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Football Brains

Hard-hitting evidence connects concussions and dementia

| From BU Today | By Caleb Daniloff

Christopher Nowinski wrestled for WWE for two years before retiring with postconcussion syndrome. Today, Nowinski is codirector of BU’s Center for the Study of Traumatic Encephalopathy, which is studying the brains of deceased athletes for signs of the degenerative disease chronic traumatic encephalopathy (CTE). Photos courtesy of Christopher Nowinski.

Christopher Nowinski just can’t be dismissed as an alarmist.

A defensive lineman in college, Nowinski suffered multiple concussions and once played with a hyperextended elbow. At six-foot-five and 270 pounds, he wrestled for WWE (World Wrestling Entertainment) for two years under the ring name Chris Harvard, a nod to his alma mater. Under the klieg lights, he suffered more nasty head blows and blacked out during a move gone wrong, even trashed a hotel room in his sleep. Since retiring five years ago, the 31-year-old has been treated for depression, headaches, and memory trouble.

“I’m definitely not the same guy I used to be,” he says.

Now codirector of BU’s Center for the Study of Traumatic Encephalopathy (CSTE) and author of Head Games: Football’s Concussion Crisis from the NFL to Youth Leagues, Nowinski is adamant that concussions can cause dementia, and he’s got the brains — figuratively and literally — to prove it.

CSTE is a collaboration between BU neurologists and Nowinski’s Sports Legacy Institute, which he cofounded with Robert Cantu, a leading authority on concussions. Cantu, who wrote the original — and largely unheeded — guidelines on returning to play after a concussion, is also a CSTE codirector and a School of Medicine clinical professor of neurosurgery. The center’s researchers made news last year when they found evidence of chronic traumatic encephalopathy (CTE) in the brains of several deceased football players with a history of repeated concussions, including former Houston Oilers linebacker John Grimsley. The avid outdoorsman accidentally shot himself while cleaning his gun, a task he ordinarily could perform in his sleep. Symptoms of the progressive and degenerative disease CTE include confusion, memory loss, impaired judgment, paranoid and aggressive behavior, depression, and dementia.

Grimsley is not the only high-profile athlete to die tragically, causing researchers to suspect a link with CTE. In 2004, Justin Strzelczyk, 36, former offensive lineman with the Pittsburgh Steelers, led police on a high-speed hit-and-run chase that ended with his death in a fiery crash. Retired Philadelphia Eagles’ safety Andre Waters shot himself in 2006, at age 44; Canadian professional wrestler Chris Benoit, 40, killed his wife and child and then himself in 2007. Tampa Bay Buccaneer Tom McHale, a nine-year veteran, died from a drug overdose in 2008 at the age of 45. Nowinski obtained their brains, and like Grimsley’s, all showed signs of CTE. So far, only one deceased NFL player tested, 24-year-old Damien Nash, who died in 2007, did not have the disease.

Last month, three active NFL football players — Pro Bowlers Lofa Tatupu of the Seattle Seahawks, Matt Birk of the Baltimore Ravens, and Sean Morey of the Arizona Cardinals — agreed to donate to the cause, allowing researchers to analyze their brains after death. Athletes from the NHL, the NBA, and Major League Soccer have signed up, too, bringing the deposits in CSTE’s brain bank to 186 — 16 actual and 170 pledged. The center’s target is 500.

In an effort to bring physicians, coaches, athletic trainers, and other health-care providers up to speed on the latest concussion research, diagnostics, and recommended playing guidelines, BU’s School of Medicine held a conference at Gillette Stadium, home of the New England Patriots, on October 2, called Concussion and the Athlete.

A few days before the gathering, results of an NFL-commissioned study were leaked to the press: it showed that 6.1 percent of retired players above age 50 reported diagnoses of dementia, Alzheimer’s, or other memory-related diseases, compared to 1.2 percent for comparably aged men in the United States, and 1.9 percent of former players between 30 and 49 years old indicated similar diagnoses, compared to 0.1 percent of the general population. The NFL, however, claims the study is incomplete and wants further findings.

On October 11, CBS’ 60 Minutes tackled the issue, interviewing Cantu and CSTE neurologist Ann McKee, a MED associate professor of neurology and pathology. On Monday, The New Yorker further raised the profile by publishing a piece about concussions and sports injuries based in part on conversations with Nowinski, as well as McKee and Cantu. Now Congress, led by the House Judiciary Committee, has announced plans to hold hearings on head trauma and the NFL.

