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Diagnosing CTE in Living Former Players: Revisiting a Prior Discovery

June 27, 2023
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CTE, or chronic traumatic encephalopathy, is an established brain disease linked to repeated brain trauma. Currently, there isn’t a diagnostic test available to confirm whether a living person has CTE; it can only be diagnosed after death.

Scientists and healthcare professionals have been researching if there are types of tests that could be used to test for CTE in living players. These kinds of diagnostic scans are available for other neurodegenerative diseases. To diagnose Alzheimer’s Disease, for example, physicians and researchers can inject tracers (chemicals that bind to specific proteins in the brain and body), which can only be seen during a PET (positron emission tomography) scan.

As CTE is an important focus for the broader football community, our investigators decided to replicate a landmark study from 2019. In this study, researchers injected a PET tracer into a group of former NFL players, and found that the tracer “lit up” the same areas of the brain that were identified in previous autopsy studies that diagnosed CTE.

Our researchers recreated this study by testing 27 living former NFL players as part of our In-Person Assessments study, along with a control group of 11 men who are not football players.

What we Found

  • When the researchers recreated the 2019 study, there were no differences in tracer uptake between former NFL players and controls in those same brain areas previously studied. This means that the tracer did not “light up” any parts of the brains in former players.
  • When they examined whether the amount of tracer visible on PET was linked to aspects of football play, the team found no strong relationships between tracer uptake and football experiences (total years of football, age of first exposure to professional football, number of concussions while playing).
  • Additionally, It is important to note that the this tracer (developed for Alzheimer’s Disease and used in both studies) demonstrated differences in how it appeared in Black players versus white players . The disparity between the two suggests that this tracer may not be a good diagnostic tool when studying diverse populations and that new targeted tracers should be investigated in the search for a test to diagnose CTE in living players.

What This Means for You

  • Our results call into question whether this tracer can and should be used to diagnose or study CTE in living players. More research is needed to examine this and other tracers for diagnosing CTE through scans.
  • CTE continues to only be diagnosable after a person has died. We recognize that some former players in our study may have the underlying brain changes associated with CTE. Conditions common to former NFL players such as hypertension, sleep apnea, depression, anxiety, chronic pain, and the use of prescription pain medicine can be potential causes of cognitive dysfunction and are treatable. If you are experiencing cognitive symptoms or other health issues, please reach out to your primary care team or a specialist.
  • Most importantly, if your physician believes you may have CTE, request a referral to see a specialist who is highly experienced in treating the cognitive symptoms associated with this condition. These physicians will have access to the latest research and recently established criteria that can be considered for treatment. This CDC fact sheet [PDF], Answering Questions About Chronic Traumatic Encephalopathy (CTE), provides useful information regarding CTE, diagnosis, and other information.

Below are some steps former players can take when discussing symptoms with their physicians, as well as other resources for improving cognitive health today.

With a Specialist or a Doctor

If your clinician suggests that you may have CTE, ask if you have been tested for the following conditions that can affect cognitive function:

  • High blood pressure
  • Diabetes or high blood sugar
  • Sleep apnea
  • High cholesterol
  • Other heart conditions
  • Low testosterone
  • Depression

If you think you may be experiencing symptoms of cognitive impairment, talk to your primary care physician (PCP) about getting a comprehensive neurocognitive evaluation from a neurologist or highly trained specialist.

To learn more about your health during a visit to the doctor:

  • Ask questions
  • Don’t be afraid to question a CTE diagnosis – it might be something else
  • Seek second opinions from specialists
  • Follow through and follow up with your physicians

It is important that your physician listens to you. Your PCP should be someone you trust, who understands your background, and with whom you can work.

With a Doctor or on Your Own

Physical exercise has been shown to be effective in improving cognitive health and quality of life:

  • Ask your physician to recommend specific exercises and lifestyle choices known to provide cardiovascular benefit while limiting wear and tear on joints, especially if you’ve had a prior ACL tear or joint injury.
  • Even if you are not going to the gym, find resources for working out indoors. On YouTube, FitnessBlender and Yoga with Adriene are two great channels that keep our study team active.

Train your brain:

Reach out to your social circle:

  • Maintaining a healthy social life with friends and family has been shown to improve cognitive function, physical health ,and even extend the lifespan.
  • Arrange a hangout with long distance family and friends through Zoom or FaceTime to strengthen these vital connections.

Further Resources

  • The Trust’s Brain and Body partners provide a thorough mental (cognitive, social emotional) and full body physical health assessment. Following the assessment, each partner will also provide a recommendation containing a plan of action that each
    player can follow after his visit. For more information, visit the Players Trust website.
  • Sleep apnea or other sleep problems may affect cognition and mood. Check out this resource on sleep apnea [PDF] and consider consulting your doctor about a sleep evaluation that may help you to learn more about your own sleep.
  • The NFL Life Line is a free, independent and confidential phone consultation service that is available to former players and their families 24 hours a day, 7 days a week. The Life Line is run by professionals who are trained to assist individuals seeking resources for mental or physical health concerns or who are experiencing personal or emotional crises. Contact: (800) 506-0078.
  • The Players Assistance & Counseling Services benefit provides eligible former players and their families with up to eight free counseling sessions a year for matters ranging from family/marital concerns to depression. Contact (866) 421-8628 for more information on the benefits provided by NFL Work/Life Resources.

If you have questions about this information, please email our team at players@footballplayershealth.harvard.edu or call us at 617-432-5000. You can also visit our website to learn more about our research and prior results.

If you are in distress or require immediate assistance, please contact the NFL Lifeline at 1-800-506-0078 or visit their website to chat with a trained counselor.