Giving Athletes A Heads-Up On Concussions

Football players take a lot of hits, but when does hard-headed play go too far? New research suggests that head trauma can do lasting damage. Two brain researchers talk about what happens in the brain when a player gets hit, and how athletes can better protect themselves.

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You're listening to SCIENCE FRIDAY from NPR News. I'm Ira Flatow.

It might be that we just hear more about them lately, but head injuries from sports activity seem to be on our radar screen more, from high school players suffering from concussions to those in the pros suffering life-long brain damage. New research says that the damage caused by repeated concussions can eat away at the brain, but how can you tell when the brain has had enough? A group of researchers at Boston University started a brain bank. They're studying brains donated by former football players to think about how to help people protect themselves. Our guests are Robert Stern, associate professor of neurology and co-director of the center for the study of traumatic encephalopathy at Boston University School of Medicine. He is also co-director of BU's Alzheimer's Disease Clinic and Research Program.

Thanks for being with us today, Dr. Stern.

Dr. ROBERT STERN (Boston University): It's a pleasure to be here.

FLATOW: Ann McKee is director of neuropathology at New England Virginia Medical Center. She is also an associate professor of neurology and pathology and director of the neuropathology core also at the Alzheimer's Disease Center. Thanks for being with us today, Dr. McKee.

Dr. ANN MCKEE (VA Medical Center): Thanks for being here. I mean, thank you for having me. I should just say that I'm at the VA Medical Center.

FLATOW: Oh, I'm sorry.

Dr. MCKEE: That's okay.

FLATOW: (Unintelligible) forget what I said. You're at the VA Medical Center.

(Soundbite of laughter)

Dr. MCKEE: Right.

FLATOW: Dr. Stern, so what is this disease called? Is it something new?

Dr. STERN: Well, it used to be referred to as Dementia Pugilistica or Punch-Drunk Syndrome. So it's actually nothing new. It's been around, described since 1928, in boxers. And so it had been thought of as being a relatively common thing in boxers for the last 80-plus years, but it's only in the last decade or two that the term chronic traumatic encephalopathy, or CTE, has been used to describe this same disease. And what it is, it's a progressive neurodegenerative disease that's similar to Alzheimer's disease but it's not all the same as Alzheimer's.

FLATOW: Hmm.

Dr. STERN: It's a unique disorder.

FLATOW: This is not something Muhammad Ali has?

Dr. STERN: Well, it could be. It definitely could be, because one of the things that is part of the disease in some people is movement problems and Parkinsonian features, as well as early memory and cognate difficulties, depression, impulse control problems and behavior change.

FLATOW: (Unintelligible) we've been calling it being punch-drunk for years, and now we have a real name that you've put to it.

Dr. STERN: That's right.

FLATOW: And Ann McKee, what do the changes look like in the brain?

Dr. MCKEE: Well, what you see in the brain is this tremendous deposition of a protein called TAU, T-A-U. And the TAU actually accumulates inside the nerve cell and it slowly builds up and stops the nerve cell from functioning properly. It interrupts its normal connections with other nerve cells and eventually the nerve cell dies. It's similar in some ways to Alzheimer's disease but it's definitely not Alzheimer's disease. It clinically sometimes looks like Alzheimer's disease but pathologically it's a unique disorder that we've only seen in individuals that have repetitive head trauma.

FLATOW: Do we know, Dr. Stern, how to recognize this?

Dr. STERN: Well, I wish I could tell you that we could recognize it in someone while they're alive and to be definitive about it, but we don't yet. We're really in the infant stages of understanding the disease. We do know that there is that triad of the early symptoms, of memory problems, depression and impulse control difficulties in someone who does have a history of repetitive head trauma, and that these problems start years or decades after the person stopped playing their contact sport. So it's not something that is just a cumulative effect of a bunch of head trauma.

It is this disease that gets put in place, a cascade of events in the brain that gets started while someone is hurting their head in sports, for example, and then it continues to develop the degenerative problems that Dr. McKee was referring to.

FLATOW: I see that's why you say you think Ali might be subject to this because it did happened years later.

Dr. STERN: Exactly. That's right.

FLATOW: Yeah. And now, Dr. Stern, you're collecting brains. Is that correct?

Dr. STERN: Well, yeah. The brains are actually being collected in Dr. McKee's brain bank at the Bedford VA Medical Center, and we as a team, in our Center for the Study of Traumatic Encephalopathy, are looking at this disease from all different perspectives, from looking at the brain tissue, at the brain bank, to following a large group of athletes through the course of their life and seeing what their symptoms are like, what the course of the clinical presentation is, and then all these athletes will be donating their brains and spinal cord tissue after they pass away.

FLATOW: And Dr. McKee, how do you get them to do this, to do donate those brains?

Dr. MCKEE: Well, it's been - well, what we do is we call up as soon as we hear in the news that a prominent athlete has died. I mean, basically we ask for the brain of every athlete that we know of that's died and we look on the Web and follow the news stories and if we see an athlete that died, we try to contact the family and ask them if they'd willing to participate in this study. Because it was often a cold call, it's - you know, they don't know us, we don't know them�

FLATOW: Yeah.

Dr. MCKEE: �it's been very helpful for - for all the publicity that we've been getting in the media, and especially the support of some active players, like - like the three Pro Bowl players that recently donated their brain, or have signed up to donate their brain when they die. Getting participants like that makes it more likely that when we call these individuals or the families of these individuals after they die, that will consider donating their brains.

FLATOW: And anybody we would know so far?

