Study Raises Questions about Long-Term Consequences to Brain Health of Young Athletes in Contact Sports

A JAMA Neurology study found that young contact sports athletes could be at risk for neurogenerative diseases

A recent study published in JAMA Neurology found that young contact sports athletes may be at risk for long-term neuropathologic disorders, including chronic traumatic encephalopathy (CTE), a progressive and fatal brain disease associated with repetitive head impacts (RHI). The study, which examined the brains of 152 deceased contact sports (including football, soccer, hockey, rugby, and wrestling) participants younger than 30 years old at the time of death, CTE was found in 63, or 41.4 percent.

“What is newsworthy about this is that there has not been a study like this before,” said Brent Masel, MD, national medical director with the Brain Injury Association of America (BIAA). “These weren’t 50-year-old retired NFL players. These were people who played competitive sports for a relatively short period of time.” Of the 63 athletes with CTE, 71 percent played only as high as the high school or collegiate level.

Regardless of whether or not CTE was found, all of the participants in the study had, prior to their death, demonstrated behavioral changes consistent with those seen in older individuals later diagnosed with CTE. Interviews with their family members found that problems with depression and apathy were noted in about 70 percent, and that neurobehavioral changes such as executive dysfunction and impulse control issues were common.

Every participant in the study, with or without CTE, had aspects of traumatic encephalopathy syndrome – the clinical syndrome associated with CTE – which include cognitive impairment, especially episodic memory and executive dysfunction, and neurobehavioral dysregulation, such as impulsivity, explosivity, and emotional dysregulation.

And while Masel acknowledged the convenience sampling of the brains studied, such as the fact that the families of the deceased who donated the brains noticed something was wrong with their loved ones prior to their deaths or the high number of deaths attributed to suicide and accidental overdose, which could indicate pre-existing mental health disorders, the incidence of CTE was much more prevalent than he would have ever anticipated.

“This is a three alarm reading if you are an adult responsible for protecting young athletes,” shared Greg O’Shanick, MD, medical director emeritus with BIAA, in a recent blog post titled New CTE Anxieties in Youth Contact Sports.

RHI and length of time involved in playing a contact sport appeared to have an association with developing CTE, CTE was seen in even amateur athletes, and prevalence of CTE appeared higher in professional athletes, with 11 of 12 professional football players studied diagnosed with CTE.

The report published in JAMA notes that not all individuals exposed to RHIs will develop CTE, and 89 donors (58.6 percent) in this sample did not have CTE. Still, those who work with or treat young athletes, including coaches, athletic directors, trainers, and school nurses, as well as parents of young athletes, should take precautions to minimize the risk of repeated head trauma.

O’Shanick offered several suggestions for ways that adults can better protect youth in contact sports:

• Creating structure and guidance for impact exposures, such as non-contact drills;
• Implementing age restrictions on full contact and number of head impacts;
• Aggressively enforcing safety requirements with significant consequences to responsible adults, schools, and systems for infractions; ensure all equipment is adequately fitted and utilized safely; and
• Enforcing limits on head impacts experienced.

The full study can be found at https://jamanetwork.com/journals/jamaneurology/fullarticle/2808952.