Houston Oilers....

, former Tampa Bay Buccaneers
Tampa Bay Buccaneers
The Tampa Bay Buccaneers are a professional American football franchise based in Tampa, Florida, U.S. They are currently members of the Southern Division of the National Football Conference in the National Football League – they are the only team in the division not to come from the old NFC West...

 guard Tom McHale
Tom McHale (American football)
Thomas McHale was an American offensive guard in the National Football League. During his career he played for the Tampa Bay Buccaneers , Philadelphia Eagles and Miami Dolphins...

,
former Cincinnati Bengals
Cincinnati Bengals
The Cincinnati Bengals are a professional football team based in Cincinnati, Ohio. They are members of the AFC's North Division in the National Football League . The Bengals began play in 1968 as an expansion team in the American Football League , and joined the NFL in 1970 in the AFL-NFL...

 wide receiver Chris Henry, and former Chicago Bears
Chicago Bears
The Chicago Bears are a professional American football team based in Chicago, Illinois. They are members of the North Division of the National Football Conference in the National Football League...

 safety Dave Duerson
Dave Duerson
David Russell Duerson was an American football safety in the National Football League who played for the Chicago Bears , the New York Giants , and the Phoenix Cardinals .-Early life:...

, have all been diagnosed post-mortem with CTE. Athletes from other sports have also been identified as having CTE, such as hockey players Reggie Fleming
Reg Fleming
Reginald Stephen "Reggie, The Ruffian" Fleming, was a professional hockey player in the National Hockey League with the Montreal Canadiens, Chicago Black Hawks, Boston Bruins, New York Rangers, Philadelphia Flyers and Buffalo Sabres...

 and Bob Probert
Bob Probert
Robert Alan Probert was a Canadian professional ice hockey forward. Probert played for the National Hockey League's Detroit Red Wings and Chicago Blackhawks...

.

An autopsy conducted in 2010 on the brain of Owen Thomas, a 21-year-old junior lineman at the University of Pennsylvania
University of Pennsylvania
The University of Pennsylvania is a private, Ivy League university located in Philadelphia, Pennsylvania, United States. Penn is the fourth-oldest institution of higher education in the United States,Penn is the fourth-oldest using the founding dates claimed by each institution...

 who committed suicide by hanging himself, showed early stages of chronic traumatic encephalopathy, making him the youngest person — and the second amateur player — to be diagnosed with the condition. The doctors who performed the autopsy indicated that they found no causal connection between the nascent CTE and Thomas's suicide. There were no records of Thomas missing any playing time due to concussion, but as a player who played hard and "loved to hit people," he may have played through concussions and received thousands of subconcussive impacts on the brain.

Study and developments

In 2002, Dr. Bennet Omalu, a forensic pathologist and neuropathologist
Neuropathology
Neuropathology is the study of disease of nervous system tissue, usually in the form of either small surgical biopsies or whole autopsy brains. Neuropathology is a subspecialty of anatomic pathology, neurology, and neurosurgery...

 in Pittsburgh, Pennsylvania
Pennsylvania
The Commonwealth of Pennsylvania is a U.S. state that is located in the Northeastern and Mid-Atlantic regions of the United States. The state borders Delaware and Maryland to the south, West Virginia to the southwest, Ohio to the west, New York and Ontario, Canada, to the north, and New Jersey to...

 found Chronic Traumatic Encephalopathy (CTE) in the brains of Mike Webster, Terry Long
Terry Long (American football)
Terry Long was a National Football League offensive lineman. He played from 1984–1991 for the Pittsburgh Steelers....

, Andre Waters
Andre Waters
Andre Waters was an NFL defensive back who played for the Philadelphia Eagles and Arizona Cardinals from 1984 to 1995. Waters was regarded as one of the NFL's hardest-hitting defenders, serving as an integral part of one of the league's top defenses...

, Justin Strzelczyk
Justin Strzelczyk
Justin Conrad Strzelczyk was a former American football offensive lineman who played nine seasons in the NFL, all for the Pittsburgh Steelers from 1990–1998 and helped the team gain a Super Bowl berth. He can also be seen in the 1997 Adam Sandler music video, "The Lonesome Kicker"...

 and Tom McHale
Tom McHale (American football)
Thomas McHale was an American offensive guard in the National Football League. During his career he played for the Tampa Bay Buccaneers , Philadelphia Eagles and Miami Dolphins...

. Repeated concussions and sub-concussions incurred during the play of football over a long period can result in CTE. The brain changes in CTE and DP are similar and are delayed sequelae of repeated concussions and sub-concussions of the brain. In 2009, Omalu discovered the same condition in recently retired wrestler Andrew "Test" Martin, who died aged 33 from a drug overdose.

