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An N.F.L. Doctor Desires to Know Why Some Players Get C.T.E. and Others Don’t

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PITTSBURGH — Joseph Maroon, a neurosurgeon, began working for the Pittsburgh Steelers as a consulting doctor starting in 1977 and over 46 years has examined and treated stars from the notoriously hard-nosed dynasty, including the Hall of Famers Terry Bradshaw, Mean Joe Greene and Lynn Swann.

Lots of them, he said, worry in regards to the health of their brains because they played when concussions were viewed as “dings,” full-contact practices were common and essentially the most violent hits were still permitted.

“Actually, everyone who has participated at that level has some concern,” Maroon said last week in his office on the University of Pittsburgh Medical Center Presbyterian Hospital. “But we haven’t seen the epidemic that one might anticipate from playing in that era with less protective helmets, less rules and harder fields. There’s just so many unknowns.”

A growing variety of scientific studies done over the past 15 years have found links between repeated head trauma and chronic traumatic encephalopathy, a degenerative brain disease. Lots of those have come via the C.T.E. Center at Boston University, which has examined the brains of lots of of former N.F.L. players and other athletes and military personnel.

But Maroon, who up to now has called the rates of C.T.E. in football players a “rare” phenomenon and “over-exaggerated,” felt there needed to be more research on why some athletes have few or not one of the symptoms tied to C.T.E., including memory loss, impulse control issues and depression, while others are overwhelmed by them.

So five years ago, Maroon and the Steelers’ owner, Art Rooney II, approached doctors on the University of Pittsburgh’s Alzheimer’s Disease Research Center to debate starting a sports-focused brain bank that studies the roles that age, genetics, substance abuse, the variety of head hits and other aspects play in the event of C.T.E.

The result’s the National Sports Brain Bank on the University of Pittsburgh, which is able to formally open on Thursday. After being delayed several years by the Covid-19 pandemic, the middle has accepted pledges of brains from athletes including the previous Steelers running backs Jerome Bettis and Merril Hoge.

C.T.E. may be diagnosed only after death, and doctors are still years away from developing a test to detect the disease within the living, so posthumous donations to brain banks are still the first approach to advancing the research.

The middle will even begin recruiting volunteers — athletes from all levels of sports, in addition to nonathletes to function a control group — to supply their health histories and be monitored in the approaching years. That information will probably be in comparison with the conditions of their brains after they die to find out which, if any, aspects played a job of their having or not having C.T.E.

“We don’t know where the edge is for C.T.E.,” said Julia Kofler, the director of the neuropathology department on the University of Pittsburgh, who will oversee the sports brain bank. “You actually see cases that had very minimal pathology that had symptoms, and that’s the query. I believe we actually need to have as many cases as we are able to to reply these epidemiological questions.”

The National Sports Brain Bank will depend on the infrastructure on the Alzheimer’s Disease Research Center, which already has greater than 2,000 brains, though most are usually not from athletes. The Sports Brain Bank will use seed funding from the Chuck Noll Foundation, the Pittsburgh Foundation and the Richard King Mellon Foundation to seek out volunteers for the long-term study and other people willing to pledge their brains.

Maroon, Kofler and others in Pittsburgh acknowledged the work of doctors at Boston University, who’ve been the undisputed leaders in C.T.E. research. Researchers there have more 1,350 brains not only from football players, but in addition from athletes who played hockey, rugby, soccer and other sports, in addition to members of the military. To this point, about 700 of those brains have been found to have C.T.E.

But Maroon said that some research produced by the Boston group was biased, because families had typically donated the brains of relatives who exhibited symptoms consistent with C.T.E. after they were alive. When asked to supply details of their family members’ head traumas, those families’ memories of the previous players’ concussion histories is likely to be imprecise.

The long-term study undertaken by researchers at Pittsburgh should “reduce, eliminate, obviate that type of bias,” Maroon said.

Ann McKee, the neuropathologist who leads the C.T.E. Center at Boston University, said her group had for a few years acknowledged the choice bias amongst families. She also said doctors at Boston University were already undertaking several longitudinal studies.

“We’re doing all of this,” McKee said, adding that “it’s all the time great to have one other group involved, and it’ll speed up the research and speed up scientific discoveries, especially concerning treatment. In order that’s unbelievable.”

Unlike Boston University, the National Sports Brain Bank isn’t shying away from ties to the N.F.L. The Chuck Noll Foundation for Brain Research, named for the previous Steelers head coach who was diagnosed with Alzheimer’s disease before his death in 2014, has provided seed money to the bank. The muse was began in 2016 partly with a donation from the Steelers’ charitable arm and has provided greater than $2.5 million in research grants to explore the diagnosis and treatment of brain injuries, primarily people who occur in sports.

“It was essential for the Steelers that we get behind this,” Rooney said in a phone interview. “Obviously, we’re within the early stages of this, but we’re hopeful that it gets the type of attention that it’s going to wish to actually achieve success.”

Hoge, the previous Steelers running back who has agreed to donate his brain, said he had chosen the National Sports Brain Bank since the University of Pittsburgh and other institutions in the town had been centers of innovation in brain health, including the event of helmet technology. He also noted that Noll, his former coach, had pushed for the development of a test to guage a player’s cognitive abilities that might be used as a baseline to discover concussions. It was a forerunner to the Immediate Post-Concussion Assessment and Cognitive Test (IMPACT) that has been used globally.

Hoge, who in 2018 co-wrote the book “Brainwashed: The Bad Science Behind C.T.E. and the Plot to Destroy Football,” added that he believed within the integrity of the research on the Pittsburgh brain bank.

“There’s a lot misunderstanding and fear,” Hoge said. “Helping them find that right information and giving them other information and resources to assist them with the thought process, I believe, may be very essential.”

Gil Rabinovici, the director of the Alzheimer’s Disease Research Center on the University of California, San Francisco, said that “this kind of research is best conducted when the funders and investigators are freed from any potential conflicts,” referring to the Pittsburgh group’s N.F.L. links.

He added that the researchers in Boston had done an “excellent job” in describing the pathology of C.T.E., “but in science, you search for independent replication with different groups studying the identical scientific questions using different methods, and hopefully reaching similar conclusions.”

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