First reported as ‘punch drunk syndrome’ in boxers, chronic traumatic encephalopathy (CTE) is described as the long-term neurodegenerative consequence of repetitive mild traumatic brain injury. CTE can manifest clinically in the form of memory disturbances, behavioural and personality changes, Parkinsonism, and speech and gait abnormalities. Given its similarity to other neurodegenerative disease states, at present, CTE is indistinguishable from diseases such as Alzheimer’s until neuropathological examination post mortem. Neuropathologically, CTE is characterized by tauopathies predominantly in the superficial layers of the cortex, the depths of sulci and around vasculature.
Following initial reports of CTE pathology in ex-boxers, followed by similar findings more recently in American football players and other athletes, research into the relationship between repetitive head injury and neurodegenerative disease pathology has vastly increased in recent years. In line with this, so too has popular interest in the risk of CTE in sports players: the first description of CTE in ex-NFL football players was depicted in the film Concussion.
Today sees the release of a new neuropathological study in Acta Neuropathologica that describes CTE pathology in a series of retired Association Football (soccer) players – the first study of its kind – further hinting towards a relationship between repetitive head injury in sport and development of neurodegeneration, including CTE. But what does this mean for sport? Should players be wary of heading the ball? Whilst these observations alone do not describe a causative relationship between repetitive head injury in sport and development of CTE pathology and neurodegenerative symptoms, they nonetheless highlight the need for further systematic investigation.
To find out more about the study, its implications and limitations, we spoke to lead author Helen Ling (University College London, UK) in this exclusive interview.
00.12 – First could you tell us a bit about your background?
00.50 – Could you tell us about the background of your recent paper on CTE in soccer players? How did this research come about?
02.22 – What were the key findings?
06.10 – What are the limitations on this study?
09.21 – Given these limitations, can you establish whether there is a causative relationship here? Are footballers, particularly those heading the ball, at increased risk of developing CTE?
11.07 – We’re seeing an increase in attention paid to head injury in sport and calls for changes to return to play protocols – do your recent findings support this?
11.58 – What are the risks of heading in children? Do you think we should ban children from heading the ball like the USA?
12.36 – What are the future research directions following this study? What other research is going on in this area?
13.37 – Finally, what do you see as the key questions to be address in regard to head injury in sport in the next 5–10 years?