Invisible scars

Brain-related sports injuries linked to dementia and depression

Boston University (BU) has a bank stocked with brains: the “Brain Bank” at it’s Center for the Study of Traumatic Encephalopathy houses brain and spinal cord tissue of deceased athletes and military personnel. Within a few years, the bank has collected dozens of donations, most notably from former professional hocky and football athletes. Concussions and other forms of brain trauma are common in these professions, and the centre studies the effects such incidents have on health. Through their donations, athletes hope to help uncover the long-term consequences of this severe brain trauma.

According to the McGill University Health Centre (MUHC), concussions account for 20 per-cent of all injuries in ice hockey, and only slightly less in rugby, football, and soccer. Ambitious athletes begin playing their sport of choice as young children, before their brains have fully developed. Without careful precautions, concussions can swiftly accumulate and the effects of repetitive brain injury can be quickly compounded. The more concussions one has, the more susceptible they are to another and the worse the concussion is likely to be.

A recent study of 85 brains at the Center for the Study of Traumatic Encephalopathy found that four out of every five were afflicted with chronic traumatic encephalopathy (CTE). The devastating symptoms of CTE, which are thought to include depression and dementia, are caused by the abnormal accumulation of tau protein which leads to tissue death. The damage is irreparable, and CTE itself is incurable.

It is unfortunate that most research on CTE must currently be conducted post-mortem. The spinning, rapid acceleration, and jolted stops that cause the brain to bump violently against the skull (causing concussion) often leave few obvious external signs. It is only after mental health is noticeably impaired, or after death, that the full extent of the damage is known. NFL linebacker Junior Seau is the most recent in a series of athletes who have committed suicide and been subsequently diagnosed with CTE.

Yes, the sample that BU researchers studied was a biased one. Brains are most often donated by individuals who not only have suffered brain trauma, but who also already display symptoms of CTE. However, the findings help establish that there is a definite link between repetitive head trauma and long-term brain diseases like CTE.

Steps have been made by major regulatory bodies to reduce the prevalence of head injuries. The NHL, for example, now requires players to get immediate medical attention if they suffer a blow to the head. But athletes must still be proactive when it comes to injuries. Dr. Scott Delaney, a physician and consultant to the Montreal Alouettes, made clear in a MUHC “HealthBeat” radio interview that doctors are “still dependent on a very basic thing…the athlete coming forward to volunteer his or her symptoms.”

Further changes to the rules in the NHL made all intentional and targeted blows to the head illegal, and the rules regarding “boarding,” the act of pushing or checking a player into the boards surrounding the ice rink, were made more stringent. Detractors, like the colourful sports commentator Don Cherry, continue to glorify the unnecessary violence of the game – even when faced with evidence that fighting, and associated head injuries, have been linked to depression and the early onset of dementia. It is this culture of competitive contact sports that often encourages an athlete to continually shrug off their symptoms, leading to several undiagnosed concussions that may have long-term consequences.

A few concussions will not lead to CTE, but any sort of head injury requires proper treatment. Rola Abouassaly, a senior physiotherapist at the Sports Medicine Clinic of the McGill Sports Complex, stresses the importance of “having athletes be educated” as to what a concussion is.  “Some people don’t think they have a concussion,” and don’t realize that their dizziness or trouble concentrating may be linked to a recent head injury, she explained. The treatment for any trauma is sufficient rest in order to allow the brain to recuperate. Excessive brain stimulation should also be avoided – perhaps a difficult task for a McGill athlete.

Awareness campaigns like those carried out by the Montreal Children’s Hospital stress the importance of educating athletes. Their “Trauma Concussion KiT,” available online, includes techniques for diagnosing a concussion as well as information on symptoms and sports-specific guidelines.

Further preventative tools are also in the works. An iPad app developed by Jay Alberts, a researcher at the Cleveland Clinic, aims to help coaches and athletes diagnose concussions if a physician is not nearby. A Canadian startup known as ShockBox has developed helmet sensors to detect the severity of a hit. The sensors are commercially available, and the company hopes to have them on every NHL helmet in the future, as they should be – the major leagues serve as inspiration to young athletes. When athletes speak out, with their words as well as their actions, taking care of your brain can become cool as well as common sense.