That was the question neuropathologist Bennet Omalu, MD, wanted to answer when Webster’s body appeared at the Allegheny Coroner’s Office for autopsy. Dr. Omalu made his first incision in Webster’s chest to take a look at his heart. Yes, it was definitely a heart attack that caused his early death. But there had to be more to this case. Webster was a menace on the field and possessed an unwavering strength and hunger for success. But his troubled life after football led Omalu to dig deeper. Omalu spent days and nights studying Webster’s brain to find an explanation. His brain appeared normal — no shrinkage as found in brains with Alzheimer’s, and no obvious contusions like in dementia pugilistica, a form of dementia found in boxers with repeated traumatic blows to the head. Then he saw it: little brown and red splotches everywhere. Also known as tau proteins, these accumulations of tangles are key drivers in dementia because they slowly spread and kill brain cells. Omalu knew he was onto something big, and presented his findings in a study published in the journal Neurosurgery, naming the condition chronic traumatic encephalopathy (CTE). Chronic traumatic encephalopathy (CTE) is a degenerative brain disease caused by repeated subconcussive hits to the head. Thus far it has been identified in individuals with a history of repetitive hits to the head, with military veterans and contact sport athletes having the highest risk. To date, CTE can only be identified during a postmortem autopsy. But symptoms of the condition can be present years before death, as they were in Webster’s case. “Often times in CTE, memory problems, difficulty multitasking, behavior problems such as aggression, and mood problems including depression worsen over time,” says Michael Alosco, PhD, a postdoctoral fellow with the Alzheimer’s Disease and CTE Center at Boston University. “If they live into older age, those with CTE will develop dementia.” Since 2009, a team of researchers at the VA-BU-CLF Brain Bank, located at Boston University, has studied hundreds of brains in the hopes of understanding the mechanisms of CTE and finding a way to diagnose the condition prior to death. So far, the researchers have diagnosed CTE in 110 out of the 111 former NFL players who have donated their brains, including five of the NFL’s most legendary athletes. Here are their stories:
1. Aaron Hernandez
The notorious football player had just been found not guilty of a 2012 double homicide, so his suicide was a shock to many. What drove the 27-year-old to take his own life? A postmortem brain scan revealed that Hernandez had been suffering from the degenerative brain disease CTE. The scan, performed by Ann McKee, PhD, lead researcher of the CTE Center at Boston University, showed evidence of brain atrophy, damage to the frontal lobe, and large portions of black spots created by tau protein. “We’ve never seen this in our 468 brains, except in individuals some 20 years older,” Dr. McKee said in an article published November 9, 2017, in the New York Post. Hernandez also showed all of the typical signs of CTE during his lifetime, including:
Changes in mood, such as depression, aggression, irritability, impulsivity, and anxietyHeadaches and migrainesMemory problems
Following the CTE diagnosis, Hernandez’s family filed a $20 million lawsuit against the New England Patriots and the NFL. According to an article published September 21, 2017. in USA Today, who obtained a copy of the 18-page filing, the lawsuit contends that both the league and the team “were fully aware of the damage that could be inflicted from repetitive impact injuries and failed to disclose, treat, or protect him from the dangers of such damage.” The family has since dropped the lawsuit but left open the possibility of filing it in a different court. We’ll have to wait and see.
2. Frank Gifford
According to an article published on November 25, 2015, by WABC-TV, the family’s statement went on to say: “We… find comfort in knowing that by disclosing his condition we might contribute positively to the ongoing conversation that needs to be had; that he might be an inspiration for others suffering with this disease that needs to be addressed in the present; and that we might be a small part of the solution to an urgent problem concerning anyone involved with football, at any level.” Though Gifford took many hits in his career, a devastating tackle by Eagles linebacker Chuck Bednarik in November 1960 likely contributed to his CTE. Knocked instantly unconscious by the blow, Gifford was in the hospital for 10 days and unable to play for two years after suffering from one of the most notorious concussions in NFL history. Some lasting symptoms of his deep brain concussion, spinal concussion, and eventual CTE included tingling fingers, confusion, and short-term memory loss. Gifford spent his post-football years as a television sports commentator and working to help the NFL impose rules on helmet-to-helmet hits. “It’s hard to do,” Gifford said in an article published in The New York Times. “You have to start in high school and get them to play the right way. And it’s hard on officials, whether on the field or in the league office, who have to be judge and jury.”
