1 in 3 former NFL players believe they have CTE

More than 1 in 3 living former NFL players believe they have chronic traumatic encephalopathy (CTE), a neurological condition that stems from repeated head trauma. Whether they actually have it, though, cannot be confirmed while they are alive. The diagnosis requires a post-mortem brain examination.
The study by Mass General Brigham researchers, published Sept. 23 in the journal JAMA Neurology, included 1,980 former National Football League players who were part of the Football Players Health Study at Harvard University.
The study found that those who think they have CTE report many more cognitive problems than those who don’t think they have it. They also are more likely to report low testosterone, depression, headaches and chronic pain. Because those and other conditions can create cognitive problems even when there was no head injury, the symptoms may not be related to CTE, the researchers said.
The challenge is that without a definitive diagnosis — not possible during one’s life — other conditions that are treatable might not be considered if people assume they have CTE. So people will miss the chance to have troubling symptoms alleviated. Patients and their physicians should focus on what can be treated, the researchers said.
The study also found that of those who believe they have CTE, 25% reported frequent suicidal thoughts compared to 5% of former players who did not believe they have CTE. “While concerns about CTE are legitimate, treating comorbid conditions may alleviate symptoms and improve overall mood,” the researchers said in a news release.
“As complex human beings, our beliefs can exert a strong impact on our health,” said coauthor Dr. Ross Zafonte, president of Spaulding Rehabilitation and chief of the departments of Physical Medicine and Rehabilitation at Massachusetts General Hospital and Brigham and Women’s Hospital. Zafonte is also the principal investigator of the Football Players Health Study at Harvard. “The symptoms that raise CTE concerns are real and CTE concerns are valid, but it’s critical to understand that having persistent fears about this condition can take a toll on mental health. When these concerns discourage former NFL players from receiving effective treatments for other or interrelated conditions related to physical and emotional health, it’s our responsibility to intervene.”
Added first author Rachel Grashow, of the Harvard T.H. Chan School of Public Health, “A key takeaway from this study is that many conditions common to former NFL players such as sleep apnea, low testosterone, high blood pressure and chronic pain can cause problems with thinking, memory and concentration. While we wait for advances in CTE research to better address living players’ experiences, it is imperative that we identify conditions that are treatable. These efforts may reduce the chances that players will prematurely attribute symptoms to CTE which may lead to hopelessness and thoughts of self-harm.”
Interventions like weight loss, exercise, getting better sleep and cutting down on salt intake could all potentially improve brain function, according to senior author Dr. Aaron Baggish, a professor of medicine at the University of Lausanne in Switzerland and a senior faculty member of the Football Players Health Study and former director of the Cardiovascular Performance Program at the Massachusetts General Hospital Heart Center.
Among study limitations, the researchers said that 1 in 5 of those with perceived CTE had received a diagnosis of Alzheimer’s disease, vascular dementia or other dementia. The researchers couldn’t verify the diagnosis or its accuracy. And they noted that they were unable to determine the extent of suicidality, so it could be misclassified.
In July 2023, the National Institutes of Health reported in its “Research Matters” blog that blows to the head from football, boxing and soccer can cause traumatic brain injury.
“Studies of American football players have identified a serious consequence of repeated traumatic brain injuries. In a condition called chronic traumatic encephalopathy, or CTE, tangles of a protein called tau build up in the brain after repeated head impacts. The resulting brain damage is similar to that seen in Alzheimer’s disease,” the article said. “CTE can lead to dementia and eventually death.”
In a study published in Nature Communications, researchers from Massachusetts General Hospital and Boston University collected data from nearly three dozen studies that employed helmet accelerometers in youth, high school and college football players. The accelerometers measured speed, direction and number of direct head impacts. From that, the team of experts estimated the number and types of head blows a person might experience in a given football season playing a specific position.
They compared that to 631 brains that had been donated by former football players. They had averaged 12 years of football and died at around age 60. About 28% or 180 of them didn’t have evidence of CTE in their brains. Another 163 had low-stage CTE and 288 had high-stage CTE. “As seen in previous studies, the number of reported concussions wasn’t associated with CTE incidence or severity,” the study recap said.
But they noted that reducing the number and force of head impacts could have a significant impact on preventing CTE.