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New Dementia Attacking Athletes

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BOSTON, MA ( Ivanhoe Newswire) - Super Bowl champs and NFL hall of famers are a few of the athletes who will be part of a major study after they are dead. A former pro-wrestling star who helped get the NFL's concussion policy changed wants to treat and prevent a form of dementia called CTE.

From high school to Harvard to the NFL, Isaiah Kaczyvenski's life was football. Now, the former linebacker who still suffers the effects of at least five concussions has committed to help a new team. One day Isaiah's brain will be in the brain bank. This is where neuropathology Dr. Ann Mckee examines the donated brains of deceased athletes.

"Headaches, sleeplessness, not feeling right emotionally," Isaiah told Ivanhoe.

Looking for signs of chronic traumatic encephalopathy, or CTE, it's believed to be caused by repeat concussions or other brain trauma.

"You'd compare it [brain] to some older person say 70's and 80's with severe end stage dementia," Ann McKee, M.D., a professor of neurology & pathology & laboratory medicine and director of the Neuropathology Core, explained.

Dr. McKee examined the brain of a professional boxer with some temporal atrophy, that's too small.

Center for the study of traumatic encephalopathies, Chris Nowinski recruits athletes to donate their brains. The former professional wrestler is also Isaiah's college teammate.

"This is the only type of dementia that exists that's preventable," Chris Nowinski explained. CTE has been spotted in deceased college and high school athletes. Nowinski says to help prevent it we need to limit what young athletes do on the field.

"And people are going to fight like heck to say should a 6 -year-old be heading a soccer ball," Nowinski said.

Isaiah knows he's at risk for CTE and that when his brain gets here it could prevent the next generation from developing it.

More than 500 living athletes have agreed to donate their brains to the research.to data; and.nearly 100 brains have been examined at the brain bank.  More than 50 have been diagnosed with CTE. Chris and Isaiah have started going to the Super Bowl every year to recruit NFL players to donate their brains. Dr. Mckee said right now there's also a big need for brains from non-athletes to help with her research.

RESEARCH SUMMARY

BACKGROUND: The progressive degenerative disease of the brain in athletes with a history of repetitive brain trauma is known as Chronic Traumatic Encephalopathy. It was originally introduced as the term punch-drunk in 1928 due to repeated blows to the head professional boxers endured.  Then it became known as dementia pugilistica and the psychopathic deterioration of pugilists- a pugilist is a boxer.  The Center for the Study of Traumatic Encephalopathy at Boston University is currently recruiting athletes to donate their brains in order to study, understand and hopefully find a way to reverse the effects of CTE.  CTE is known to cause memory loss, confusion, impaired judgment, impulse control problems, aggression, depression and eventually, progressive dementia.
(SOURCE : www.bu.edu)

CAUSES:  CTE is caused by repetitive head injuries, in which the trauma triggers progressive degeneration of the brain tissue, including the buildup of an abnormal protein called tau. 
(SOURCE: www.bu.edu)

SYMPTOMS:  CTE has three different stages.  The first stage is characterized by effective disturbances and psychotic symptoms.  The second stage shows signs of social instability, erratic behavior, memory loss and initial symptoms of Parkinson's disease.  The third stage consists of general cognitive dysfunction progressing to dementia and is often accompanied by full blown Parkinson's, as well as speech and walking abnormalities.
(SOURCE : www.bu.edu)

APPLICATION: The VA CSTE Brain Bank was established in 2008 at the Bedford Veterans Administration Medical Center in Bedford, MA.  Brain donations of the deceased are accepted in order to study the tissue and spinal cord to better understand the effects of trauma on the human nervous system.  It would help to establish a diagnostic test for living persons with CTE, genetic risk factors, environmental risk factors and treatment for CTE.
(SOURCE : www.bu.edu)

INTERVIEW

Dr. Ann McKee, M.D., Neuropathologist at the Bedford VA Medical Center, talks about fighting the new dementia.

As part of being Co-Director, what exactly is the research you are doing here at the brain bank?

Dr. Ann McKee: I run the brain bank, which is actually turning out to be a very active brain bank. We've had 88 brains come into the bank since we began a little over 3 years ago. We coordinate the harvesting of brains with families of loved ones and then the brain and spinal cord arrive here to be studied. We photograph them, dissect them very carefully, and then flash freeze a portion of the brain for future studies, such as some molecular studies and some biochemical studies. We also fix a portion of the brain so we can do a comprehensive neuropathological analysis. We are looking for: What did the person die from? How bad was the disease? Are there any mitigating factors? The total process takes us about 3 months per brain.

Are all these brains from formal athletes?

Dr. Ann McKee: In the CTSE brain bank, there are formal athletes as well as some military veterans. The CSTE brain bank originally focused on athletes, but we have become interested in military veterans as well because so many of them are experiencing traumatic brain injuries in the current wars. We are expanding into all different arenas.

In the three plus years you've been doing this, what have you found and what are the conditions these brains are in?

Dr. Ann McKee: We are looking at this disease called Chronic Traumatic Encephalopathy (CTE). When we first saw it in football players, it was extraordinary because these men are dying way too young, around age 45-50, for various reasons. Then, when we studied their brains we found that they had extensive neurodegeneration. Many of these men were diagnosed with Alzheimer's disease or other neurodegenerative disease while they were alive, but our post-mortem analysis shows that many of them had CTE. CTE is a distinct disease and has a different pattern than something like Alzheimer's disease. The devastation we saw in these football players' brains was shocking.

