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CTE is a real risk for football players

By Les Carpenter
Wednesday, October 28, 2009

Late this summer in a room at the Boston University School of Medicine, Ann McKee pulled the brain of a Hall of Fame football player named Lou Creekmur from the box in which it had arrived and nearly gasped.

As a neuropathologist and the co-director of BU's Center for the Study of Traumatic Encephalopathy, she has spent more than two decades examining the brains of people who had suffered from dementia, searching for the telltale signs of what might have actually caused the condition. But from the moment she took Creekmur's brain into her hands, placing it on the table, it was obvious as to what had tormented him in the final years of his life. The brain itself had shrunk. There was a widening of the ventricles where fluids had filled tiny cisterns in an effort to replace the lost mass. And structures important to things like language and learning were shriveled.

When the slides of his brain matter were prepared for her to study, she didn't even need to place them under a microscope: the deposits of tau, a protein found in the central nervous system, signifying chronic traumatic encephalopathy (CTE) or "punch-drunk syndrome" were so large all she had to do was lay the slide on a light table to make a diagnosis.

Though Creekmur was 82 when he died this July, he did not have Alzheimer's as many thought. Rather McKee was looking at the most obvious case of dementia caused by head trauma she had ever seen in a football player.

"It was clear from the moment I first saw it," she said.

McKee expects to announce her discovery on Capitol Hill Wednesday at a House Judiciary subcommittee hearing on on head trauma in football players. Creekmur's brain is the 11th out of 11 former football players the BU center has examined for CTE and discovered evidence of the condition, buttressing the argument that repeated concussions in football have long-term effects and can lead to dementia at a young age.

Wednesday's hearing, which will include NFL Commissioner Roger Goodell, and DeMaurice Smith, the executive director of the NFL Players Association along with several medical experts, is the latest in a series of such hearings called by Congress in the last three years on the overall subject of the health and care of retired NFL players. This will be the first, however, to directly deal with concussions. And it comes a month after a study conducted for the NFL by researchers at the University of Michigan revealed higher than normal numbers of memory-related diseases in former players.

NFL spokesman Greg Aiello would not comment directly on the Creekmur findings but said the league believes the Michigan study shows a need for more research.

"We know concussions can lead to problems if they are not treated properly and that is why we have been committed to aggressively addressing this issue in a comprehensive way," he said.

The NFL is getting more pressure on the subject than in the past from the players' union, which was accused late in the tenure of former executive director Gene Upshaw, of ignoring the medical needs of retired players. The NFL Players Association now has formed its own concussions committee.

"This happens to be an area where there is controversy, where there are strongly held positions," Smith said at a news conference Tuesday, adding that a significant amount of information now exists on head trauma and football. "We need to get this right."

Creekmur, who played 10 seasons as an offensive lineman with the Detroit Lions in the 1950s, would not at first seem like a prime candidate for CTE. While he broke his nose 13 times during his career, he was adamant about taping his fingers and ankles and was so rarely injured, he never missed a game, according to his wife Caroline, who married him in 1976 after his career was over. He was a gifted speaker with a bright mind, she said, a man who loved to talk to groups and had a wonderful memory.

But about five years ago, he began to deteriorate. Caroline noticed changes in his behavior. He didn't go out as much and grew moodier. As his ability to talk fell apart he grew frustrated and sometimes turned violent.

She took him to doctors who diagnosed him with dementia but told her she would never know the cause of his mental condition until after he died and his brain could be examined. Some told her he had Alzheimer's, but Caroline had family members who suffered from Alzheimer's and her husband didn't act the way they did. He still understood the world around him but struggled at times to maneuver within it.

"I could see the sadness in his eyes," she said.

With the dementia diagnosis he was a part of the NFL's Plan 88, a fund named after Baltimore Colts tight end John Mackey, who is struggling with similar issues. This qualified him for funding from the league for which Caroline said she is "grateful." But when her husband died a few days after falling at an assisted-living facility where she normally stayed with him, she wanted his brain to be studied.

"I just hope it helps players now that they know this is a possibility and can happen" she said of the diagnosis of CTE in her husband.

McKee said the Creekmur case is important because his brain clearly shows that he did not have Alzheimer's and that the damage in the brain is undoubtedly CTE.

"I think it's a recognition that NFL players were coming down with this disorder for a long time," she said. "We've only seen CTE in individuals who have had head trauma. You can't attribute that to Alzheimer's."

While some critics of the CTE research might point to Creekmur's age as a reason to not take the diagnosis seriously -- many people in their 80s suffer from forms of dementia -- McKee said the fact he was so old and clearly did not have Alzheimer's is an important breakthrough.

"In the past it's been easy to minimize the older players because we know Alzheimer's is so common," she said. "Because we know this is CTE we also know it could have been prevented."

Staff writer Mark Maske contributed to this report.

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