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Absence of chronic traumatic encephalopathy in retired football players with multiple concussions and neurological symptomatology

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Hazrati, Lili-Naz, Tartaglia, Maria C., Diamandis, Phedias, Davis, Karen D., Green, Robin E., Wennberg, Richard, Wong, Janice C., Ezerins, Leo +1 more·2013·Frontiers in Human Neuroscience
DOI 10.3389/fnhum.2013.00222PMC PMC3662898
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Abstract

BACKGROUND: Chronic traumatic encephalopathy (CTE) is the term coined for the neurodegenerative disease often suspected in athletes with histories of repeated concussion and progressive dementia. Histologically, CTE is defined as a tauopathy with a distribution of tau-positive neurofibrillary tangles (NFTs) that is distinct from other tauopathies, and usually shows an absence of beta-amyloid deposits, in contrast to Alzheimer's disease (AD). Although the connection between repeated concussions and CTE-type neurodegeneration has been recently proposed, this causal relationship has not yet been firmly established. Also, the prevalence of CTE among athletes with multiple concussions is unknown. METHODS: We performed a consecutive case series brain autopsy study on six retired professional football players from the Canadian Football League (CFL) with histories of multiple concussions and significant neurological decline. RESULTS: All participants had progressive neurocognitive decline prior to death; however, only 3 cases had post-mortem neuropathological findings consistent with CTE. The other 3 participants had pathological diagnoses of AD, amyotrophic lateral sclerosis (ALS), and Parkinson's disease (PD). Moreover, the CTE cases showed co-morbid pathology of cancer, vascular disease, and AD. DISCUSSION: Our case studies highlight that not all athletes with history of repeated concussions and neurological symptomology present neuropathological changes of CTE. These preliminary findings support the need for further research into the link between concussion and CTE as well as the need to expand the research to other possible causes of taupathy in athletes. They point to a critical need for prospective studies with good sampling methods to allow us to understand the relationship between multiple concussions and the development of CTE.

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  • It is well established that a large percentage of former athletes identified as having CTE neuropathology also have neuropathology associated with age related neurodegenerative diseases such as AD, PD, Lewy body disease, hippocampal sclerosis, and ALS to the extent that they meet full neuropathological criteria for an alternative, well-characterized neurodegenerative disease.

    “It is now well established that a large percentage of former athletes identified as having CTE neuropathology also have neuropathology associated with age related neurodegenerative diseases such as AD, PD, Lewy body disease, hippocampal sclerosis, and ALS [14, 41–44] to the extent that they meet full neuropathological criteria for an alternative, well-characterized neurodegenerative disease [16].”

    From The Need to Separate Chronic Traumatic Encephalopathy Neuropathology from Clinical Features (2017) · cites this paper as [41]

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  • CTE-consistent pathology has been reported in cases with no history of head trauma, indicating that it may be a common pathology within the general population and not specific to the aftermath of mTBI.

    “It is also important to note that CTE-consistent pathology has been reported in cases with no history of head trauma, further indicating that it may be a common pathology within the general population and not specific to the aftermath of mTBI [55, 69, 89, 119].”

    From DNA repair deficiency and senescence in concussed professional athletes involved in contact sports (2019) · cites this paper as [55]

  • In different autopsy series, the percentage of former professional American football players who have died and donated their brains to research varies from 50%, 80%, to 97%.

    “In different autopsy series, the percentage of former professional American football players who have died and donated their brains to research varies from 50 % [88], 80 % [146], to 97 %) [128].”

    From The neuropathology of sport (2014) · cites this paper as [88]

  • CTE has been diagnosed neuropathologically in American football players, professional and amateur boxers, ice hockey players, professional wrestlers, soccer players, rugby players, and a professional baseball player.

    “Although CTE was first identified in association with boxing, CTE has been diagnosed neuropathologically in American football players, professional and amateur boxers, ice hockey players, professional wrestlers, soccer players, rugby players, and a professional baseball player (Figs. 3, 4, 5, 6) [38, 65, 66, 88, 91, 127, 128, 146–148].”

    From The neuropathology of sport (2014) · cites this paper as [88]

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Authors
Hazrati, L.-N., Tartaglia, M. C., Diamandis, P., Davis, K. D., Green, R. E., Wennberg, R., Wong, J. C., Ezerins, L., & Tator, C. H.
Affiliations
  • University of Toronto (CA)
  • University Health Network (CA)
Corresponding author
Hazrati, Lili-Naz
ORCID
Venue
Frontiers in Human Neuroscience
Publisher
Frontiers Media SA
Published
2013
Volume
7
Pages
222-222
ISSN
1662-5161 (ISSN-L)
DOI
10.3389/fnhum.2013.00222
PMC
PMC3662898
OpenAlex
W2127938589
Cited by
146
References
27
Citations by year
2026: 1 · 2025: 2 · 2024: 8 · 2023: 7 · 2022: 10 · 2021: 6 · 2020: 7 · 2019: 10 · 2018: 15 · 2017: 16 · 2016: 17 · 2015: 26 · 2014: 13 · 2013: 7
FWCI
15.33
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Frontiers in Human Neuroscience (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • eScholarship@McGill (McGill) (submittedVersion)
  • eScholarship@McGill (McGill) (submittedVersion, cc-by)
Funders
Physicians' Services Incorporated Foundation
Topics
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
  • Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
  • Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
Keywords
chronic traumatic encephalopathy, repeated concussions, Canadian Football League, tauopathy, neurofibrillary tangles, Alzheimer's disease, amyotrophic lateral sclerosis, Parkinson's disease, postmortem neuropathology, neurocognitive decline

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