BU study: Young amateur athletes are getting CTE


High school and college athletes can develop the brain disease most commonly associated with professional contact sports, the study shows.

Director Ann McKee and neuropathologist Victor Alvarez at Boston University’s CTE Center in 2017. Boston University School of Medicine.

Researchers at Boston University’s Chronic Traumatic Encephalopathy Center studied 152 young athletes’ brains and found that 41% of them — including many amateur players — had CTE, the brain disorder most commonly associated with professional contact sports.

CTE is a degenerative brain disease that can develop from repeated head impacts — the kind sustained by ice hockey, soccer, rugby, and above all football players. It’s a progressive disease, meaning it becomes more and more severe with age even if the patient has no new head trauma. As it worsens it can cause behavioral, mood, and cognitive changes, and even dementia. 

The new study suggests that young amateurs, including high school and college athletes, are more likely than the general population to develop CTE. Dr. Ann McKee, director of BU’s CTE Center, explained that physicians should keep this in mind when young patients come in reporting head trauma.

“Physicians and other caregivers need to recognize that just the play of contact sports can result in long-term symptoms that most probably can be reversed, but should be cared for properly and shouldn’t be minimized or trivialized,” McKee told Boston.com.

CTE can’t yet be diagnosed in living patients, so the researchers studied brains donated by the families of young athletes under 30 who died. They chose to focus on younger athletes because although CTE has been reported in subjects as young as 17, little is known about the earliest stages of the disease, or how it impacts younger brains.

In addition to studying the donor brains themselves, McKee and her colleagues performed posthumous clinical evaluations of the young athletes — examining their medical records and interviewing their next of kin to learn about their symptoms.

The researchers’ goal is to eventually be able to identify CTE in living patients and develop therapies for the disease.

“These [were] generally quite healthy young people, so it allows us to see the very earliest pathology of CTE in the brains of otherwise normal individuals. It gives us insight into what cells in the brain are first affected, where the first changes are,” McKee explained. “Those are all clues for how this starts, and they’ll give us insights into developing new ways to detect the disease during life.”

Of the 63 brain donors diagnosed with CTE, 48 were football players, six were ice hockey players, and four were soccer players. Of the 48 football players with CTE, 12 were professionals and the rest were amateur players who played in high school and/or college.

The vast majority of the brain donors in the study were male, and CTE has most commonly been described in male athletes. Of the 11 female subjects in the study, the BU researchers diagnosed one, a 28-year-old who was a Division 1 college soccer player, with CTE. This is the first time a female amateur athlete has been diagnosed with CTE, McKee said. 

“Ideally, we would have half of our brain donors being women, because we’re very concerned about the susceptibility to CTE based on gender,” McKee said. “But the unfortunate fact is that we have very few brain donors that are women. We’re trying to improve that number.”

During the posthumous evaluations, McKee and her colleagues didn’t find any statistically significant differences in subjects’ cognitive, behavioral, or mood symptoms that could provide hints to the early warning signs of CTE.

“Based on [the subjects’] clinical symptoms, we couldn’t tell those who had CTE from those who didn’t, McKee said. “I think a lot of that is due to the fact that we weren’t able to evaluate these people during life and conduct more sophisticated tests.”

That just underscores the importance of learning more about the disease, she said, and eventually finding a way to diagnose it in living patients.