Autopsies of athletes detail brain damage

Unique patterns of accumulated tau protein differ from Alzheimer’s disease.

Bennet Omalu, UC Davis

The brain damage found in a growing number of professional football players has been described in detail by a UC Davis Medical Center researcher and colleagues in the July issue of Neurosurgery. The pattern of protein tangles and plaques in chronic traumatic encephalopathy (CTE) is distinct from those in Alzheimer’s patients, they report, pointing the way toward an objective diagnosis of the disease.

“The first thing is to identify the disease, give it a name, and identify its pathology. We’ve done that,” said Bennet Omalu, associate clinical professor of pathology at UC Davis Medical Center and co-director of the Brain Injury Research Institute at West Virginia University. Omalu was the first to describe CTE in 2002, after examining the brain of former Pittsburgh Steelers football player Mike Webster.

CTE is thought to be caused by blunt force impacts to the head. It can take years to manifest as behavioral and personality changes, including memory loss and mood disorders. These can progress to serious cognitive impairment, culminating in early dementia.

“We’re seeing CTE in any activity that subjects your brain to repeated acceleration and deceleration,” Omalu said.

In the current study, Omalu and colleagues detailed histological examinations of the brains of 17 athletes who played contact sports, including eight professional football players, four professional wrestlers and three high school football players. All had died suddenly from suicide, drug abuse or in accidents. The researchers diagnosed CTE in 10 of the 14 professional athletes, and one high school football player.

The study revealed important differences between CTE and Alzheimer’s disease. Subjects with CTE had tangles of tau proteins in their brains that were similar to those seen in later-stage Alzheimer’s patients. However, these tangles occurred in a very different pattern. While the tangles in Alzheimer’s patients are scattered throughout the brain, those in the athletes exhibited a “skip phenomenon:” The tangles occurred in some areas of the cerebral cortex but were absent in others within the same lobe. In addition, the brains of the athletes did not show the classic neuritic amyloid plaques or the widespread cerebral atrophy characteristic of Alzheimer’s disease. Finally, the subjects diagnosed with CTE ranged from 18 to 52 years old, whereas Alzheimer’s disease typically does not occur until after age 60.

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