Nowinski isn’t waiting. “My goal is to find treatment or a cure,” he says. “There’s a couple of generations of guys walking around with this in their head, without any hope.”

Bostonia: What was your reaction to the NFL study?
Not surprised. It’s always with a heavy heart that you see the evidence. What we’ve seen with our 10 elite football player brains very much supports the idea that NFL players under 50 have a 19 times greater rate of CTE.

The NFL commissioned the study. Is that a hopeful sign?
They had a very bizarre reaction. They paid for it, yet they tried to distance themselves from it. But you understand their position. The guys who commissioned the study are probably not the same guys who have to react to it. They all have different jobs. Some of their jobs are to protect the brand at any cost.

What does it mean that active players have joined the cause?
It’s a huge step in creating acceptance and awareness. Most guys run away from us and say, “I’ll talk to you when I’m retired.” They’re young, still on the bubble maybe, their spots aren’t guaranteed, they haven’t made their money. But Matt Birk is a perennial Pro-Bowler, so it won’t hurt his career. Sean’s at the end of his career. Lofa’s one of the best players in the game. These guys felt compelled by the research. They’ve generated hundreds of articles across the country and world, this was on the Jay Leno Show. That’s a big deal.

Are you surprised by the momentum you’ve created in such a short time?
No. I learned very quickly with the first article in 2007, when I called someone at the New York Times and said, “I’ve got Andre Waters’ brain and it’s got this disease, what does that mean?” He called me back and said, “It’s front page of the New York Times.” You’re talking about very famous people, one of the most popular sports in America, and very tragic stories. That’s what the media like. It sells ads, it sells papers. And for us, to leverage that is free education.

In most cases, you’re the one who approaches athletes about donating their brain. How do you broach such an unusual request?
It’s usually in social situations, at dinner, over drinks. When they say they like our research, I say, “You can support it by donating your brain.” Sometimes if you hit somebody cold, they’re like, “You’re being weird,” and they look at you funny. But there’s no cold calling. We don’t just grab phone numbers. These are guys we’re engaged with. All of the early donors I knew personally. They trusted me not to abuse their names and their brains when they died. Out of that, the momentum has come for people to call up Boston University and say, “Where’s that brain donation program? I want to sign up.” That happens a lot.

Have you heard of any tension in the locker room about this?
I’m sure there are people who want to bury their heads in the ground and cover their ears. There’s been no negativity personally toward me by those who step onto the field. I remember a good friend of mine who was best friends with an assistant coach, a coordinator in the NFL, who was told, “Tell Nowinski to knock it off.” But the players know that this is in their best interest. They all have a hunch that there’s something off about whacking your head as hard as they do.

What do you say to people who claim you’re going to kill football?
If science can kill football, then maybe football deserves to be killed. It’s not like we’re blowing up Pop Warner headquarters. The whole point here is to give everybody a choice, especially when you’re talking about your kids’ futures. If something you sign your kid up for will really hurt later on, you should know and think twice. If fewer people choose to play, then more power to them.

Can you envision an environment where football can be safer?
Football’s been reformed multiple times in its history. In 1905, coaches from Harvard and Yale and Princeton went to the White House to see Teddy Roosevelt to convince him that football could be played safely by inventing the forward pass and other rules. I think we’re at that stage again. The proof is in the brains. It’s too dangerous as it is. The NCAA recently changed the rules on “two-a-days,” which when I was playing was two hitting practices a day for the last three weeks before the season. They changed it to one practice could be hitting and one couldn’t. You could cut out hitting in practice to once a week outside of games and cut trauma to the head by 50 percent. You could do that tomorrow if the will was there. You can have age limits, better diagnosis on the field. You can see a structure where the game could survive.

Will advances in helmet technology make a difference?
Xenith has developed helmets that spread the impact. Part of the problem with helmets and concussions is helmet-to-helmet contact, so better helmets with the message don’t use your helmet as a weapon is a great combination.

How are your symptoms today?
I still get headaches. I take a stimulant for cognition. Without it, I’m not as productive, not as focused. I have to be worried.

Do you have a dialogue with the NFL?
We have a dialogue, but the only time we focus on them is when they say something in the media that is really dumb, like, “Lots of people get memory problems.” I don’t know how much of a dialogue we’re going to get because I think they’re stuck in the same place as Big Tobacco. If they admit football is the cause, their bank accounts will be cleaned out. That’s their primary concern.

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