In 2007, neuropathologists from the Sports Legacy Institute examined the brain of Chris Benoit
Chris Benoit
Christopher Michael "Chris" Benoit was a Canadian professional wrestler whose career and life ended in a murder–suicide...

, a professional wrestler with the WWE, and identified pathognomonic brain tissue changes of CTE. Chris Benoit had killed his wife and son before committing suicide
Chris Benoit double murder and suicide
The Chris Benoit double murder suicide occurred over a three-day period ending on June 24, 2007. World Wrestling Entertainment professional wrestler Chris Benoit killed his wife, Nancy Benoit, strangled his seven-year-old son, Daniel, and subsequently committed suicide by hanging. Autopsy results...

 by hanging at age 40. In 2008, the Sports Legacy Institute joined with the Boston University School of Medicine
Boston University School of Medicine
Boston University School of Medicine is one of the graduate schools of Boston University. Founded in 1848, the medical school holds the unique distinction as the first institution in the world to formally educate female physicians. Originally known as the New England Female Medical College, it was...

 (BUSM) to form the Center for the Study of Traumatic Encephalopathy (CSTE). Since then, autopsies of eleven professional American football players by neuropathologist Dr. Ann McKee found CTE in all cases. BU researchers also found CTE in an amateur football player, 21-year old University of Pennsylvania lineman Owen Thomas, following his suicide. Thomas was the second amateur football player diagnosed with CTE, after Mike Borich, who died at 42. Neuropathologists at Boston University
Boston University
Boston University is a private research university located in Boston, Massachusetts. With more than 4,000 faculty members and more than 31,000 students, Boston University is one of the largest private universities in the United States and one of Boston's largest employers...

 also diagnosed Reg Fleming
Reg Fleming
Reginald Stephen "Reggie, The Ruffian" Fleming, was a professional hockey player in the National Hockey League with the Montreal Canadiens, Chicago Black Hawks, Boston Bruins, New York Rangers, Philadelphia Flyers and Buffalo Sabres...

 as the first hockey player known to have the disease. This discovery was announced in December 2009, six months after Fleming's death.

On December 21, 2009, the National Football League Players Association announced that it would collaborate with the CSTE at the Boston University School of Medicine
Boston University School of Medicine
Boston University School of Medicine is one of the graduate schools of Boston University. Founded in 1848, the medical school holds the unique distinction as the first institution in the world to formally educate female physicians. Originally known as the New England Female Medical College, it was...

 to support the Center's study of repetitive brain trauma in athletes. Additionally, in 2010 the National Football League
National Football League
The National Football League is the highest level of professional American football in the United States, and is considered the top professional American football league in the world. It was formed by eleven teams in 1920 as the American Professional Football Association, with the league changing...

 gave the CSTE a $1 million grant with no strings attached. In 2008, twelve living athletes (active and retired), including hockey players Pat LaFontaine
Pat LaFontaine
Patrick Michael LaFontaine is an American former ice hockey center in the National Hockey League who spent his entire career playing for the league's New York-based teams; LaFontaine skated for the New York Islanders from 1983 until 1991, the Buffalo Sabres from 1991 until 1997, and the New York...

 and Noah Welch
Noah Welch
Noah Paul Welch is an American professional ice hockey defenseman who currently plays for HV71 in the Swedish elite league Elitserien while under contract to the Winnipeg Jets of the National Hockey League .-Playing career:...

 as well as former NFL star Ted Johnson
Ted Johnson
Ted Curtis Johnson is a former American football player in the National Football League. He grew up in Carlsbad, California where he graduated from Carlsbad High School in 1991. From there he attended the University of Colorado and was drafted by the Patriots in the second round of the 1995 NFL...

, committed to donate their brains to CSTE after their deaths. In 2009, NFL Pro Bowlers Matt Birk
Matt Birk
Matthew Robert Birk is an American football center for the Baltimore Ravens of the National Football League. He was drafted by the Minnesota Vikings in the sixth round of the 1998 NFL Draft. He played college football at Harvard....

, Lofa Tatupu
Lofa Tatupu
-Seattle Seahawks:Tatupu quickly established himself as one of the top defensive players in the league as a rookie in 2005, in which he was named to the Pro Bowl, while leading the NFC Champion Seahawks in tackles, with 104, en route to their first Super Bowl appearance in franchise history...

, and Sean Morey pledged to donate their brains to the CSTE. In 2010, 20 more NFL players pledged to join the CSTE Brain Donation Registry, including Chicago Bears linebacker Hunter Hillenmeyer
Hunter Hillenmeyer
Hunter Taverner Hillenmeyer is an American football linebacker who is currently a free agent. He was originally selected by the Green Bay Packers in the fifth round with the 31st pick of the 2003 NFL Draft. Hillenmeyer attended high school at Montgomery Bell Academy in Nashville...