3. Ken Stabler
Kim Bush, Stabler’s long-time partner, mentioned to ESPN’s Outside the Lines (OTL) that Stabler suffered from severe headaches in addition to disorientation and forgetfulness. “We talked at length about head injury,” Bush told OTL. “He was certain that he was suffering from the consequences of playing football.” Stabler died of colon cancer at the age of 69, and per his request, had his brain donated for research to the Boston University CTE Center. After studying Stabler’s brain scans, McKee of the Boston CTE Center confirmed a diagnosis of CTE and told The Associated Press that the disease was widespread throughout his brain, with severe damage to areas involved with learning, memory, and regulation of emotion. Chris Nowinski, the founder of the Concussion Legacy Foundation, told The Associated Press that it was interesting that Stabler anticipated his diagnosis years in advance. “And even though he’s a football icon, he began actively distancing himself from the game in his final years, expressing hope that his grandsons would choose not to play,” he said. Stabler’s case broadened the reach for positions at risk for CTE. He was a quarterback, a position considered less likely to be tackled in the run of play. In fact, the NFL imposes rules to protect quarterbacks from being sacked too aggressively, such as the “Brady Rule” that restricts players from hitting a quarterback below the knee without getting a penalty. “While we know on average that certain positions experience more repetitive head impacts and are more likely at greater risk for CTE, no position is immune,” McKee said in an article published February 3, 2016, by KRON.
4. Andre Waters
“Football killed him,” Omalu was quoted in an article published in the Palm Beach Post after examining his brain, adding that Waters’ brain tissue resembled that of an 85-year-old in the early stages of Alzheimer’s. “If Waters had lived another 10 to 15 years, he would’ve been fully incapacitated,” Omalu said in an article published in The New York Times. Waters racked up hundreds of tackles in his 12 seasons with the Eagles and the Arizona Cardinals, and the effects of repeated head trauma had taken their toll. On the field, Waters was nicknamed “Dirty Waters” for his aggressive style of tackling, which, to no surprise, often began with his head. “He used his head a lot,” Waters’s former high school coach, Antoine Russell, told the Palm Beach Post. “When we were in school, because I knew our insurance was not too good, I tried so many times to stop him.” Waters was anything but dirty off the field, known as a brother to his teammates, a generous friend to those he cared about, and a loving son to the mother he thanked God every day for. But post-NFL, Waters developed depression that drove him to take his life.
5. Junior Seau
Seau was one of the NFL’s fiercest linebackers, with a 20-year career as a lead force for the San Diego Chargers, the Miami Dolphins, and the New England Patriots. His list of professional honors is extensive, with achievements such as a 10-time All-Pro select, a 12-time Pro Bowl select, a 1990 All-Decade Team select, and a 2015 Pro Football Hall of Fame inductee. After Seau’s suicide, his family insisted on having his brain examined for signs of CTE. The family donated his brain to the National Institute of Health (NIH). According to the autopsy report published in February 2016 in the journal World Neurosurgery, Seau’s brain revealed abnormalities consistent with CTE and similar to autopsies of people with “exposure to repetitive head injuries.” The NFL responded in a statement about the NIH’s findings, saying that the report “underscores the recognized need for additional research to accelerate a fuller understanding of CTE.” The NFL followed with a $30 million research grant to the NIH so that they can explore CTE and promote the long-term safety of athletes at all levels. Meanwhile, at the Boston University CTE Center, researchers are committed to studying the donated brains of former athletes to learn more about CTE and the long-term effects of contact sports. “Our goal is to better characterize what CTE looks like in the brain, what causes it, and the different risk factors, like genetics or lifestyle, that may play a role,” says Dr. Alosco.
