One in three former professional football players believe they have CTE

Key takeaways:

• Among players with perceived CTE, over 25% reported suicidal thoughts.
• Conditions like low testosterone, depression, cognitive symptoms and pain were common in those with perceived CTE.

Around one-third of former professional football players perceived themselves as having chronic traumatic encephalopathy, according to results from a cross-sectional study published in JAMA Neurology.

The analysis showed links between perceived chronic traumatic encephalopathy (CTE) and multiple adverse health outcomes related to cognitive impairment, including a doubling in the risk for suicidal thoughts among former players who believe they have developed the impact-related neurological condition.

“We want to encourage those who treat athletes and other populations at risk for head injury to proactively investigate all the different health domains that may affect cognitive function (sleep, pain, mood, CVD), and treat what can be treated,” Rachel Grashow, PhD, MS, director of Epidemiological Research Initiatives at the Football Players Health Study at Harvard University, told Healio. “Proactive conversations with patients about CTE may offer opportunities to assess thoughts of self-harm or suicide in those who may harbor CTE concerns.”

According to Grashow and colleagues, it is unknown how many living American-style football players perceive themselves as having CTC neuropathological change (CTE-NC), “the autopsy-based finding of phosphorylated tau aggregates in neurons at the depth of cortical sulci around a small vessel,” they explained. Meanwhile, associations between CTE and factors like demographics, other health conditions and suicidality have not been rigorously established, they added.

In the analysis, the researchers surveyed 1,980 former professional football players between 2017 and 2020 to determine the percentage of perceived CTE, factors associated with these beliefs and any potential link between suicidality and CTE-NC.

They found that 34.4% of players reported having perceived CTE.

Mood instability, pain, depression, cognitive symptoms, low testosterone and greater exposure to head injury occurred more frequently among those who reported perceived CTE.

Additionally, 25.4% of participants with perceived CTE reported suicidality vs. 5% without perceived CTE.

Grashow and colleagues found suicidality among those with perceived CTE to be independently associated with depression (OR per standard deviation [SD] unit = 2.36; 95% CI, 1.79-3.14), anxiety (OR per SD unit = 1.57; 95% CI, 1.21-2.02) and emotional and behavioral dyscontrol (OR per SD unit = 1.47; 95% CI, 1.09-1.99).

In contrast, they reported reduced odds for suicidality linked to physical activity recommendations (OR = 0.68; 95% CI, 0.46-1) and having diabetes (OR = 0.47; 95% CI, 0.25-0.88).

Ultimately, those with perceived CTE remained twice as likely to report suicidality (OR = 2.06; 95% CI, 1.36-3.12) after the researchers adjusted for established suicidality predictors.

The researchers acknowledged some study limitations. Self-reporting of comorbidities tied to perceived CTE mean the results “cannot be used to determine the degree to which true underlying CTE-NC explains the clinical profile of men reporting perceived CTE or whether perceived CTE stems from misattribution of symptoms caused by alternative disease processes,” Grashow and colleagues wrote.

“These conditions and others reported are treatable, which offers former NFL players and other populations at risk for head injury opportunities to potentially reduce or manage symptoms that could contribute to CTE concerns,” Grashow told Healio.

Regarding future research, “it is imperative that we conduct longitudinal studies that examine whether treatments for common conditions that cause cognitive symptoms (eg, sleep apnea, hypertension, depression, chronic pain, and more) are effective in those exposed to head injury,” she said.

References:

• Grashow R, et al. JAMA Neurol. 2024;doi:10.1001/jamaneurol.2024.3083.
• Study of former NFL players finds 1 in 3 believe they have CTE. Available at: https://www.massgeneralbrigham.org/en/about/newsroom/press-releases/study-finds-1-in-3-former-nfl-players-believe-they-have-cte. Published Sept. 23, 2024. Accessed Sept. 23, 2024.