Brain Trauma Increases Risk For Parkinson’s Disease

Concussions Contribute To Neurodegenerative Disorders

By Nicholas Bakalar, New York Times

A traumatic brain injury, even a mild concussion, increases the risk for Parkinson’s disease, a new study reports.

Researchers identified all patients diagnosed with T.B.I. in a Veterans Health Administration database — 162,935 men and women — and matched them with the same number of people with similar health and behavioral characteristics but who had not had a brain injury. The study is in Neurology.

Of the T.B.I. cases, half were mild, involving a blow to the head with some subsequent symptoms but with little or no unconsciousness. The rest were moderate to severe, involving extended unconsciousness or long-term symptoms.

Muhammad Ali fighting Parkinson's

After controlling for age, race, income and many medical and psychiatric diseases, they found that compared with those who had had no T.B.I., those with a mild T.B.I. had a 56 percent increased risk for Parkinson’s disease; those with moderate to severe T.B.I. had an 83 percent increased risk.

“We don’t have brain autopsies, so we don’t know what the underlying biology is,” said the lead author, Dr. Raquel C. Gardner, an assistant professor of neurology at the University of California, San Francisco. “But in Parkinson’s you see abnormal protein accumulation, and there’s some evidence that T.B.I. is linked to deposits of these abnormal proteins. This study provides the most definitive evidence that there is this association.”

Read The Full Article About TBI and Neurological Disorders.

The new findings could be problematic for the increasingly-embattled NFL, which has spent years – and billions of dollars – trying to dismiss the idea that tackle football is not as dangerous to players as scientists claim.  The findings come amid a huge swell in research showing that attempts to curb the rate of concussions may not be enough: even subconcussive hits, or just one debilitating hit, could sew the seeds for crippling neurodegenerative diseases including CTE, Alzheimer’s and Parkinson’s.

Chronic Traumatic Encephalopathy

“Previous research has shown a strong link between moderate to severe traumatic brain injury and an increased risk of developing Parkinson’s disease but the research on mild traumatic brain injury has not been conclusive, said Senior study author Professor Kristine Yaffe, of the University of California, San Francisco. “Our research looked at a very large population of U.S. veterans who had experienced either mild, moderate or severe traumatic brain injury in an effort to find an answer to whether a mild traumatic brain injury can put someone at risk.”

Moderate to severe traumatic brain injury was defined as a loss of consciousness for more than 30 minutes, alteration of consciousness of more than 24 hours or amnesia for more than 24 hours.

Mild traumatic brain injury was defined as loss of consciousness for zero to 30 minutes, alteration of consciousness of a moment to 24 hours or amnesia for zero to 24 hours.

The researchers identified 325,870 veterans from three US Veterans Health Administration medical databases. Half of the study participants had been diagnosed with either a mild, moderate or severe traumatic brain injury and half had not.

The study participants, who ranged in age from 31 to 65, were followed for an average of 4.6 years. At the start of the study, none had Parkinson’s disease or dementia. All traumatic brain injuries were diagnosed by a physician.

A total of 1,462 of the participants were diagnosed with Parkinson’s disease at least one year and up to 12 years after the start of the study. The average time to diagnosis was 4.6 years.

A total of 949 of the participants with traumatic brain injury (0.58 percent) developed Parkinson’s disease, compared to 513 of the participants with no traumatic brain injury (0.31 percent).

A total of 360 out of 76,297 with mild traumatic brain injury (0.47 percent) developed the disease and 543 out of 72,592 with moderate to severe traumatic brain injury (0.75 percent) developed the disease.

After researchers adjusted for age, sex, race, education and other health conditions such as diabetes and high blood pressure, they found that:

  • Those with any kind of traumatic brain injury had a 71 percent increased risk of Parkinson’s disease;
  • Those with moderate to severe traumatic brain injury had an 83 percent increased risk, and those with mild traumatic brain injury had a 56 percent increased risk of Parkinson’s; and
  • Researchers found that those with any form of traumatic brain injury were diagnosed with Parkinson’s disease an average of two years earlier than those without traumatic brain injury.

“This study highlights the importance of concussion prevention, long-term follow-up of those with concussion, and the need for future studies to investigate if there are other risk factors for Parkinson’s disease that can be modified after someone has a concussion,” said study lead author Assistant Professor Raquel Gardner, also of the University of California, San Francisco. “While our study looked at veterans, we believe the results may have important implications for athletes and the general public as well.”

