Experts caution about unverified CTE diagnoses in former football players

Reviewed by Danielle Ellis, B.Sc.Oct 6 2023

Former professional American football players who have medical and mental health conditions including depression, anxiety or sleep apnea are more likely to receive an unverified diagnosis of chronic traumatic encephalopathy, or CTE, compared to those without those conditions, report researchers from the University of Pittsburgh School of Medicine, Harvard University and Vanderbilt University Medical Center in Sports Medicine today.

Receiving a CTE diagnosis that cannot be verified until after death could further exacerbate mental health conditions in former players due to the current lack of treatments for the disease, the experts caution.

We agree that CTE neuropathology is real, yet the current narrative about CTE and health after football, in general, is incomplete. Currently, a definitive causal link between brain health issues experienced in life and CTE-associated brain changes seen in autopsies has yet to be established."

Shawn Eagle, Ph.D., co-lead author, research assistant professor of neurological surgery at Pitt

CTE is a neurodegenerative disease associated with a history of repetitive head impacts and is characterized by the presence of toxic protein aggregates and brain tissue degeneration seen at autopsy. By definition, it is impossible to confirm a CTE diagnosis in a living individual, yet prior research by co-lead author Rachel Grashow, Ph.D., M.S., and colleagues from the Football Players Health Study (FPHS) at Harvard University showed that 3 in every 100 former football players report being diagnosed with CTE by a medical professional.

"It is important for the next generation of players to know the long-term health risks they may face, and that is the ultimate goal of CTE research," said Eagle. "There is still a lot to be learned, and, in the meantime, we want people to receive proven treatments for conditions that may mimic CTE, such as hypertension, sleep apnea, depression and anxiety, among others."

This research was supported by the Football Players Health Study at Harvard University, which is funded by the National Football League Players Association (NFLPA). The NFLPA had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; nor the decision to submit the manuscript for publication. This research is in collaboration with the Brain Health Initiative at the University of Pittsburgh, which receives funding from the National Football League Scientific Advisory Board (SAB). The content is solely the responsibility of the authors and does not necessarily represent the official views of the University of Pittsburgh and UPMC, and Harvard Medical School, Harvard University and its affiliated academic health care centers.

Other authors of the study are David Okonkwo, M.D., Ph.D., of Pitt; Douglas Terry, Ph.D., of Vanderbilt University Medical Center; Rachel Grashow, Ph.D., M.S., Heather DiGregorio, B.S., Aaron Baggish, M.D., Marc Weisskopf, Ph.D., Sc.D., and Ross Zafonte, D.O., all of Harvard University.