On Monday night, a gunman killed four people and himself in Manhattan in an attack that reportedly targeted the NFL’s headquarters in the city.
The gunman, Shane Tamura, left behind a note in which he said he’d been suffering from chronic traumatic encephalopathy, or CTE, as a result of playing football. He had asked for his brain to be studied as part of CTE research.
The discourse about football’s impact on the brain is not new to the NFL. Both players and their families have sued the league time and time again over the matter of brain damage and its effects on players’ post-career lives.
CTE is a “progressive neurodegenerative disease,” explained Dr. Jeremy Tanner, an assistant professor of neurology at the Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases at UT Health San Antonio. Research shows that football players, along with other people who participate in high-contact sports and activities, are more likely to develop the disease.
A study out of Boston University’s CTE Center found 40% of athletes under 30 had developed early signs of the disease upon their death. Another study out of BU found that roughly 91% of studied NFL players had the disease when they died.
Experts told HuffPost that CTE research is ongoing, but there are clear links between head injuries, behavioral changes and the disease itself. Here’s what to know:
What is CTE?
Like other brain diseases, such as Alzheimer’s disease or Parkinson’s disease, CTE affects how we think, behave, move and “really anything that the brain is responsible for,” said Dr. Daniel H. Daneshvar, the co-director of Mass General Brigham Sports Concussion Clinic.
“It occurs in patients that have sustained traumatic brain injury, so blows to the head that may or may not have resulted in concussions,” said Dr. Aaron S. Lord, the chief of neurology and program director for clinical research at NYU Langone Hospital–Brooklyn.
The more head injuries that occur, the higher the risk of developing chronic traumatic encephalopathy, Lord added.
The thought pattern used to be that concussions increased CTE risk, but this isn’t the case, added Daneshvar.
“Concussions themselves aren’t what drives CTE risk. It’s a repeated traumatic brain injury to the tune of hundreds or thousands over the course of decades that… increases the risk of someone having CTE,” he said, adding that the number of traumatic brain injuries also affects the severity of the disease.
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A gunman who claimed he suffered from CTE as a result of playing football killed four people in Manhattan.
Can someone be diagnosed with CTE?
You can’t walk into a doctor’s office and get a diagnosis of CTE. Right now, it can only be diagnosed after death, during an autopsy, said Lord.
That means that people who may or may not have CTE can still get a gun license, a fact that can get lost in the discourse on social media about Tamura carrying the weaponry he had.
The New York Police Department reported he had a “documented mental health history,” but it’s unclear if this would restrict his gun access.
People who play contact sports are at higher risk — but any activity that involves frequent head impact is a risk factor.
Specifically, CTE has been identified in players who engage in contact sports such as football, rugby, hockey and rodeo, said Tanner, adding that it’s also been seen in soccer players.
“And it seems… the more total years played, the higher the risk,” Tanner said.
It often is developed over time, after someone stops playing the sport, or the head trauma ends, explained Tanner.
Daneshvar added that “we’ve also seen [it] in individuals who experience intimate partner violence, in individuals who serve in the military.”
Again, Daneshvar notes, the more often the head injury happens, the higher the risk of CTE.
“Famously, in the literature, there was a circus clown who was repeatedly shot out of a cannon and who was found to have CTE,” he said.
CTE can cause behavioral changes and memory problems.
“Chronic traumatic encephalopathy [is] typically associated with changes in cognition and in behavior,” said Tanner.
“In behavior, a common symptom is what’s called neurobehavioral dysregulation. For some people, this can present as a shortened fuse or more or irritability or agitation,” Tanner said. For others, this can mean paranoia, aggression, impulse control issues and trouble regulating emotions, he added.
Neurobehavioral dysregulation tends to be more common in “those affected by the disease in younger stages,” Tanner noted. “Additionally, chronic traumatic encephalopathy is associated with changes in memory and with executive function, particularly planning, organization, multitasking… managing information and integrating it.”
“And those symptoms seem to be more common in older adults with the disease,” he added.
It’s important to note that a lot of these symptoms can also be signs of other neurological disorders or mental health diseases, said Tanner.
In the end, individuals with a CTE diagnosis had problems with thinking, memory and behavior, said Daneshvar. But, once again, these things can be related to a multitude of other issues.
“We can’t say for sure what clinical signs someone presents with are related to CTE pathology versus something else because humans are complex. We have a lot of different reasons for the way we behave,” said Daneshvar.
If you do notice mental health changes, memory issues or other neurological problems, Tanner advises people to see a specialist for an evaluation.
“It’s often a neurologist or a psychiatrist or a sports medicine specialist who has expertise in evaluating those with repetitive head impacts in sports,” Tanner said. “It can be hard to distinguish what’s the primary cause, and so looking at the number of years of head impact exposure can be a clue that there could be an increased risk for CTE.”
Seeking medical attention for any neurological changes is essential, whether you’re dealing with CTE or not.
“I see individuals who have histories of repeated traumatic brain injuries and are experiencing problems now, and I can’t say with certainty whose problems are related to CTE versus not… but what I can do, and what I do every day, is treat them, and our treatments for people’s symptoms are successful,” said Daneshvar.
While there is no cure for CTE, doctors can still help, Daneshvar noted.
“I think that’s a really important message, too. I think people think that CTE is some incurable, immovable thing, right? And it is treatable.”
CTE has been linked to violence in some cases, but not always.
″In some cases, [CTE] has been linked to violent and aggressive behaviors,” Tanner said.
One of the most talked about cases of CTE is that of Aaron Hernandez, a deceased former football player who was convicted of murder.
“The short fuse, the impulse control. One way to think about it could be when you’re playing sports, you can turn [your aggression] on and off. You lose that ability to control the ‘on and off’ switch you use to regulate your aggression when on the field and off the field,” Tanner explained.
There are some things you can do to lower your risk of CTE.
As mentioned above, people who take part in particular sports or activities, such as football and rugby, are at higher risk of CTE. But there are a few habits that can help protect your brain.
Lord added that wearing a helmet — whether that’s on a bike ride or while playing football — is also an important way to protect yourself.
Tanner suggests that instead of playing tackle football, try playing flag or touch football.
“We have a lot more to learn about how to prevent this disease,” Tanner said. “What I would suggest is trying to minimize, as much as [you’re] able, head contact and head impacts.”
“For former football players and others, there’s the new Diagnose CTE study that’s really looking at trying to understand how we can identify these symptoms during life and better understand this disease,” Tanner said.
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The study is actively recruiting former football players to learn about the unknowns of the disease.
If you or someone you know needs help, call or text 988 or chat 988lifeline.org for mental health support. Additionally, you can find local mental health and crisis resources at dontcallthepolice.com. Outside of the U.S., please visit the International Association for Suicide Prevention.