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Ken Stabler Added To Growing List Of CTE Victims

Brain Disease Found In Former Quarterback

By John Branch, New York Times

Shortly before he died in July, the former NFL quarterback Ken Stabler was rushed away by doctors, desperate to save him, in a Mississippi hospital. His longtime partner followed the scrum to the elevator, holding his hand. She told him that she loved him. Stabler said that he loved her, too.

Ken Stabler CTE

“I turned my head to wipe the tears away,” his partner, Kim Bush, said recently. “And when I looked back, he looked me dead in the eye and said, ‘I’m tired.’ ”

They were the last words anyone in Stabler’s family heard him speak.

“I knew that was it,” Bush said. “I knew that he had gone the distance. Because Kenny Stabler was never tired.”

The day after Stabler died on July 8, a victim of colon cancer at 69, his brain was removed during an autopsy and sent to scientists in Massachusetts. It weighed 1,318 grams, or just under three pounds. Over several months, it was dissected for clues, as Stabler had wished, to help those left behind understand why his mind seemed to slip so precipitously in his final years.

On the neuropathologist’s scale of 1 to 4, Stabler had high Stage 3 chronic traumatic encephalopathy, or CTE, the degenerative brain disease believed to be caused by repeated blows to the head, according to researchers at Boston University. The relationship between blows to the head and brain degeneration is still poorly understood, and some experts caution that other factors, like unrelated mood problems or dementia, might contribute to symptoms experienced by those later found to have had CTE.

CTE and football players

Stabler, well known by his nickname, the Snake, is one of the highest-profile football players to have had CTE. The list, now well over 100 names long, includes at least seven members of the Pro Football Hall of Fame, including Junior Seau (above), Mike Webster and Frank Gifford.

Frank Gifford CTE

Few, if any, had the free-spirited charisma of Stabler, a longhaired, left-handed quarterback from Alabama who personified the renegade Oakland Raiders in the 1970s. Stabler was the NFL’s most valuable player in 1974 and led the Raiders to their first Super Bowl title two seasons later. He ended his 15-year NFL career with the New Orleans Saints in 1984.

“He had moderately severe disease,” said Dr. Ann McKee, chief of neuropathology at the V.A. Boston Healthcare System and a professor of neurology and pathology at Boston University School of Medicine, who conducted the examination. “Pretty classic. It may be surprising since he was a quarterback, but certainly the lesions were widespread, and they were quite severe, affecting many regions of the brain.”

Quarterbacks are provided more protection from hits than most football players, but they still take wicked blindside hits. An offensive line’s purpose is, in part, to protect the quarterback, and leagues like the NFL have special rules to discourage severe blows to players in the most important position on the field.

CTE brain

But Stabler’s diagnosis further suggests that no position in football, except perhaps kicker, is immune from progressive brain damage linked to hits to the head, both concussive and subconcussive.

Stabler is the seventh former NFL quarterback found to have had CTE by Boston University, which says it has found CTE in 90 of the 94 former NFL players it has examined, including the former Giants safety Tyler Sash, who died at 27 in September and whose diagnosis was made public last week.

On Wednesday, the family of another Super Bowl quarterback, Earl Morrall, told The New York Times that Morrall was found to have Stage 4 CTE after his death in 2014 at age 79.

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Read The Full Story About CTE


Tony Dorsett Battling Neurodegenerative Disorder

Hall-Of-Famer Taking Disease In Stride

Editor’s Note: Chronic encephalopathy is very similar to Alzheimer’s and Creutzfeldt-Jakob disease. In fact, all are part of a family of diseases known as Transmissible Spongiform encephalopathies (TSE). When lumped together, these diseases are part of a protein epidemic that is killing millions of people around the globe, wildlife across North America and an unknown number of livestock. The causes of the diseases are numerous, but new pathways are evolving due to global mismanagement of the contagion and the victims. That’s why the family of diseases includes the word “transmissible.”

Tony Dorsett, the Dallas Cowboys’ Hall of Fame running back, received the news he suspected was coming on Monday. He has brain disease.

Tony Dorsett CTE

“It hit me like a ton of bricks,” he told reporters on Wednesday that tests at UCLA show he has signs of chronic encephalopathy, the degenerative brain disease that has been linked to head trauma, depression, dementia and suicide in former NFL players.

Hall of Fame offensive lineman Joe DeLamielleure and former All-Pro defensive lineman Leonard Marshall received the news from researchers after having brain scans and clinical evaluations at UCLA. Another player also was tested, although those results and his identity are not yet available. Last year, UCLA tested five other former players, according to ESPN, and found signs of CTE in all of them. CTE is marked by an abnormal presence of tau protein, which strangles brain cells.

