New Method Helps Diagnose Sports-Related Brain Damage

Repeated brain injuries in athletes due to heavy contact during both professional and amateur play has physicians concerned about cumulative brain trauma. Especially worrisome are the types of serious head injuries that can come from participating in heavy contact sports, such as football, ice hockey, soccer, wrestling, and/or boxing. Even skiing and horse riding are high on the list for head trauma despite less contact with other competitors.

An estimated 3.8 million sports-related injuries occur in the United States each year according to the U.S. government; the American Journal of Sports Medicine calculates sports injuries as second only to automobile crashes as the leading cause of concussions among young people between the ages of 15 to 24. Even those athletes who practice and play contact sports regularly — but do not get removed from the game or season because of an injury — should be concerned.

Many Athletes At Risk

According to a 2013 article in the medical journal Neurology, all athletes, even those without a traumatic brain injury (TMI), showed significant structural differences in the brain as well as cognitive delays that were unattributable to other non-sports-related injuries. Physicians are concerned that athletes who suffer seemingly minor but repeated blows to the head are especially at risk for chronic traumatic encephalopathy (CTE), which currently affects up to 17 percent of athletes and others who suffer ongoing brain trauma. Most at risk are athletes who practice their chosen sport for years, sometimes decades.

Originally known as ‘dementia pugilistica’ since the 1920s, CTE was first noticed in athletes who boxed for a living, incurred repeated head injuries and trauma, and who later developed early-onset dementia as well as serious cognitive problems. The symptoms of CTE are memory loss, personality changes, and Parkinsonism in the form of speech and walking (gait) abnormalities. Other less specific signs are depression, angry outbursts, and suicidal thoughts and/or actions.

What Is CTE?

Unlike other types of neurological deterioration, CTE is distinct. It is marked by specific structural changes throughout the brain (in the cerebral hemispheres, medial temporal lobe, thalamus, mammillary bodies, and even the brain stem itself). Moreover, distinct microscopic changes called neurofibrillary “tangles” are seen that are directly associated with the condition. Scientists believe that the build-up of proteins in the nerve fibers cause the tangles while breaking down nerve cells, causing nerve deterioration and subsequent brain damage.

At last, however, there are advancements being made in identifying nerve damage and diagnosing CTE in its earliest stages. According to a study published this month in the journal Translational Psychiatry, a new neuroimaging technique developed at the Icahn School of Medicine at Mount Sinai in New York is now able to identify a protein called tau that builds up in injured brains after repeated head trauma.

When an experimental compound is injected into the body during a positron emission tomography (PET) scan, it can identify those specific proteins enabling CTE to be be more easily diagnosed, distinguishing it from other forms of dementia. Until now, that distinction was only fully possible by examining the brain after death.

“Our data suggest that PET imaging using the tau tracer is an effective method of diagnosing or ruling out chronic traumatic encephalopathy in a living brain,” explains Samuel Gandy, MD, and Director of the Center for Cognitive Health and NFL Neurological Care at Mount Sinai Hospital. “Estimates of the prevalence of CTE have varied wildly, with the most recent figure coming from the National Football League [that] predicts that one in three NFL players will suffer significant brain damage. We can now begin to test this while that players are still alive. Moreover, we are now equipped to tell prospective athletes of all ages some real data on the risks that accompany sports involving repeated traumatic brain injuries.”

Unlike earlier PET scans, the new tracer compound is able to distinguish CTE from more common conditions that cause similar cognitive symptoms and memory problems, such as Alzheimer’s. The new test will be made available to the public at Mount Sinai Hospital beginning in October 2014.