I think the last time you were here, we had maybe five brains and now we’re up two. We’re in the nineties.
Dr. Sanjay Gupta
00:00:08
This is Dr. Ann McKee. She runs the world’s largest brain bank focused on traumatic brain injury and CTE, chronic traumatic encephalopathy. It’s a joint project between the VA Boston health care system, the Concussion Legacy Foundation and Boston University’s CTE Center. I visited there a few times over the course of my career, but this visit back in 2012 really stood out to me because of who else was there to meet her.
Hi. Ann McKee, how do you do?
Dr. Sanjay Gupta
00:00:38
Connie and Ron Stiles came to Dr. McKee after the death of their son, Nathan. He was just 17 years old, a homecoming king and a star football player. The last game of his senior year at Spring Hill, Kansas High School was the best of his career. He ran for 165 yards and two touchdowns in the first half alone. But 2 minutes before halftime, he walked off the field screaming, saying that his head hurt. He collapsed. By the next morning, he would be dead.
The ironic thing is Nathan didn’t start football until he was in seventh grade because he didn’t want to get hurt.
Dr. Sanjay Gupta
00:01:15
You see, earlier that month, Nathan had suffered a concussion during a game that everyone, including Nathan’s doctor, thought had healed, but it hadn’t. His autopsy revealed that he had died from second impact syndrome, which is just what it sounds like when there is a second blow to the head before the first one resolves. So Nathan’s parents decided to donate his brain to Dr. McKee’s lab so it could be studied. And what Dr. McKee found shocked her.
Dr. Sanjay Gupta
00:01:44
What we’re seeing here is this definitely caused by blows to the head.
It’s never been seen in any reported case except in a case of repeated blows to the head.
Dr. Sanjay Gupta
00:01:54
Specifically, she saw these unnatural tau protein deposits in 17 year old Nathan’s brain.
And this is looking at it under the microscope and seeing all those dark brown…
Dr. Sanjay Gupta
00:02:05
They are the same kind of protein deposits that you would typically see in someone with Alzheimer’s much older.
Dr. Sanjay Gupta
00:02:12
Did this surprise you?
Yes, it definitely did. It can start very early.
Dr. Sanjay Gupta
00:02:18
That’s amazing. 17 years old.
Dr. Sanjay Gupta
00:02:20
Nathan is the youngest person known to have the degenerative brain disease known as CTE or chronic traumatic encephalopathy. Nathan’s parents knew that obviously nothing could bring back their son, but they also knew there would be a lot more athletes in the future just like him.
We have all the confidence, the world or something to be learned from it. It’s in the right place here to do just that.
I think I want it to be my life’s mission to make sure this doesn’t happen to other kids.
Dr. Sanjay Gupta
00:02:49
It’s been 12 years since Nathan’s death, and in large part because of Dr. McKee’s research, there have been some safety improvements for athletes, especially in football practice. Routines, for example, have been adjusted. Concussion protocols have undergone close to 180 degree change. Helmets have some extra padding in them. In fact, this season in the NFL, quarterbacks will have the option to wear a helmet designed specifically for their possession. The hope that it could reduce the severity of head impacts for many of these quarterbacks, it can’t come soon enough. This past season, there were a number of high profile head injuries.
Miami Dolphins quarterback Tua Tagovailoa is back in the NFL’s concussion protocol for the second time this season. Tagovailoa was last in concussion protocol after week four when he was carted off the field on a stretcher and briefly hospitalized after his head hit the turf…
Dr. Sanjay Gupta
00:03:41
Tweaks like those can make the game safer, arguably, but it’s never going to be 100% safe. That’s just a fact. So it’s clear from the pieces to the pro’s head injuries are a concern. It’s not going away. But I can tell you, even as a neurosurgeon myself, there is still a lot we don’t know about concussions, these traumatic brain injuries. And as a parent, how do you balance those concerns with the many benefits of youth sports?
Prof. Julie Stamm
00:04:10
I know there’s always this push that you want to get back as soon as possible from any injury as an athlete. But this is your brain and you only get one.
Dr. Sanjay Gupta
00:04:17
Today, we explore the concussed brain. I’m Dr. Sanjay Gupta, CNN’s chief medical correspondent. And this is Chasing Life.
