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UCLA study may have found the “Holy Grail” of concussion research: CTE in living brains

andrew bucholtz

While concussions are perhaps the most crucial issue facing football at all levels today, most of the discussion of their long-term after-effects (and chronic traumatic encephalopathy, or CTE, in particular) has centred around post-mortem autopsies of former players. That may be about to change, as a new UCLA study appears to have found the first evidence of CTE in living players, and that could have huge implications for football in both the U.S. and Canada. From ESPN's Mark Fainara-Wada and Steve Fainaru, who have been doing great work on the concussions front, here's why this new study (published in the American Journal of Geriatric Psychiatry Tuesday, available as a PDF here) matters so much:

Brain scans performed on five former NFL players revealed images of the protein that causes football-related brain damage -- the first time researchers have identified signs of the crippling disease in living players.

Researchers who conducted the pilot study at UCLA described the findings as a significant step toward being able to diagnose the disease known as Chronic Traumatic Encephalopathy, or CTE, in living patients.

"I've been saying that identifying CTE in a living person is the Holy Grail for this disease and for us to be able make advances in treatment," said Dr. Julian Bailes, co-director of NorthShore Neurological Institute in Evanston, Ill., and one of the study's co-authors. "It's not definitive and there's a lot we still need to discover to help these people, but it's very compelling. It's a new discovery."

The study examined five former NFL players using a patented brain-imaging tool, all of whom had sustained at least one recorded concussion during their careers, and it found tau protein (the key evidence for CTE) in each of their brains. What's interesting is how differently they've been affected, though. Fred McNeill, a linebacker who played with the Minnesota Vikings for 12 years, is already suffering from early-onset dementia at 59 and is largely looked after by his family and caregivers, while 65-year old former Chargers, Bengals and Chiefs' quarterback Wayne Clark said "I don't feel like I'm suffering from any real symptoms at this point."

Much of that difference in symptoms may be the differing levels of contact these players experienced. Linebackers are banging and crashing on most plays, while quarterbacks are only occasionally hit, and Clark was primarily a backup during his NFL career. Similar results have been found north of the border: 24 of the 25 former Hamilton Tiger-Cats the Hamilton Spectator tested in 2011 scored below-average on key brain function indicators, but some weren't experiencing any notable symptoms, while others were really struggling. There's still much to learn about how concussions affect former players, but the huge breakthrough in this study (which has plenty of respected scientists involved, including Dr. Bennet Omalu, who was the first to find CTE in a former NFL player's brain) is how it suggests we may soon have the ability to move from guessing at CTE in living patients (via neurological tests, discussion of their symptoms and such) to actually testing for the presence of CTE's characteristic tau protein buildup with these scanners.

That would be a substantial advance, and it would have huge implications for current players. At the moment, when there are debates around whether oft-concussed players like Buck Pierce should keep playing or hang up their cleats, they're not based on conclusive evidence. We know Pierce has had a number of concussions, but even he doesn't know how they might affect him in the future; not all concussions are equal, and sustained subconcussive trauma may be just as bad. Star NFL linebacker Junior Seau had CTE, but never suffered a recorded concussion during his playing career. The ability to examine living brains for CTE would be a transcendent leap forward in concussion research, and that's why prominent concussion scientists like Dr. Robert Cantu (who I interviewed in December about concussion research) are so excited about this study:

"This is the Holy Grail if it works. This is what we've been waiting for, but it looks like it's probably preliminary to say they've got it," said Dr. Robert Cantu, a senior adviser to the NFL's Head, Neck & Spine Committee and co-director of Boston University's Center for the Study of Traumatic Encephalopathy. "But if they do have it, this is exactly what we need."

To be sure, this study is no panacea for concussions. There's a long way to go before this is proven to the standards that would be required to bring this approach in as part of concussion analysis in active players. Even if this is found to be a proven and effective means of diagnosing CTE (and just how much tau protein is present in a given brain), there's still a lot of work to be done, such as finding clear indicators of exactly what kind of hits cause the tau buildup and determining just how much particular tau buildups impact players' lives. It's not an end, but a beginning. Still, this is a tremendously exciting breakthrough, and one that could play a vital role in transforming the concussion debate. It will be fascinating to see what comes of this in the days and weeks ahead.