HJAR Nov/Dec 2023

HEALTHCARE JOURNAL OF ARKANSAS I  NOV / DEC 2023 21 just talking about NFL players, we’re talk- ing about people who only play up through high school, up through college. Those non- concussive injuries can still be injuries, and the more frequent they happen, the greater the risk for short-term and long-term prob- lems, including a neurodegenerative disease that results in someone losing their ability to learn and remember and solve problems and function independently and eventually can die. But it’s not even just CTE. There are other diseases. We just published a paper this month on Parkinson’s disease, indicating that people who played American football, including just amateur football, were at, I think, 67% increased odds for having Par- kinson’s disease. There are mortality studies in professional football players that have shown significantly increased risk or death from neurodegenerative diseases, including diseases that cause dementia and Parkin- son’s disease. And one really horrible find- ing, over and over again, is increased risk for ALS, Lou Gehrig’s disease. Then, in a paper that I led looking at former college football players at Notre Dame who played between 1960 and 1980, there was increased risk for mortality from neurodegenerative disease. But a striking finding that I wasn’t expect- ing at all was an increased mortality from brain cancer, and we must look into that even further. Editor It makes sense, chronic neuroinflam- mation from the hits these players take would spur a plethora of effects, includ- ing cancer. Backing up for a moment, you mentioned white matter brain changes af- ter just one season of playing. Does that white matter return to normal during the off season? Stern Great, great question. It’s unclear. There haven’t been enough studies that follow a group of players, let’s say college players, over one season and then see at the beginning of the next season, before the next season starts, if it’s gotten better. One of the reasons for that is because the high-level players don’t have an off season. Think of college — there’s no off season. There are three seasons. Think of high-level, high school players who play club and go to summer camps. They’re playing all the time. It’s hard to know what an off season is, and is it an adequate amount of time to return those immediate changes to the white mat- ter back to normal? There’s not enough known. The few studies that have been able to look at it a little bit … some show it does, some show it doesn’t. Some show it a little bit, so not sure yet. Editor So as someone who’s been a lead- ing neuro researcher for a long time, study- ing neurodegeneration, what does it mean when you say white matter changes after one season of playing tackle football? What does that mean to Robert A. Stern, PhD, Professor of Neurology, Neurosurgery, and Anatomy & Neurobiology, Boston Univer- sity Chobanian & Avedisian School of Medi- cine, Director of Clinical Research, Chronic Traumatic Encephalopathy Center? Stern It means that there’s a problem and that if we’re talking about playing a game, playing a game should not result in changes of any type to the brain. And, if those changes are directly related to the number of hits you get, it means there’s a big prob- lem. Specifically, if the white matter integrity changes after just one season, it means that the different parts of the brain are not going to be able to communicate with each other as quickly and as accurately as they’re sup- posed to. If you’re talking about a student who’s playing a game, just one season after which the different parts of the brain are not communicating with each other well, that’s a problem. Editor You just summed up what everyone needs to know. Stern That’s a problem. Editor That’s a problem. Thank you for your time. Stern You’re welcome. Thank you. n If you’re talking about a student who’s playing a game, just one season after which the different parts of the brain are not communicating with each other well, THAT’S A PROBLEM.