The research, published in the BMJ, studied the brains of NFL players who died from 2016 to 2021 and found that one in four had CTE—a figure that is almost certainly an undercount, the researchers say. Depending on how they crunched the numbers, the CTE incidence rose as high as 91%.
It was in 1928 that pathologist Harrison Martland first described the condition now known as CTE in boxers experiencing what he called “punch drunk” syndrome. It was not until 2002 that the disease was first diagnosed in an NFL player, when neuropathologist Bennet I. Omalu examined the brain of Mike Webster, a former player for the Pittsburgh Steelers, and found the buildup of tau proteins around blood vessels, thinning of tissue, and overall brain atrophy that characterize the disease. CTE is only firmly diagnosable by autopsy, but the range of symptoms that point to the disease—including memory loss, confusion, aggression, depression, apathy, tremors, and slurred speech—can be pronounced during a person’s life.
In the new study, Daneshvar and his colleagues examined the brains of 235 former NFL players who had donated their brains to science. (A total of 878 players died in that 2016-2021 window.) Of the brains studied, 215 were found to have CTE—or 91%. The researchers arrived at their much lower one-in-four figure by making the exceedingly cautious assumption that none of the remaining 643 brains would have shown signs of the disease—an assumption that Daneshvar believes would not stand up if the brains had been examined.
Another part of the study looked at a larger time window—from 2008 to 2021—during which 1,712 former NFL players died. Of those, 338, including the 235 already analyzed, donated their brains to research, and of that group, 315 had CTE. That makes for a possible CTE prevalence of as high as 93.2%, though if the researchers once again made the conservative—if unrealistic—estimate that all of the unexamined brains were disease-free, the figure would drop to 18.4%.
How to make football safer
That’s a big improvement over the days when concussed players were simply described as having had their “bell rung,” and then sent back out onto the field to continue the game. But concussions are only the most extreme symptoms of brain trauma; there’s a lot of damage that’s done invisibly, with no signs at all. According to one 2012 study in the Annals of Biomedical Engineering, a college football player may sustain up to 1,000 subconcussive hits to the head over the course of a single season of play.
In addition to the concussion protocols, the NFL has made other rule changes to reduce the incidence of brain trauma, including outlawing both helmet-to-helmet hits and so-called blindside blocks, in which an unsuspecting player is struck from behind, often leading to head and neck injuries. Bigger changes could come during practice, when 70% of hits occur, Daneshvar says. These friendly collisions, he adds, do as much cerebral damage as actual blows sustained during a game.
Another concern is that measures like this may be coming too late, since young players may be reaching the NFL having sustained brain damage already. Former New England Patriots player Aaron Hernandez, for example, was only 27 when he died by suicide while serving a life sentence for murder. He had spent just four years in the NFL and he was posthumously diagnosed with the worst case of CTE that Boston University researchers had ever seen in a person his age.
“We don’t need to eliminate football to make it substantially safer,” says Daneshvar—but just like in the pros, high school and college football programs could be changed to minimize or eliminate collisions in practice, and to outlaw hits during games that could be exacerbating trauma to the brain.
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