How can you compare a forty-five year olds brain, what would it be compared to?

Dr. Ann McKee: You could compare it to an older person's brain, someone in their seventies or eighties with severe end-stage dementia. CTE is a very slow progressive disease so by the time they reach their late forties and early fifties it will have become quite extensive. We have over 57 cases with this disorder and have seen a range now from the earliest stages in young athletes, people with just mild injuries, all the way to the severe end, the advanced stage of this disease. We are seeing how it affects the brain, which parts of the brain that are affected first and then what the sequence of changes are. We have seen some tremendously altered brains; some of these players have brains that are half the size they should be. Instead of the 1,600 grams it should approximately weigh, it weighs 800 grams. We don't see this in every single brain we study, but when we do see it, it is unbelievable.

How is what you're seeing, leading you to the treatments of CTE?

Dr. Ann McKee: First of all, three years ago, no one had any idea this disease even existed. No one realized it was living among us. We thought it could only happen to boxers who are getting hit in the head on a constant basis. But it turns out that football players are affected with this disease as well, and this hits home with a lot of people because football is one of the most popular games in America. No one expected that playing football could cause so much brain damage.

Where is your research going at this point?

Dr. Ann McKee: First, we are trying to define the earliest stages of this disease like what goes wrong in the beginning. We want to figure this part out because that is when we have our biggest opportunity to prevent it from getting worse. If we can understand the mechanisms, what triggers it, what pathways does the sequence of change evolve through, then we can figure out how to interrupt that path and prevent this disease from developing. Our hope is to stop the disease from developing in the beginning, even if individuals have had one or two concussions.

In just three short years, you have come so far?

Dr. Ann McKee: That's true; there are so many aspects of this that are truly incredible to me. I've been looking at brains after death for almost twenty-five years now and to come across this disease that is so fulminant in some individuals that we didn't recognize it before that. It's been an extraordinary experience and now that we understand what it is, we can pick it apart and try to prevent it from happening.

What do you expect to see over the next few years of research?

Dr. Ann McKee: People have started contacting us worried that they have CTE and the message that I want to send to those people is now that we know about the disease, we have the greatest hope and ability to diagnose and treat this disease. This is just the beginning, what we've learned in such a short time has been so extraordinary. Our chances of coming up with a way to prevent it is also very good for the near future.

What is the biggest breakthrough you have seen?

Dr. Ann McKee: It has all been incredible. We have seen about 10% of individuals in our brain bank with CTE that also have a motor neuron component, so linking this ALS, or Amyotrophic Lateral Sclerosis, like disease to head trauma is going to stand the test of time, or at least I think so. Originally, we saw this ALS-like component in three athletes, but we now have six identified cases and two more waiting for analysis. I believe we will see a connection of head trauma not only with CTE but, also with some other degenerative diseases. Depending on the genetic make-up of the person, trauma seems to bring out whatever your predispositions are - it may be what triggers CTE's expression.

It can start in the head and move?

Dr. Ann McKee: Yes, it starts in the head. It also involves the motor neurons that are in the spinal cord. It can spread, but certainly the nerve cells in the brain have the longest projections, called axons, which go all the way down the spinal cord, some of them are two yards long. The process can travel from one nerve cell to the next – it can even connect nerve cells in the brain with nerve cells in the spinal cord.

Where do you see the research going? It seems it's still on a smaller scale; would you like to see it expand more?

Dr. Ann McKee: Absolutely, that's one of our greatest hopes that this research will expand tremendously. We really want to get into understanding injuries that are suffered by military veterans, understanding their blast injuries and combat induced concussions. We are concerned that all the things we are seeing in athletes may also affect our war fighters.

One thing that I've noticed is that we have an explosion in public awareness. We used to really need to reach out to people to get brains and we now we are to the point that people are referring their loved ones to us.

We have heard it's close to five hundred that are committed now?

Dr. Ann McKee: Yes, just this morning we had a family that reached out to us that we otherwise would not have known about. That's happening more and more.

That must be very encouraging then?

Dr. Ann McKee: Very encouraging, but I think we need a gigantic effort; I said we had eighty-eight brains; we need hundreds of brains, five hundred to a thousand to really understand this disorder. Since there are so many different aspects of the disease, we need to understand the genetic dispositions and that is going to take numbers. I would really like to expand that and then expand our experimental modeling of this disease.

In the three plus years you have been doing this, what surprises you with the conditions that these brains are in?

Dr. Ann McKee: We have this huge spectrum of the disease; young people who barely have the disease and people in the middle ages who have end-stage disease. We understand how it affects the brain, which parts of the brain are affected first, and what the sequences of changes are.

What would you like to see in the near future?

Dr. Ann McKee: We would like to compare experimental models to different types of trauma, different frequencies of trauma, and different severities of trauma.

FOR MORE INFORMATION, PLEASE CONTACT:

Christine Baugh
The Center for the Study of Traumatic Encephalopathy
(617) 638-6143
cbaugh@bu.edu

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