Chronic traumatic encephalopathy neuropathologic change is uncommon in men who played amateur American football

Grant L Iverson; Pouya Jamshidi; Amanda O Fisher-Hubbard; Amy Deep-Soboslay; Thomas M Hyde; Joel E Kleinman; Joyce L deJong; Claire E Shepherd; Lili-Naz Hazrati; Rudolph J Castellani

doi:10.3389/fneur.2023.1143882

Chronic traumatic encephalopathy neuropathologic change is uncommon in men who played amateur American football

Front Neurol. 2023 Jun 19:14:1143882. doi: 10.3389/fneur.2023.1143882. eCollection 2023.

Authors

Grant L Iverson^{1

2

3

4

5}, Pouya Jamshidi⁶, Amanda O Fisher-Hubbard⁷, Amy Deep-Soboslay⁸, Thomas M Hyde^{8

9

10}, Joel E Kleinman^{8

9}, Joyce L deJong⁷, Claire E Shepherd^{11

12}, Lili-Naz Hazrati¹³, Rudolph J Castellani⁶

Affiliations

¹ Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States.
² Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States.
³ Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, MA, United States.
⁴ MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, United States.
⁵ Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, United States.
⁶ Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
⁷ Department of Pathology, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States.
⁸ Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, United States.
⁹ Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States.
¹⁰ Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States.
¹¹ Neuroscience Research Australia, Randwick, NSW, Australia.
¹² School of Medical Sciences, University of New South Wales, Kensington, NSW, Australia.
¹³ Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.

Abstract

Introduction: We examined postmortem brain tissue from men, over the age of 50, for chronic traumatic encephalopathy neuropathologic change (CTE-NC). We hypothesized that (i) a small percentage would have CTE-NC, (ii) those who played American football during their youth would be more likely to have CTE-NC than those who did not play contact or collision sports, and (iii) there would be no association between CTE-NC and suicide as a manner of death.

Methods: Brain tissue from 186 men and accompanying clinical information were obtained from the Lieber Institute for Brain Development. Manner of death was determined by a board-certified forensic pathologist. Information was obtained from next of kin telephone interviews, including medical, social, demographic, family, and psychiatric history. The 2016 and 2021 consensus definitions were used for CTE-NC. Two authors screened all cases, using liberal criteria for identifying "possible" CTE-NC, and five authors examined the 15 selected cases.

Results: The median age at the time of death was 65 years (interquartile range = 57-75; range = 50-96). There were 25.8% with a history of playing American football and 36.0% who had suicide as their manner of death. No case was rated as definitively having "features" of CTE-NC by all five authors. Ten cases were rated as having features of CTE-NC by three or more authors (5.4% of the sample), including 8.3% of those with a personal history of playing American football and 3.9% of those who did not play contact or collision sports. Of those with mood disorders during life, 5.5% had features of CTE-NC compared to 6.0% of those who did not have a reported mood disorder. Of those with suicide as a manner of death, 6.0% had features of CTE-NC compared to 5.0% of those who did not have suicide as a manner of death.

Discussion: We did not identify a single definitive case of CTE-NC, from the perspective of all raters, and only 5.4% of cases were identified as having possible features of CTE-NC by some raters. CTE-NC was very uncommon in men who played amateur American football, those with mood disorders during life, and those with suicide as a manner of death.

Keywords: autopsy; depression; neuropathology; suicide; tau.