Researchers have found the hallmarks of chronic traumatic encephalopathy spread throughout the brain of a 25-year-old former college football player who sustained more than 10 concussions during some 16 years of playing football.
The discovery, reported Monday in the journal JAMA Neurology, appears to reflect the youngest-ever patient diagnosed after death with widespread CTE -- degenerative brain changes accompanied by a range of neuropsychiatric symptoms that are linked to repeated blows to the head.
The authors of the latest report note that the brains of athletes as young as 17 have shown "focal lesions" -- limited and isolated spots of clumped proteins -- that suggest CTE. But they wrote that "widespread CTE pathology ... is unusual in such a young football player." Most of the former athletes whose brain autopsies have revealed widespread CTE have been between 45 and 80.
The young man died of cardiac arrest resulting from a staph infection of the tissues surrounding the heart. His case is unusual in that before his death, he appears to have enrolled in a research study called Understanding Neurological Injury and Traumatic Encephalopathy (UNITE), part of an effort to recognize the signs of CTE in living persons.
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As a result, researchers have detailed results of neuropsychological testing performed on the young man before his death. That testing shows that he was readily able to remember and describe key memories from his past experience and his overall levels of intellectual function were normal. But his short-term memory and some elements of executive function were noticeably impaired.
That testing came in the wake of behavior that closely resembled that seen in several athletes who were found after their deaths to have brains riddled with clumps of tau protein, which is a hallmark both of Alzheimer's dementia and of chronic traumatic encephalopathy.
The young man, who had a family history of depression and addiction, was described as apathetic and joyless, and had sleep problems and low appetite. He had been playing contact football -- as a defensive linebacker and special teams player -- since he was 6, ending his career as a sophomore at a Division I college football program.
After he began failing courses, he left college just short of earning a degree, and had difficulty maintaining a job. He smoked marijuana daily to relieve his headaches and anxiety, and had become verbally and physically abusive toward his wife.
The authors of the report, led by Boston University neurologist Dr. Ann C. McKee, note that it was impossible to discern whether the young man's cognitive profile and his behavior was an early sign of CTE, or possibly just of depression. It was, at least, consistent with a diagnosis of post-concussive syndrome.
Nevertheless, the authors of the report called it "instructive." They suggested that along with other cases from the UNITE study, the findings might help focus future efforts to discern the early signs of CTE in living individuals who might still make changes -- such as quitting contact sports -- before more damage is done.