The family of Kelly Catlin, the Olympic cyclist who died by suicide last week at 23, has donated her brain to Veterans Affairs-Boston University-Concussion Legacy Foundation Brain Bank, seeking answers for a series of behavioral changes that they believe contributed to her death.
“Our family decided to have a neuropathologic examination performed on Kelly’s brain to investigate any possible damage caused by her recent head injury and seek explanations for recent neurologic symptoms,” her father, Mark, said of the family’s decision.
The BU-CTE Center, which houses the brain bank, confirmed that the donation had been received from California. Center officials estimated to Mark Catlin that clinical and pathological research could take up to 12 months to complete.
With tissue from more than 660 donors, the brain bank bills itself as “the largest tissue repository in the world focused on traumatic brain injury (TBI)” and Chronic Traumatic Encephalopathy (CTE). Researchers there also study the effects of concussive and sub-concussive hits that leave no symptoms.
Although the bank contains mostly the brains of former football players, “we have a large collection of brains from people who engaged in a wide variety of sports (including boxing, ice hockey, rugby, soccer, mixed martial arts, professional wresting, baseball, etc.), military-related activities and other activities associated with head trauma,” Ann McKee, the neuropathologist who is the center’s director, wrote in an email.
The center also has some brains of victims of domestic violence and repetitive physical abuse. It has begun a “large recruitment campaign” for female brains because, according to McKee, “there is considerable interest in the effects of gender on outcome” and “there is some suggestion from the clinical literature that the consequences of concussion may be greater in women" than men.
Kelly Catlin, whose body was discovered Thursday in her on-campus residence at Stanford University, was until recently a multitasking whirlwind who balanced graduate work in computational and mathematical engineering with her cycling career, according to family members. She was part of a team that won a silver medal in pursuit at the Rio Olympics in 2016 and also competed in professional road cycling.
Two crashes, one in which she broke her arm in October and another in which she sustained a concussion in December, seemed to take away the control that Catlin had always prized, according to her family. In January, she attempted suicide for the first time and became almost unrecognizable to family members. “She was not the Kelly that we knew,” said her father, a recently retired pathologist in the Minneapolis area. “She spoke like a robot. We could get her to talk, but we wondered, ‘what has happened to our Kelly?’”
She suffered from severe headaches and light sensitivity and found it impossible to focus on her studies, they said. Mark Catlin described a “perfect storm” of depression, classic concussion symptoms, overtraining, “not being able to say no” and other physical problems.
“Everything was open to her, but somehow her thinking was changed and she couldn’t see beyond, I guess, her depression,” he said this week. “After her concussion, she started embracing nihilism. Life was meaningless. There was no purpose. This was a person with depression. For her, she could no longer concentrate on her studies or train as hard. She couldn’t fulfill what she felt were her obligations to herself, she couldn’t live up to her own standards. She couldn’t realize that what she needed to do was get away and rest, heal. We were all searching for the magic words, that life was worth living.”
According to McKee, “a large number of brain donors to the bank experienced a recent concussive event," like Catlin.
“The changes we see most commonly [in tissue] include inflammation, microscopic bleeding and damage to the axons in the white matter of the brain,” McKee wrote. “In some young individuals who experienced repetitive impact injury, we also see the earliest beginnings of CTE, as focal collections of abnormal tau in neurons around small blood vessels.”
Whether the symptoms pointed to by Catlin’s family members point to a brain injury isn’t yet possible to say, according to McKee.
“Those are unfortunately common symptoms of a brain injury such as concussion, although the symptoms can have many other causes,” she wrote. “The goal of our research is to enable novel insights into concussive and sub-concussive injury in a way no other research can. By understanding the ways that the human brain reacts to concussive injury, we are hoping to discover new ways to diagnose concussion during life and develop effective treatments.”
That’s a goal fully supported by Taylor Twellman, a former MLS star whose soccer career was ended by whiplash and concussion in 2008. Twellman, now an ESPN soccer analyst, said in a phone interview this week that the description of Kelly Catlin’s overwhelming problems sounded all too familiar.
“I’m having a day that’s a dizzy day for me, and a little more than 10 years ago was my last concussion,” Twellman said. “It’s all relative for most people. What’s interesting to me is the millions of dollars that are involved in this medical discussion, but none of it is about rehabilitation. The constant conversation is about prevention, but more focus needs to be on recovery and rehabilitation, and that’s a gray area. What would work for me is one thing; for someone like Kelly is another. You’ve got to look at all facets of the brain. You’ve got to look at anxiety. Everyone is different, and we have to help brains heal to the extent they can.”
For an athlete, Twellman said, a physical injury is far easier to accept than post-concussion struggles.
“It’s one thing to deal with the loss of the athletic ability; it’s another not to be able to feel your body.” he said. “Everybody’s career ends at some point and athletes know that, but this is no different than a blown ACL. What people don’t understand is not being able to go to a movie or type on a computer. You can’t do what you usually do. What are we doing as a support group, as a society?”