Why NFL Players Suffer Dementia, Depression

Christopher Wanjek

Date: 05 June 2007 Time: 07:29 AM ET

Football concussions: hut, hut, uh, what comes next?

Professional football players say that competing in the pros before a packed house of 70,000 fans provides memories that last a lifetime---or at least until their 40s when their memory and other cognitive skills start to diminish as a result of a long career of blows to the head.

It's enough to make you depressed. In fact, according to a study in the current issue of Medicine & Science in Sports & Exercise, the rate of clinical depression among former football pros is indeed strongly associated with number of concussions they sustained on the field.

The study, from the University of North Carolina, adds to a growing body of research on dementia and memory loss among retired athletes revealing how football takes an unreasonable toll on the mind as well as the body.

Put me in, coach

A concussion is a bruise to the brain. A mild concussion is a blow that causes confusion and short-term memory loss; the so-called classic concussion entails a loss of consciousness, and the aftereffects are far worse. The chance of receiving a second concussion is four times greater than receiving the first.

In a sport known for bullnecked brutes with veins in their teeth who are bred to compete, concussions often go unnoticed or unreported. There is little appreciation among the coaches, trainers, players and even the fans about the seriousness of concussions, especially the kind that don't render a player unconscious and are therefore not obvious.

The National Football League head office finally may be taking the issue seriously, though. In May, NFL Commissioner Roger Goodell issued a new set of guidelines that could save a few brains, provided coaches are brainy enough to abide by them.

A high school knockout

For professional football players, the trouble begins in high school. The Centers for Disease Control and Prevention estimate that there are 300,000 concussions per year in high school sports. The CDC distributes a brochure for high school coaches to recognize the signs of mild concussion, such as confusion, irritability or an inability to follow instructions or answer clearly.

Of course, these characteristics matched half the players on my high school's football team, even the guys who never played. So admittedly coaches have their work cut out.

In the United States, each state has guidelines for how to manage high school athletes who receive concussions. Colorado's guidelines are perhaps the strictest, developed by the Colorado Medical Society in response to the deaths from head injuries of several Colorado high school football players.

The Colorado guidelines characterize concussions into three grades, the first grade being the least severe (with no amnesia or loss of consciousness) and the third grade the most severe (loss of consciousness). A grade-one concussion will force a player out of the game for at least twenty minutes, pending further evaluation. A grade-two concussion keeps a player out of the game and practice for at least a week; a grade-three concussion benches the player for at least a month.

Still, many doctors say the guidelines don't go far enough. As reported last year in the journal Brain Injury, even grade-one concussions take a week or two to heal. The study's lead author, Michael McClincy of the University of Pittsburg, recommends a standard, objective test instead of subjective concussion grade evaluations to determine the severity of a concussion.

The ultimate price

Bennett Omalu, a neuropathologist at the University of Pittsburg, claims that repeated concussions likely contributed to the depression and ultimate suicide of Philadelphia Eagles' cornerback and safety Andre Waters, who shot himself last November at age 44. According to Omalu, Waters' brain was similar to that of an 85-year old with early-stage Alzheimer's. Waters was known as one of the hardest hitters in the league.

Up until last season, NFL players dinged in the head routinely returned to the game after 15 minutes if their symptoms of confusion and such went away. This year, players will start the season with standardized neuropsychological baseline testing as part of a long-term plan to assess mental health. The players will be educated about the dangers of concussions.

While each team maintains the authority to establish return-to-game guidelines, Commissioner Goodell said that medical decisions must always override competitive considerations and that the NFL will establish a "whistle blower" system so that anyone may report an incident in which a doctor is pressured to return a player to the field.

It's a start. Knees and hips can be replaced; your brain is yours for life.

Christopher Wanjek is the author of the books “Bad Medicine” and “Food At Work.” Got a question about Bad Medicine? Email Wanjek. If it’s really bad, he just might answer it in a future column. Bad Medicine appears each Tuesday on LiveScience.