Young A new BU CTE Center study has found that, among a sample of 152 young athletes exposed to repetitive head impacts (RHI) who were under age 30 at the time of death, 41.4% (63) had neuropathological evidence of chronic traumatic encephalopathy (CTE), a degenerative brain disease caused by RHI. Published in JAMA Neurology, the study includes the first American woman athlete diagnosed with CTE, a 28-year-old collegiate soccer player whose identity remains private.

“This study clearly shows that the pathology of CTE starts early,” says corresponding author Ann McKee, MD, chief of neuropathology at VA Boston Healthcare System and director of the BU CTE Center. “The fact that over 40% of young contact and collision sport athletes in the UNITE brain bank have CTE is remarkable, considering that studies of community brain banks show that fewer than 1% of the general population has CTE.”

There are four stages of CTE, with stage 4 being the most severe. Nearly all the young athletes had mild CTE (stages 1 and 2), while three donors had CTE stage 3. In those with CTE, there was often other evidence of brain injury, including the presence of a cavum septum pellucidum, enlargement of the ventricles, and more perivascular macrophages in the white matter. Clinical symptoms were common among the athletes, regardless of whether they had CTE.

Clinical symptoms included depression (70.0%); apathy (71.3%); di culty controlling behaviors (56.8%); and problems with decision making (54.5%). Substance abuse also was frequent, with alcohol abuse present in 42.9% and drug abuse in 38.3% of the athletes.

“The study suggests that some of the symptoms these young athletes are experiencing are not caused by the early tau pathology of CTE,” says McKee. “It is imperative that young athletes who are experiencing neuropsychiatric symptoms seek out care, as it is likely that the symptoms can be reduced with effective management and follow up.