Dr. MCKEE: Well, they've all been prominent players. Not all of them played in this decade though, so in the '60s there was Walter Hilgenberg, Louis Creekmur, they were all quite famous athletes in their day.

FLATOW: Uh-huh.

Dr. STERN: Creekmur was a Hall of Famer. And then unfortunately we've had some younger who were prominent themselves. John Grimsley died at age 45 just a few - just two years ago. Tom McHale was a Tampa Bay Buccaneer. He died also at age 45. So we have these people who have been pretty prominent athletes who - several of whom passed away early in their life from very tragic circumstances.

FLATOW: Is it - Ann and Robert, is it just athletes then, or are there other people?

Dr. MCKEE: No. Absolutely not. It's anybody who suffers repetitive head trauma, and in the literature you'll see that there have been epileptics, there have been assaults' victims, there have been victims of domestic abuse. And we're concerned that what we're seeing in the athletes may be much more generalizable to the greater population, especially individuals like our military veterans and our soldiers who suffer repetitive head injury.

FLATOW: How about all these, you know, professional wrestlers we see on TV?

Dr. STERN: Well, in fact, the person who really got this effort started is a gentleman by the name of Chris Nowinski, who is one of co-directors of our center. Chris started the Sports Legacy Institute. He was a Harvard football player who went on to be a professional wrestler in the WWE, and unfortunately a culmination of concussions he had while playing football at Harvard and then also while being a wrestler - even though it looks fake, it's really major hits these wrestlers take, and he had to stop his athletics at that point because he was quite impaired due to the repetitive concussions. He then made it his real-life mission to try to let the world know how important sports-related head trauma is. But if you'll remember the case of Chris Benoit.

FLATOW: Mm-hmm.

Dr. STERN: He's the very famous World Wrestling Entertainment wrestler who tragically killed his wife and child and then killed himself. Initially, it was believed that it was steroids, you know, steroid rage, that caused him to act so completely out of character. And, in fact, what happened was that when his brain was examined by the Sports Legacy Institute people, it turned out he had extensive evidence of CTE.

FLATOW: Wow.

Dr. STERN: Likely that his behavior was caused by this degenerative brain disease.

FLATOW: What do we tell to parents whose kids are playing football and getting hit on the head?

Dr. STERN: That's a great question. I wish we could tell them for sure it's safe to play in all circumstances, or here's the specific things you have to be careful of. We don't know for sure, but we have to let people know. Parents know, coaches, the players themselves, we have to let them know that the brain is a very delicate part of our body. And that every time someone gets dinged or they see stars or they have their, quote, their �bell rung,� those are concussions.

And even the times when someone doesn't have a specific clinical symptom like the concussion, they may be hurting their brain inside that hard skull anyways.

FLATOW: Would they be doing that in soccer, a header, you know, hitting the ball with your head?

Dr. STERN: Well, we don't know for sure yet. You know, it used to be when soccer started, there was a much harder leather ball, and that was probably doing a lot of damage. But, yes, it is very possible that heading might be doing some kind of sub-concussive blow to the brain, but we don't know for sure.

FLATOW: Your message is be aware. Don't just send your kid out after some sort of head banging going on in football.

Dr. STERN: Be very aware. Make sure the kid does not return to play if they've hurt their head in any case, and seek medical attention. And take a very careful step-wise return not just to the playing of the sport, but also to even, you know, text messaging and doing things intellectually that can be harmful to their brains while they're still recovering from a concussion.

FLATOW: And, Dr. McKee, if you have athletes who want to participate in donations, how should they reach you?

Dr. MCKEE: Well, they can look on the Web site either the Boston University Alzheimer's Disease Center and look for the Center for the Study of Traumatic Disease, or you can look on the Sports Legacy Institute Web site. Both areas will have individuals to contact and we'd be extremely interested in any participants out there.

FLATOW: How expansive is your collection at this point?

Dr. MCKEE: Well, right now, we've had over 20 athletes donate their brain. We've had - we've examined the brains of seven football players. And as we get more attention to this problem, we seem to be becoming - you know, we have a faster and faster rate of collecting brains.

FLATOW: Mm-hmm.

Dr. STERN: Those are the brains of players who have passed away that we actually have their brain tissue. Right now, we have approximately 200 athletes, both professional and college, retired or active, who have agreed to participate in our longitudinal research study. And after they pass away, they'll be donating their brains.

FLATOW: Mm-hmm.

Dr. STERN: And right now, what they're doing is participating in an annual telephone examination of what their symptoms are along with what their past medical and concussion history is.

FLATOW: All right. So you're getting cooperation, I guess, from both the NFL and the NCAA and people like that.

Dr. STERN: Well, we�

(Soundbite of laughter)

Dr. STERN: I wouldn't necessarily say we're getting cooperation from the leagues. We're getting tremendous cooperation from the athletes. There have been some really fabulous athletes all around the country who have said, you know, enough is enough. We need to take this thing seriously, and anything I can do to help the researchers figure out what this disease is all about, I'll be glad to help.

FLATOW: Well, thank you both for taking time to be with us and talking about this. We'll get a little bit more publicity about this after this program is over, I can assure you. Thank you.

Dr. MCKEE: Thank you.

Dr. STERN: Thank you.

FLATOW: Dr. Robert Stone(ph) and Dr. Ann McKee, talking about this new kind of illness for the brains.

We're going to take a short break and come back and talk lots more about ethics, the ethics of all this what's going on in Congress with health care. So stay with us. We'll be right back after this break.

I'm Ira Flatow. This is SCIENCE FRIDAY from NPR News.

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