“Don’t ask me what tau protein is because I don’t know exactly what it all is,” Dorsett said. “All I know is that before, [doctors] could only be able to find tau if you die first and they open up your brains.”

Dorsett was part of the recent $765 million settlement between the NFL and more than 4,500 former players. For Dorsett, a Heisman Trophy winner at Pitt who rushed for 12,739 yards over 12 NFL seasons, it wasn’t so much the big knockout hits as the thousands of little ones that many scientists believe may be even more pernicious.

Dorsett, 59, told “Outside the Lines” that his “quality of living has changed drastically and it deteriorates every day.” He gets lost just driving two of his daughters, aged 15 and 10, to their games. More frightening are his temperamental outbursts and his inability to control his emotions.

“It’s painful, man, for my daughters to say they’re scared of me,” he said, pausing as he choked up. “It’s painful.”

Like so many others in a story that is all too common, he has been told he is clinically depressed. And he thinks of the suicides of Junior Seau, Dave Duerson and Ray Easterling. All had CTE.

CTE and football players

“I’ve thought about crazy stuff, sort of like, ‘Why do I need to continue going through this?’” he said. “I’m too smart of a person, I like to think, to take my life, but it’s crossed my mind.”

He told the Morning News that he’s facing the diagnosis and fighting it with nutrition. “It’s enlightening to know what I have, what I’m dealing with,” Dorsett said. “Now it’s time to find out, how can we can come back from it? I actually was told [by researchers] that it can be reversed. I was like, ‘What?’ They said, ‘Yeah, it can be reversed, slowed down, stopped.’ I’m like, ‘Oh, okay, so we need to get on out of here and get on that program immediately. …

“I’m being proactive. I’m trying to cut it off at the pass, slow it down, do whatever I can to fight this thing. But it’s tough, man, it’s frustrating as hell at times.”


Brain Injuries and Football Explored On PBS

CTE Rising Among Many Athletes

Football season brings with it a sense of all-American competitive spirit and nostalgia. Unfortunately, as more information comes out about the brain injuries caused by this sport, there’s a much darker side that we can’t afford to ignore.

Chronic Traumatic Encephalopathy

Tuesday’s  PBS Frontline documentary  ‘League of Denial’ documentary tackles the serious subject of concussions and other brain injury suffered during play and does so relentlessly – for a very good reason. The NFL’s attempts to cover up the gravity of these injuries is ongoing but ‘League of Denial’ shatters their convenient bubble with heartbreaking stories and alarming facts.

What a Football Player’s Brain Can Look Like

The beginning of the film focuses specifically on Mike Webster, former Steelers offensive lineman, and the struggles he dealt with after football.

Webster’s brain is credited as one of the first to show that the damage football could cause; when Webster died at only age 50, Oncologist and Neuropathologist, Dr. Bennett Omalu, known as the “brain seeker” in some circles, decided to preserve his brain, finding in Webster’s brain what is now known as chronic traumatic encephalopathy (CTE). It’s also the disease that Chargers linebacker Junior Seau was found to have after his suicide.

CTE and football players

“If I had not been told [Webster’s] age I would have thought he was 70,” Dr. Omalu said of the 50-year-old Webster.

Things quickly shift toward Frontline’s straight-up accusation that the NFL knew the danger of concussions all along and did its best to cover up any concerns over the issue. There aren’t many punches pulled in the documentary, with Frontline claiming the Paul Tagliabue regime appointed doctors who consistently denied the link between mental health issues and the NFL, despite strong evidence to the contrary.

But none of this is really news. It’s merely a much deeper look at an ongoing problem and an opportunity to generate greater awareness of the connection between brain injury in football players and its subsequent neurodegenerative consequences. Airing smack dab in the middle of football season also makes it rather timely – and eye-opening. And let’s not forget that the NFL reached a $765 million settlement over concussion-related brain injuries among its 18,000 retired players, agreeing to compensate victims, pay for medical exams and underwrite research. Right before this provocative documentary aired.

What We Already Know About Brain Injury and Dementia

As it was found in a September 2012 study published in Neurology, from data gathered on 3,439 ex-professional football players, average age 57 years, who had played during at least five seasons from 1959 to 1988 for the NFL had triple the risk of death caused by diseases that destroy or damage brain cells compared to other people and four a times greater risk of dying from ALS or Alzheimer’s disease.

Ken Stabler CTE

So will this knowledge, coupled with Frontline’s compelling documentary really change anything?

