Pittsburgh, October 6, 2023 -- Former professional American football players who have 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 could further exacerbate mental health conditions in former players due to the current lack of treatments for the disease, the experts caution.
“The current narrative about CTE and health after football, in general, is incomplete,” said co-lead author Shawn Eagle, PhD, research assistant professor of neurological surgery at Pitt. “Contrary to common assumption, there is no definitive causal link between brain health issues experienced in life and CTE-associated brain changes seen in autopsies.”
CTE is a neurodegenerative disease associated with a history of repetitive head impacts and is characterized by the presence of toxic aggregates of misfolded phosphorylated tau proteins 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, PhD, MS, 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.
Despite recent efforts to standardize the criteria for diagnosing traumatic encephalopathy syndrome—the clinical neurological syndrome seen in some individuals with repeated head injuries—its definition remains broad and its usefulness as a proxy of CTE has not been validated.
“If two patients come to the doctor with complaints about depression and anxiety, we have concerns that the doctor may treat them differently simply because one has a history of playing football,” Eagle said.
In their study, researchers conducted comprehensive health surveys of more than 4,000 former professional American football players whose ages ranged from 24 to 89 years old. Among the study cohort, 77 individuals reported that they had been preemptively diagnosed with CTE by their health care provider.
The analysis showed that the likelihood of getting a CTE diagnosis was significantly higher in individuals with depression and anxiety alone and in combination, as well as in those diagnosed with sleep apnea and ADHD. These findings suggest that former football players could be receiving unsubstantiated CTE diagnoses when more widely occurring disorders are more plausible.
The authors point out that many of those disorders and comorbidities have safe and established treatments and urge clinicians treating former players to evaluate and treat conditions that may account for cognitive dysfunction, such as depression, anxiety, sleep apnea and hypertension.
“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. “We want to prevent an unwarranted sense of doom among those with a football history. 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. 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, MD, PhD, of Pitt; Douglas Terry, PhD, of Vanderbilt University Medical Center; Rachel Grashow, PhD, MS, Heather DiGregorio, BS, Aaron Baggish, MD, Marc Weisskopf, PhD, ScD, and Ross Zafonte, DO, all of Harvard University.
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For more information on this study, please contact:
Anastasia Gorelova
412-491-9411
Beth Mausteller
412-297-2298