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New Scan May Enable Better Diagnosis, Treatment for Athletes’ Brain Damage

January 22, 2013 at 12:00 AM EST
Jeffrey Brown talks with Dr. Gary Small of UCLA about how new procedures may enable doctors to identify serious head injuries in athletes and others, and the grave importance of protecting our brains from physical trauma.
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JEFFREY BROWN: Next: how brain scans may be able to help identify serious head injuries to living and retired football players and to the rest of us.

In less than two weeks, football fans will gather for the country’s biggest sporting event, Super Bowl Sunday. But even as pro football is drawing strong ratings, there are growing concerns about the long-term effects of concussions and other hits to the head.

Today, researchers in California and Illinois reported they can identify protein deposits in the brains of living players that could help identify those at risk of developing an injury known as CTE, chronic traumatic encephalopathy. The study done by Gary Small of UCLA and others is quite small. Five former players, all retired and between the ages of 45 and 73, were given a compound that showed a buildup of a protein known as tau in the brain.

DR. GARY SMALL, UCLA: We see, here’s the cortex and the deeper brain structures.

JEFFREY BROWN: Dr. Small is the lead author of the new paper published in “The American Journal of Geriatric Psychiatry.”

GARY SMALL: This is the first time we have been able to image in living football players protein deposits that we have observed in people with Alzheimer’s disease.

JEFFREY BROWN: Until now, CTE has only been identified postmortem in autopsies by looking at cross-sections of the brain.

Wayne Clark, a backup quarterback with the San Diego Chargers in the ’70s, is one of the players who participated. He has mild memory loss.

WAYNE CLARK, former National Football League player: When I first saw the scan, I thought, whoa, that looks pretty extensive. I know recalling names which I recall used to be pretty easy for me and so forth. And now I go through stages where I think, ooh, how come I can’t remember that? And I am — always wondered, are these age-related or are they concussion-related?

JEFFREY BROWN: Findings so far are only preliminary, but they may help doctors identify and treat brain disease before it impacts other players.

The issue is a major concern for football at the professional and collegiate level and possibly even younger players. More than 4,000 former players are suing the NFL for head injuries and the risks they faced.

And we get more on this study from its lead author, Dr. Gary Small, professor of aging and director of the Longevity Center at UCLA and author of the book “The Alzheimer’s Prevention Program.” He joins us tonight from New York.

Dr. Small, first of all, why is it important to be able to look at living players, rather than at autopsies? What’s the significance?

GARY SMALL: Generally, the brain gets damaged gradually over time.

And what our hope is, to find problems early on, so we can protect a healthy brain, rather than wait until there’s extensive damage.

JEFFREY BROWN: So, just fill in the picture a little bit for us in layman’s terms. What is it that you’re — what is it that you’re looking at in the brain? What do you look for after there’s been a concussion or repeated hits?

GARY SMALL: What we’re looking for are tiny abnormal protein deposits that collect in areas of the brain that control muscle movement, that control mood, control thinking and memory.

And what we have done is studied this extensively in Alzheimer’s patients. And now, for the first time, we have looked at professional athletes who have had concussions, who have had some of these symptoms. And we see a pattern that we’d expect from autopsy studies.

JEFFREY BROWN: So, what — what — tell me more about the pattern. What — what happens? What do you see?

GARY SMALL: What we see is collections of these tiny protein deposits in deep portions of the brain and actually in an area of the brain that controls emotion, which is not surprising, since many of these players have mood symptoms.

They have higher levels of depression than normal people.

JEFFREY BROWN: So, what’s the hope then in knowing this information, especially in knowing it earlier? What does that — what might that allow you to do?

GARY SMALL: It might allow us to develop a test for managing these problems. If a player has a concussion, we might know when to keep that player out of the game for a while.

It also allows us to test new drugs and treatments that are geared towards protecting the brain before these protein deposits build up and other damage occurs.

JEFFREY BROWN: Well, you mean even one day get to the level of an actual game decision, of whether someone should stay in the game? Could it also — I assume, therefore, it could have implications for people’s careers?

GARY SMALL: That’s possible. And certainly it could help protect players.

But it’s not just professional athletes. It also has to do with amateur athletes, military personnel, auto accident victims, almost anybody who has had a blow to the head. This could be an opportunity to detect problems early on and try to protect the brain from further damage.

JEFFREY BROWN: And how does one do that, protect the brain from further damage once you see that something is, if not started, at risk for starting?

GARY SMALL: Well, right now, with sports, it’s keeping the player out of the game. The brain needs to heal, like any part of the body when there’s been an injury.

And while we’re waiting for science to catch up with new innovative treatments, we know there are lifestyle strategies that are brain-protective, aerobic physical conditioning, a healthy diet, stress management. These are the kinds of strategies in “The Alzheimer’s Prevention Program” that we recommend for everyone.

And I think it’s critically important to take note of these for head trauma victims. We know there’s a connection between head trauma and brain disease. People who get knocked out for an hour or more have a risk that is double that of the general population for developing Alzheimer’s disease.

JEFFREY BROWN: Now, you know, I think you have been very clear to say that this isn’t quite definitive. You’re not at that stage. It’s a small study. Tell me about the caveats that are still out there in your mind now and what more you need to do.

GARY SMALL: Well, we need to look at more players. We need to follow them over time. And we need to do a study of a player who has had a scan who passes away, and then look at their autopsy tissue to see if we can correlate that individual subject.

So, we have some more work to do. But we think these results are important to guide further research. One thing that was quite striking about the study was that the pattern on the brain scans was identical to the patterns seen in autopsy cases of this condition known as chronic traumatic encephalopathy, or CTE, that’s been described in players.

JEFFREY BROWN: And what kind of reaction are you getting so far from other researchers, other people who have looked into this, or from — I don’t know if you’re getting any reaction yet from the NFL or other sports organizations.

GARY SMALL: We haven’t heard from the NFL. We have had some positive response from the Players Association and a lot of encouragement from other scientists that this is interesting work.

JEFFREY BROWN: And, just finally, Dr. Small, beyond sports — and I guess this applies also to war injuries as well. What are the other implications of looking at the brain this way? You yourself do a lot of work in Alzheimer’s, so what’s the link?

GARY SMALL: Well, I think the link is that we have got to protect our heads, whether it’s from head trauma, whether it’s from wear and tear from aging, whether it’s stress, lack of exercise, overweight, obesity. There are so many physical problems that can wreak havoc on our brain health. We have really got to be careful of protecting our brains.

JEFFREY BROWN: Dr. Gary Small of UCLA, thanks so much.

GARY SMALL: Thank you.

JEFFREY BROWN: You can find links to past NewsHour coverage on concussions and the health consequences. That’s on our home page.