BRIAN E. MOORE, M.D.: An NFL player's suicide resurfaces questions over the long-term effects of playing football that could include repeated traumatic brain damage or chronic traumatic encephalopathy, which could play a role in dementia or depression.
"You know, football is a violent game. People hit hard. You put a helmet on somebody and the helmet becomes a security blanket.... I don't want to say that [the helmet] is a weapon but it makes you have no fear of striking with your head." That's what former Chicago Bears Football Coach Mike Ditka had to say to a CNN interviewer recently in the aftermath of the suicide of yet another former NFL player.
Dave Duerson, a former Chicago Bears defensive back, fatally shot himself in the chest on Feb. 17. In an accompanying suicide note, he wrote: "Please, see that my brain is given to the NFL's brain bank."
The NFL brain bank is located at Boston University Medical Center, where researchers study the brains of former football players for evidence of damage. Duerson's suicide is one in a series of self-inflicted deaths by former football players, and again raises the question of whether repeated traumatic brain damage, known as chronic traumatic encephalopathy (CTE), has played a role in the depression and dementia that so many former football players have suffered.
Although concussions can occur in a variety of sports, special attention has been given to the incidence of CTE in two sports in particular: boxing and football. That's because repeated head trauma is intrinsic to these sports, both in games and in practices, rather than a result of an occasional accident. Researchers at the Boston University CTE Brain Bank are finding that the incidence of CTE among football players is higher than has been previously recognized. These findings, in turn, bring into question the risks being incurred by school-aged children who play the game of football.
What exactly is Chronic Traumatic Encephalopathy? It's a clinical syndrome, which includes memory problems, depression, gait difficulties, slurred speech, and other neurological signs. Microscopic examination at autopsy reveals that brains with CTE harbor a large number of tangles, similar to the tangles seen in Alzheimer's disease (see photograph on the right). But CTE does not show other pathologic features of Alzheimer's disease, and is therefore a distinct disease. Examination of brains of similar-aged control subjects who were not subjected to repeated head trauma does not show these abnormal tangles.
When asked by the CNN interviewer whether traumatic brain injury can be avoided in football, Ditka answered with resignation: "Can they stop it? I doubt it... The better the equipment, the less fear you have of hitting with it, especially with the helmet. I mean it is what it is. I don't know how you're going to change it, because it's part of the game of football. You know, you're taught from the time that you're a kid: you strike, you keep your head up, you stick your head into the opponent and basically that's what happens."
It appears that Duerson purposely shot himself in the chest, rather than the head, so that researchers could examine his brain for evidence of CTE. Even though Duerson felt that his life was no longer worth living, there was some spark of hope within him that the injuries he sustained could help future players avoid a similar fate, whether they are pee-wee or big league players. For that, we should honor Duerson and the legacy he has left behind.
An Illinois House committee has approved legislation that would tighten the rules for high school athletes who suffer concussions, preventing players from returning to a game unless cleared by a licensed physician. House Bill 200 also requires school districts to adopt concussion awareness and treatment policies. There's no doubt in my mind that Duerson would be in favor of this legislation, and I would urge the Illinois House of Representatives to pass the measure.
Brian E. Moore, M.D., is a Memorial Medical Center neuropathologist.
News stories on head injuries:
ASSOCIATED PRESS: Bill would help protect athletes with concussions
ASSOCIATED PRESS: NFL urges states to pass youth concussion laws
CNN: NFL to require sideline test after head blows
AP: 'Virtual biopsy' may detect athletes' brain injury
THE STATE JOURNAL-REGISTER: Local trainers sold on the merits of impact system for concussions