New York Magazine’s Dan Amira admitted that watching football after screening the documentary “wasn’t the same,” but acknowledged that parents of young players may pose the ultimate threat to the NFL. Characters in the film itself compare the NFL to Big Tobacco, which met its day of reckoning in court in the 1990s after long denying the connection between cigarettes and cancer.

The Future of Football

Hearkening the era of fierce gladiators facing imminent death in the Colosseum, football has long been a game about warriors, about men against men, about toughness and tenacity. As Americans, we love our game. But do we love our players as much as we love the game?

As one NFL doctor who secretly met with Dr. Bennett Omalu suggested, do you know the implications of what you’re doing?

“If 10 percent of mothers in this country would begin to perceive football as a dangerous sport, that is the end of football.”

Knowing what we know about the risks, and knowing, as caregivers, what we know about the painful, tragic effects of dementia and Alzheimer’s, would we want our sons, brothers or friends to play football?


CTE Had Hold On NFL Veteran Junior Seau

Brain Injuries Stacking Up Among Athletes

Junior Seau, who committed suicide in May, two years after retiring as one of the premier linebackers in NFL history, suffered from the type of chronic brain damage that has also been found in dozens of deceased former players (and several who are still alive), five brain specialists consulted by the National Institutes of Health concluded.

CTE and football players

Seau’s ex-wife, Gina, and his oldest son, Tyler, 23, told ABC News and ESPN in an exclusive interview they were informed last week that Seau’s brain had tested positive for chronic traumatic encephalopathy, a neurodegenerative disease that can lead to dementia, memory loss and depression.

“I think it’s important for everyone to know that Junior did indeed suffer from CTE,” Gina Seau said. “It’s important that we take steps to help these players. We certainly don’t want to see anything like this happen again to any of our athletes.”

She said the family was told that Seau’s disease resulted from “a lot of head-to-head collisions over the course of 20 years of playing in the NFL. And that it gradually, you know, developed the deterioration of his brain and his ability to think logically.”

CTE is a progressive disease associated with repeated head trauma. Although long known to occur in boxers, it was not discovered in football players until 2005. Researchers at Boston University recently confirmed 50 cases of CTE in former football players, including 33 who played in the NFL.

Seau shot himself in the heart on May 2. His death stunned not only the football world but also his hometown, San Diego, where he played the first 13 years of his 20-year career. Seau led the Chargers to their first and only Super Bowl appearance and became a beloved figure in the community.

Within hours of Seau’s death, Tyler Seau said he received calls from researchers hoping to secure his father’s brain for study. The family ultimately chose the National Institutes of Health in Washington to oversee the research.

Chronic Traumatic Encephalopathy

Gina Seau said the family chose the NIH because it was a “complete, comprehensive, unbiased scientific institution of the highest level.”

In a statement, the NFL said the NIH’s finding “underscores the recognized need for additional research to accelerate a fuller understanding of CTE.”

The statement also said: “The NFL, both directly and in partnership with the NIH, Centers for Disease Control and other leading organizations, is committed to supporting a wide range of independent medical and scientific research that will both address CTE and promote the long-term health and safety of athletes at all levels. The NFL clubs have already committed a $30 million research grant to the NIH, and we look forward to making decisions soon with the NFL Players Association on the investment of $100 million for medical research that is committed in the collective bargaining agreement. We have work to do, and we’re doing it.”

The NFLPA, meanwhile, called on Congress to look into player safety in the NFL and noted that it set aside $100 million for medical research when it negotiated the latest CBA.

Ken Stabler CTE

“The only way we can improve the safety of players, restore the confidence of our fans and secure the future of our game is to insist on the same quality of medical care, informed consent and ethical standards that we expect for ourselves and for our family members. This is why the players have asked for things like independent sideline concussion experts, the certification and credentialing of all professional football medical staff and a fairer workers compensation system in professional football,” the players’ union said.

“Given their keen interest in Health and Safety issues in football, we call on Congressman Cummings, Congressman Issa and the Congressional Committee on Oversight and Government Reform to review this issue as well.

“Our players deserve the best care, and we will fight to hold the NFL and the Clubs accountable for providing it.”

Dr. Russell Lonser, the former chief of surgical neurology at the NIH, helped coordinate the study. In an interview, Lonser, who was recently named chairman of the department of neurological surgery at Ohio State University, said that because of the publicity surrounding the case, the study of Seau’s brain was “blinded” to ensure its independence.

Three independent neuropathologists from outside the NIH were given unidentified tissue from three different brains; one belonged to Seau, another to a person who had suffered from Alzheimer’s disease, and a third to a person with no history of traumatic brain injury or neurodegenerative disease.