, Hall of Famer Mike Haynes
Mike Haynes
Michael James Haynes is an American former National Football League cornerback who played for the New England Patriots and the Los Angeles Raiders. He used his speed, quickness and range to become both a premier defensive back and an outstanding punt return specialist.-Early years:Mike Haynes...

, Pro Bowlers Zach Thomas
Zach Thomas
Zachary Michael Thomas is a former American football linebacker. He was drafted by the Miami Dolphins in the fifth round of the 1996 NFL Draft. He played college football at Texas Tech....

, Kyle Turley
Kyle Turley
Kyle John Turley is a former American football offensive tackle of the National Football League, and current American recording artist. He was originally drafted by the New Orleans Saints seventh overall in the 1998 NFL Draft. He played college football at San Diego State.In addition to the...

, and Conrad Dobler
Conrad Dobler
Conrad Francis Dobler is a retired American football offensive lineman in the NFL.-Cardinals:Dobler was drafted in round 5 out of the University of Wyoming in the 1972 NFL Draft by the St. Louis Cardinals. He played right offensive guard for the Cardinals from 1972 to 1977, next to Hall-of-Famer...

, and Super Bowl Champion Don Hasselbeck
Don Hasselbeck
Donald William "Don" Hasselbeck is a former professional American football tight end in the National Football League for the New England Patriots, Los Angeles Raiders, Minnesota Vikings, and the New York Giants....

. In 2010, Professional Wrestlers Mick Foley and Matt Morgan also agreed to donate their brains upon their deaths. As of 2010, the CSTE Brain Donation Registry consists of over 250 current and former athletes.

The Center for the Study of Retired Athletes is also conducting a research study to learn if the dietary supplement Docosahexaenoic acid
Docosahexaenoic acid
Docosahexaenoic acid is an omega-3 fatty acid that is a primary structural component of the human brain and retina. In chemical structure, DHA is a carboxylic acid with a 22-carbon chain and six cis double bonds; the first double bond is located at the third carbon from the omega end...

 (DHA), a long-chain omega-3 fatty acid
Omega-3 fatty acid
N−3 fatty acids are essential unsaturated fatty acids with a double bond starting after the third carbon atom from the end of the carbon chain....

, affects signs and symptoms associated with cognitive impairment such as changes in brain function, memory and mental status, quality of life, and depression in retired NFL players aged 50 and older.

In February 2011, Dave Duerson committed suicide leaving text messages to loved ones asking that his brain be donated to research for CTE. The family got in touch with representatives of the Boston University
Boston University
Boston University is a private research university located in Boston, Massachusetts. With more than 4,000 faculty members and more than 31,000 students, Boston University is one of the largest private universities in the United States and one of Boston's largest employers...

 center studying the condition, said Dr. Robert Stern, a co-director of the research group. Dr. Stern said Duerson's was the first time he was aware of that such a request had been left by a suicide potentially linked to CTE. Stern and his colleagues found high levels of the protein tau in Duerson's brain. These elevated levels are indicative of CTE.

In July 2010, NHL enforcer Bob Probert died of heart failure. Before his death, he asked his wife to donate his brain to CTE research because it was noticed that Probert experienced a mental decline in his 40s. In March 2011, researchers at Boston University concluded that Probert had CTE upon analysis of the brain tissue he donated. He is the second NHL player from the program at the Center for the Study of Traumatic Encephalopathy to be diagnosed with CTE postmortem.

In July, 2011, Colt tight end John Mackey
John Mackey
John Mackey may refer to:*John Mackey , former American football tight end*John Mackey , founder and CEO of Whole Foods Market...

 died after several years of deepening symptoms of frontotemporal dementia
Frontotemporal dementia
Frontotemporal dementia is a clinical syndrome caused by degeneration of the frontal lobe of the brain and may extend back to the temporal lobe...

. BUSM was reported to be planning to examine his brain for signs of CTE. Also within a few months in 2011, the deaths of three hockey "enforcers" -- Derek Boogaard
Derek Boogaard
Derek Leendert Boogaard was a Canadian professional ice hockey left winger who played for the Minnesota Wild and the New York Rangers of the National Hockey League . He was of Flemish descent. Known primarily as a fighter and enforcer, his nicknames included "Boogeyman" and "The Mountie"...

 from a combination of too many painkillers and alcohol, Rick Rypien
Rick Rypien
Rick Joseph Rypien was a Canadian professional ice hockey forward who spent parts of six seasons in the National Hockey League with the Vancouver Canucks. After a major junior career of four years with the Regina Pats of the Western Hockey League, he was signed by the minor professional Manitoba...

, an apparent suicide, and Wade Belak
Wade Belak
Wade Belak was a Canadian professional ice hockey forward and defenceman. He was drafted 12th overall by the Quebec Nordiques in the 1994 NHL Entry Draft...

