Each year of playing ice hockey further increases risk for CTE

Key takeaways:

• Forty-two brain donors, including 27 of 28 professional hockey players, had CTE, including 23 of 24 who played more than 2 decades.
• Among “enforcers” whose play included active fighting, 18 of 22 had CTE.

A strong association was found between individuals who played amateur or professional ice hockey and diagnosis of chronic traumatic encephalopathy, with longer participation indicating higher likelihood of risk, recent data show.

“This is the first study to clearly establish a dose-response relationship between years of ice hockey play and chronic traumatic encephalopathy,” Jesse Mez, MD, MS, co-director of clinical research at the CTE Center and associate professor of neurology at Boston University’s Chobanian & Avedisian School of Medicine, told Healio in an email regarding the results, which were published in JAMA Network Open.

Prior research has established that chronic traumatic encephalopathy (CTE) results from repetitive head impacts (RHIs) during participation in contact sports, including American football. Mez and colleagues sought to examine associations between participation in ice hockey and subsequent CTE risk and severity.

Their cross-sectional study included 77 male brain donors (median age, 51 years) from both the Understanding Neurological Injury and Traumatic Encephalopathy and Framingham Heart Study Brain Banks whose RHIs resulted from participation in amateur or professional levels in ice hockey.

The primary study outcome was CTE diagnosis based on collective phosphorylated tau (ptau) burden from 11 regions of the brain found to be most affected, with secondary outcomes including informant-reported Functional Activities Questionnaire (FAQ) score at time of donor’s death, as well as a diagnosis of dementia by clinicians while donors were still living.

For donors who played multiple sports, the researchers analyzed the highest level played as the primary sport exposure, with participation in other sports aside from hockey taken into consideration.

Jesse Mez

Mez and colleagues found an association between the number of years played and increased odds for CTE (OR = 1.34; 95% CI, 1.15-1.55), as well as an association with increased ptau burden (SD increase per 1-year increase=0.037; 95% CI, 0.017-0.057) when adjusting for the donor’s age at death, other contact sports played, age of first hockey exposure and number of diagnosed concussions.

Data showed 42 of the 77 donors had CTE, including 27 of 28 who played professionally. Among this group, CTE was found in 18 of 19 NHL players and all nine non-NHL professionals, 13 of 28 who played in either college, junior or semi-pro ranks and two of 21 who played in youth and high school leagues. In addition, CTE was identified in 18 of 22 individuals classified as “enforcers” whose play included active engagement in fighting, according to a release related to the study.

CTE was also discovered in five of 26 donors who played hockey for fewer than 13 years, in 14 of 27 donors who played between 13 to 23 years and in 23 of 24 donors who suited up for more than 23 years.

The researchers additionally reported an association between increased ptau burden and FAQ score and dementia when adjusting for the above-mentioned factors.

“Clinicians should consider the amount of hockey play when former hockey players present with symptoms concerning for CTE,” Mez told Healio. “Also, our findings provide valuable information to players and families so that they can make informed decisions regarding the choice to play.”

Reference:

Largest study of CTE in male ice hockey players finds odds increased 34% with each year played. https://www.eurekalert.org/news-releases/1066898?. Published Dec. 4, 2024. Accessed Dec. 4, 2024.