Based on their survey responses, about 1 out of every 3 former professional National Football League (NFL) players believe they have chronic traumatic encephalopathy (CTE), according to a study published Sept. 23 in JAMA Neurology that underscores concern about the head impacts sustained over a career of training and on the playing field.
Additional findings from the survey of 1,980 former NFL players highlight a strong association between the perception of having CTE and conditions with symptoms that may mimic CTE. Authors from the Vanderbilt Sports Concussion Center and Football Players Health Study at Harvard University found that 34% of former players surveyed believed they had CTE. The study also examined mental well-being and found that suicidality was reported by 25% of players who believed they had CTE, compared to 5% in those who do not believe they have CTE.
This study does not assess for the actual presence of CTE — which can only be diagnosed after death — so it is unknown if this clinical profile associated with perceived CTE aligns with the true presence of CTE based on autopsy neuropathology. The researchers cannot rule out the possibility that some of the players who reported concerns do in fact have CTE-related brain changes, but they say that it is important for former players and their clinicians to focus on the things that can be treated.
“Understanding the proportion of former players who think they have CTE — and identifying the common symptoms in those who believe they have CTE — is an important step for helping these individuals receive medical and mental health treatment,” said Douglas Terry, PhD, assistant professor and clinical neuropsychologist in the Department of Neurological Surgery and co-director of the Vanderbilt Sports Concussion Center. Terry is the second author of this study, behind Rachel Grashow, PhD, MS, director of Epidemiological Research Initiatives for the Football Players Health Study at Harvard University.
“These findings underline the urgent need for accurate diagnostic tools and mental health support for retired NFL players. We must work to ensure that former players are efficiently diagnosed with medical, psychological and cognitive disorders, and receive appropriate treatment, regardless of whether or not these difficulties may be related to CTE,” said Terry.
Researchers used electronic and paper surveys to collect responses from retired players as part of the Football Players Health Study. The cross-sectional study ran from 2017 to 2020.
Importantly, the study also showed that men who believe they have CTE reported more cognitive difficulties and had higher rates of low testosterone, chronic pain and headaches than former players who did not believe they had CTE. The authors discuss the potential risks associated with prematurely attributing symptoms to CTE, which can lead to long-term consequences for players and their families. While it is not known who has or will develop CTE neuropathology, the belief that you have CTE may have its own psychological and broader health effects.
“A key takeaway from this study is that many conditions common to former NFL players — such as sleep apnea, low testosterone, high blood pressure and chronic pain — can also cause problems with thinking, memory and concentration,” said first author Rachel Grashow, PhD, MS, of Harvard T. H. Chan School of Public Health. “While we wait for advances in CTE research to better address living players’ experiences, it is imperative that we identify conditions that are treatable. These efforts may reduce the chances that players will prematurely attribute symptoms to CTE which may lead to hopelessness and thoughts of self-harm.”
“Until clinical guidelines and treatments for CTE become available, former players and their physicians should explore treatment interventions and positive health behavior changes that have been shown to improve cognitive function, overall health and quality of life,” said senior author Aaron Baggish, MD, a professor of Medicine at the University of Lausanne in Switzerland, and a senior faculty member of the Football Players Health Study and former director of the Cardiovascular Performance Program at the Massachusetts General Hospital Heart Center. “Physical interventions including weight loss, exercise, improving sleep and implementing a low-salt diet may improve cognitive function.”
Research driven by input from former NFL players
The Football Players Health Study at Harvard University, launched in 2014, is a comprehensive research program dedicated to examining the multifactorial causes that impact the health of former NFL players. The research has been informed by the players themselves, who have provided input on the health concerns and conditions they face after a career in football. An interdisciplinary team of researchers from Harvard University and Harvard Medical School and its affiliated teaching hospitals, including those in the Mass General Brigham system, conduct research from neurology, cardiology, sports medicine, rehabilitation medicine, chronic pain and public health. While concussion and head injury are of paramount concern, the study examines all aspects of player health across the life span. Former players can find important resources to support their health in this section of the study’s website.
This work was supported by the Football Players Health Study at Harvard University, which is funded by the National Football League Players Association (NFLPA). The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Medical School, Harvard University and its affiliated academic health care centers. 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; and the decision to submit the manuscript for publication.