, who, as Rypien, had reportedly suffered from depression; and all with a record of fighting, blows to the head and concussions -- led to more concerns about CTE. Boogaard's brain was being examined by BUSM but no results had yet been released. One National Hockey League
National Hockey League
The National Hockey League is an unincorporated not-for-profit association which operates a major professional ice hockey league of 30 franchised member clubs, of which 7 are currently located in Canada and 23 in the United States...

 player known in part for leading "the thump parade", Shawn Thornton
Shawn Thornton
Shawn Thornton is a Canadian professional hockey forward for the Boston Bruins of the National Hockey League. He is known to be an enforcer.-Playing career:...

 of the Boston Bruins
Boston Bruins
The Boston Bruins are a professional ice hockey team based in Boston, Massachusetts, USA. They are members of the Northeast Division of the Eastern Conference of the National Hockey League . The team has been in existence since 1924, and is the league's third-oldest team and its oldest in the...

, mulled the "tragic coincidence" of the three recent league deaths and said their concurrence was just that, while defending the role of fighting on the rink.

Rick Martin
Rick Martin
Richard Lionel Martin was a Canadian professional ice hockey winger who played in the NHL with the Buffalo Sabres and Los Angeles Kings for 11 seasons between 1971 and 1982...

, best known for being part of the Buffalo Sabres
Buffalo Sabres
The Buffalo Sabres are a professional ice hockey team based in Buffalo, New York. They are members of the Northeast Division of the Eastern Conference of the National Hockey League .-Founding and early success: 1970-71—1980-81:...

' French Connection, was diagnosed with CTE after his brain was posthumously analyzed. Martin was the first documented case of an ice hockey player not known as an enforcer to have developed CTE; Martin was believed to have developed the disease primarily as a result of a severe concussion he suffered in 1977 while not wearing a helmet. The disease was low-grade and asymptomatic in his case, not affecting Martin's cognitive abilities; Martin died of unrelated causes in March 2011 at the age of 59.

BUSM has also found indications of links between ALS
ALS
ALS refers to amyotrophic lateral sclerosis, also known as Lou Gehrig's diseaseIt may also refer to:-Medicine:* Advanced life support, a level of medical training* Anterolateral system, part of the nervous system...

 and CTE in athletes who've participated in contact sports. Tissue for the study was donated by twelve athletes and their families to the CSTE Brain Bank at the Bedford, Massachusetts VA
United States Department of Veterans Affairs
The United States Department of Veterans Affairs is a government-run military veteran benefit system with Cabinet-level status. It is the United States government’s second largest department, after the United States Department of Defense...

 Medical Center.

American football

  • Mike Borich
  • Lou Creekmur
    Lou Creekmur
    Louis Creekmur was an NFL left offensive tackle/guard for the Detroit Lions from 1950-59. He was also used as a defensive lineman in critical situations...

  • Dave Duerson
    Dave Duerson
    David Russell Duerson was an American football safety in the National Football League who played for the Chicago Bears , the New York Giants , and the Phoenix Cardinals .-Early life:...

  • Shane Dronett
    Shane Dronett
    Shane Dronett was an American football defensive lineman, who played for the NFL's Denver Broncos, Detroit Lions and Atlanta Falcons between 1992 and 2002.-Early years:...

  • Cookie Gilchrist
    Cookie Gilchrist
    Carlton Chester "Cookie" Gilchrist was a gridiron football player in the American Football League and Canadian Football League.-Career:...

  • John Grimsley
    John Grimsley
    John Glenn Grimsley was an American linebacker in the National Football League who played for seven seasons for the Houston Oilers....

  • Chris Henry
  • Wally Hilgenberg
    Wally Hilgenberg
    Walter Hilgenberg was a professional American football player.Hilgenberg was born in Marshalltown, Iowa in 1942. His family moved to Wilton where he grew up and graduated from Wilton High School....

  • Terry Long
    Terry Long (American football)
    Terry Long was a National Football League offensive lineman. He played from 1984–1991 for the Pittsburgh Steelers....

  • Tom McHale
    Tom McHale (American football)
    Thomas McHale was an American offensive guard in the National Football League. During his career he played for the Tampa Bay Buccaneers , Philadelphia Eagles and Miami Dolphins...

  • Justin Strzelczyk
    Justin Strzelczyk
    Justin Conrad Strzelczyk was a former American football offensive lineman who played nine seasons in the NFL, all for the Pittsburgh Steelers from 1990–1998 and helped the team gain a Super Bowl berth. He can also be seen in the 1997 Adam Sandler music video, "The Lonesome Kicker"...

  • Owen Thomas
  • Andre Waters
    Andre Waters
    Andre Waters was an NFL defensive back who played for the Philadelphia Eagles and Arizona Cardinals from 1984 to 1995. Waters was regarded as one of the NFL's hardest-hitting defenders, serving as an integral part of one of the league's top defenses...

  • Mike Webster

External links

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