Mike Greenberg and Herm Edwards comment on the study that says Junior Seau suffered from CTE, chronic brain damage associated with repeated blows to the head.

Lonser said the three experts independently arrived at the same conclusion as two other government researchers: that Seau’s brain showed definitive signs of CTE. Those signs included the presence of an abnormal protein called “tau,” which forms neurofibrillary tangles, effectively strangling brain cells.

A statement released by the NIH said the tangles were found “within multiple regions of Mr. Seau’s brain.” In addition, the statement said, a small region of the left frontal lobe showed “evidence of scarring that is consistent with a small, old traumatic brain injury.”

Lonser declined to name the neuropathologists who examined Seau’s brain.

In addition to his previous role at NIH and now at Ohio State, Lonser serves as chairman of the NFL’s research subcommittee, part of the league’s Head, Neck & Spine Committee, which helps set policy related to concussions. Lonser said the league “was not involved in anything regarding how this brain was handled or managed at any step of the process, to be absolutely crystal clear about that.”

“The NFL had no influence whatsoever,” he said.

The study of CTE and football is still in its infancy. The prevalence of the disease has not been established. It cannot be diagnosed in living people, only by examining brains that are removed during autopsy.

Frank Gifford CTE

More than 4,000 former players are suing the NFL in the federal court, alleging the league ignored and denied the link between football and brain damage, even after CTE was discovered in former players. The Seau family said it has not yet decided whether to join the lawsuits.

Over the past five years, under pressure from Congress, dissenting researchers and, more recently, the lawsuits, the NFL disbanded a controversial committee on concussions that was established in 1994 under former commissioner Paul Tagliabue. The league made several rule changes and overhauled its policies to focus on head trauma and long-term cognitive problems.

Asked if she believed the NFL was slow to address the issue, Gina Seau said, “Too slow for us, yeah.”

Tyler, whose mother was Junior Seau’s high school sweetheart, and Gina both described drastic changes they noticed in Seau during the final years of his life, including mood swings, depression, forgetfulness, insomnia and detachment.

“He would sometimes lose his temper,” Tyler said. “He would get irritable over very small things. And he would take it out on not just myself but also other people that he was close to. And I didn’t understand why.”

Seau, who also played for Miami and New England, was never listed by his teams as having had a concussion.

Gina was married to Seau for 11 years and had three children with him. They divorced in 2002, but she said they remained close friends until his death. Seau sent a group text to his four children and Gina the night before he took his life.

“I love you,” he wrote.

“The difference with Junior … from an emotional standpoint [was] how detached he became emotionally,” Gina said. “It was so obvious to me because early, many, many years ago, he used to be such a phenomenal communicator. If there was a problem in any relationship, whether it was between us or a relationship with one of his coaches or teammates or somewhere in the business world, he would sit down and talk about it.”

Gina recalled that Seau frequently said, “Let’s sit down and break bread and figure this out.” She added, “He didn’t run from conflict.”

Tyler, Gina and her two oldest children, 19-year-old Sydney and 17-year-old Jake, all said they found some solace in the CTE diagnosis because it helped explain some of Seau’s uncharacteristic behavior.

Still, it also left them conflicted that a sport so much a part of their lives had altered him so terribly.

“It definitely hurts a little bit because football was part of our lives, our childhood, for such a long time,” said Sydney, a freshman at USC. “And to hear that his passion for the sport inflicted and impacted our lives, it does hurt. And I wish it didn’t, because we loved it just as much as he did. And to see that this was the final outcome is really bittersweet and really sad.”

ESPN’s cross-platform series, “Football at a Crossroads,” by “Outside the Lines,” “SportsCenter,” and ESPN The Magazine, examines health issues surrounding football at all levels of the sport, from youth football, high school and college football, through semipro and professional football.

Jake, a high school junior who quit football to focus on lacrosse, added: “He lived for those games, Sunday and Monday nights, you know? And to find out that that’s possibly what could’ve killed him or caused his death is really hard.”

Tyler said he was holding tightly to his memories of getting up at 5 in the morning to lift weights with his father before heading to the beach for a workout and surfing. And while the diagnosis helps, he said, it can’t compensate for his loss.

“I guess it makes it more real,” he said. “It makes me realize that he wasn’t invincible, because I always thought of him as being that guy. Like a lot of sons do when they look up to their dad. You know? You try to be like that man in your life. You try to mimic the things that he does. Play the game the way he did. Work the way he did. And, you know, now you look at it in a little bit different view.”

Tyler added: “Is it worth it? I’m not sure. But it’s not worth it for me to not have a dad. So to me, it’s not worth it.”