Brain disorders that afflict professional soccer players appear to be rare in the military, the study found

A new study suggests that brain disease caused by repeated blows to the head and concussions — especially among hundreds of former NFL players — is rare among service members.

Chronic traumatic encephalopathy (CTE) has been associated with contact sports, particularly soccer and boxing. More recently, military experience, including exposure to blasts, has been discussed as a potential risk factor for the disease.

But a study of 225 donated brains from deceased active-duty and retired military members by researchers at the Uniformed Services University of the Health Sciences, due to be published Thursday in the New England Journal of Medicine, says CTE in military personnel is more strongly linked to civilian traumatic injuries.

“Our study suggests that CTE is rather uncommon in US soldiers and when seen, tends to be rather mild in terms of brain involvement and is typically associated with prior participation in contact sports, particularly soccer,” he said dr Dan Perl, one of the lead researchers on the study and a professor of pathology.

Perl is director of the Department of Defense/Uniformed Services University Brain Tissue Repository, which is essentially a brain bank. The examined brains had been donated for research purposes.

Scientists found that 10 out of 225 brains, or 4.4%, had CTE. All 10 of these service members had a history of participating in contact sports.

For comparison, the researchers cited a Boston University study published in July 2017 in the Journal of the American Medical Association, which found the progressive, degenerative disease in 87% of the brains of 202 former US soccer players. CTE has been found in 99 percent of the brains of National Football League players, 91 percent of college football players, and 21 percent of high school football players.

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Brain disease can only be diagnosed after death by examining the brain. It is believed that people with CTE will develop a range of cognitive, behavioural, mood and motor problems later in life.

Of the 45 brains of military personnel with a history of exposure to a blast, three had CTE, compared with seven of 180 brains of those with no history of exposure to a blast.

But the researchers included important caveats.

“It should be borne in mind that most of the individuals studied in this report who were subjected to intense fighting, and particularly explosions, died at a relatively young age,” Perl said. “Studies of CTE in contact athletes indicate that there is a significant period of [time] between the time they experience head trauma during their athletic career and the time they become symptomatic of the disease. …

“In the coming years, we may identify additional cases of CTE in ex-military personnel who served in the 20-year period of the war on terror (2001-2021) and who were so heavily exposed to the blast.

“Only time and further studies will tell.”

Because of the small number of CTE cases, no definitive conclusions can be drawn regarding the links between blast exposure and CTE, the researchers explained. However, their results suggest that the prevalence of CTE is rather low.

Another caveat is that collecting accurate information about traumatic brain injuries in both military and civilian settings is challenging. Some aspects of the people’s history were subsequently obtained from the next of kin.

CTE is identified by a clear pathologic pattern in the brain. Scientists were looking for distinctive lesions seen only in this disease, Perl said. The lesions are not the immediate result of a head injury and have been reported primarily in people with recurrent head injuries, such as former boxers or professional soccer players.

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“It is believed that the CTE lesions are later degenerative reactions to the numerous blows to the head, not an individual injury,” he said.

This study also shows that CTE is not a significant contributor to psychiatric disorders, alcohol and drug abuse, and suicide among these military personnel. While four of the 10 brains came from military personnel who died of suicide, the majority of the suicides they examined in the study showed no signs of CTE. The study included 49 brains from soldiers who died from suicide, and four of them had CTE.

“Accordingly, we have not been able to conclude that CTE made an important contribution to this important problem,” Perl said. “We believe that continued exploration of the biological underpinnings of military suicide is a very important part of our mission, and we will continue to do so.”

♦ Researchers found that 10 of the 225 brains had CTE. All 10 had participated in contact sports. But for eight of them there was another factor: they had suffered a non-sports-related traumatic brain injury in civilian life. Overall, the disease was present in eight brains out of 44 from military personnel who had suffered non-sports related TBI in civilian life.

♦ Of the 21 brains of those who had a head injury during military service caused by the head striking a physical object without blast exposure, three had CTE.

♦ Of the 60 Brains of Service Members who participated in contact sports, 10 had CTE, compared to none of the 165 who did not participate in contact sports.

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