Is football too dangerous? This was the title of an article in Junior Scholastic, a publication aimed at high schoolers and their parents. The article went on to discuss the sequelae (conditions the consequence of a previous disease or injury) and quoted Robert Cantu, MD, a Clinical Professor of Neurosurgery at Boston University School of Medicine (BUSM), who said that he’s seen far too many players, even young ones, “who’ve had their lives altered” by concussions. Cantu is also Co-Director of the Center for the Study of Traumatic Encephalopathy (CSTE) at BUSM.

It is important to realize that football players might suffer thousands of small blows to the head over a lifetime of playing, especially if they go on to play at the professional level. Such repetitive blows can lead to repeated bouts of mild TBI (mTBI) or concussions that eventually can lead to a brain disorder known as chronic traumatic encephalopathy (CTE). CTE, known previously as punch-drunk syndrome, was first observed in boxers (dementia pugilistica) and in clinical terms can cause memory loss, depression, and even dementia. As recently as the 1990s repetitive blows to the head were not considered a cause of later problems for either American or Australian football players but, beginning in late 2010, CTE has received greater attention with publications from BUSM and others.

CTE differs from Alzheimer’s disease (AD) neuropathologically in that it consists primarily of neuroinflammation and abnormal deposits within and outside nerve cells (neurons) called neurofibrillary tangles (NFTS). AD also has NFTs but is also primarily characterized by amyloid plaques outside of neurons. The NFTs are composed chiefly of abnormal amounts and types of a microtubule-associated protein called tau, and CTE and other conditions, including AD, are referred to as tauopathies.