Dr. Sanjay Gupta
00:04:33
Before we go any further, I do want to be clear on a few points. First of all, just because you get a concussion or even multiple concussions does not necessarily mean you will develop CTE. I’m going to talk about that in a bit. Secondly, you don’t need to be an athlete or even be doing a physical activity to get a concussion. It can happen just about anywhere. So with that, let’s start at the beginning. What does the concussed brain actually look like? I want you to for a second just think about your brain inside your skull. Imagine it is just sitting there, delicately cushioned and floating in a bath of cerebrospinal fluid, just doing its thing. Now, when your head slams into something, imagine the brain moving and twisting around in that bath, even banging into the edges, which is your skull. It’s like shaking an egg inside a shell. The delicate fibers are being pulled and pushed and at the cellular level, axons. Those are the parts of neurons that transmit nerve impulses. Those axons are actually stretching back and forth as the brain shifts. As you have that visual in your head and you’re imagining that stretching. I want to introduce our guest this week. That stretching is something she is particularly concerned with, saying that it can set off a chemical cascade that can result in all the symptoms of a concussion that you may be familiar with.
Prof. Julie Stamm
00:06:05
That would include things like confusion, dizziness, blurry vision, sensitivity to light or noise, sometimes nausea.
Dr. Sanjay Gupta
00:06:15
That’s Julie Stamm. She’s an assistant professor at the University of Wisconsin, Madison. She’s also author of the book The Brain on Youth Sports.
Prof. Julie Stamm
00:06:24
Often overlooked symptoms include things like being overly emotional or not very emotional, apathetic, and also sleep disturbances either too much or too little. And it’s happening because of stretching of pathways in the brain and chemical changes that are happening because of those that stretching of our axons, those pathways in the brain.
Dr. Sanjay Gupta
00:06:46
You know, a lot of people I talked to you, they don’t like the term concussion because they think that it sort of inherently minimizes something. You know, I got my bell rung, things like that. It’s a traumatic brain injury, right? I mean, what do you call it?
Prof. Julie Stamm
00:07:00
That’s correct. I often use the term concussion because it’s just so commonly used in sport especially. But it is a traumatic brain injury and it’s often classified as a mild traumatic brain injury. And even that feels like it minimizes the injury. We’re not worried about somebody having bleeding on the brain and, you know, having it be a critical, life threatening thing in that moment. But it still can have very significant consequences, lasting symptoms, and can very much disrupt someone’s life. So it is a serious injury.
Dr. Sanjay Gupta
00:07:32
And would a concussion look different in a kid’s brain as compared to an adult?
Prof. Julie Stamm
00:07:38
It would present chemically in a similar way, but it would look different symptomatically oftentimes. So kids are more likely to get concussions than adults. They’re more vulnerable in part because of development, in part because their heads are larger compared to their bodies, which creates a bobblehead effect, especially if you put a helmet on them. And it looks different also in how it progresses. So oftentimes children take longer to recover than adults do. And it’s also important to note that if a child recovers to their baseline where they were before the concussion, their peers have been continuing to develop and learn and grow. And so returning to baseline doesn’t mean they’re returning to where they should be. So it’s really important to be conservative with kids with concussions.
Dr. Sanjay Gupta
00:08:29
I got to say, sometimes the symptoms can can be surprising. A few years ago, I have a neighbor here in town whose son I’ve known since he was a baby. You know, he played football in high school and the sharp kid was doing really well in school. And he came over to the house one day and I was talking to him, didn’t notice anything awry. And then all of a sudden there was this part of the conversation where he was clearly asking questions about things we had just talked about. His short term memory was dramatically affected. And I got to say, it was one of the most sort of stark sort of examples for me, because I’m a neurosurgeon. I typically don’t see patients with concussion because they don’t need operations. But it can be very, very significant, especially in a teenager’s life. And as you say, it can put them behind them as compared to their peers.
Prof. Julie Stamm
00:09:21
Absolutely. I think one thing parents should know is the symptoms don’t always show up right away. Sometimes there’s a bit of a delay, so they may seem okay. And then, you know, they get home and. They’re just not themselves or they start asking questions like that. And it’s more than just sport. It affects school. It affects social relationships. So it can have a really big impact, especially if the symptoms are prolonged.
Dr. Sanjay Gupta
00:09:47
So once you do spot the symptoms, how do you treat the concussed brain? It may surprise you or not that there are still not a lot of consensus on this. Maybe you’ve heard in the past that the best medicine is to be completely still in a dark room. And whatever you do, don’t go to sleep. Well, Professor Stam says the guidance around that has shifted.
Prof. Julie Stamm
00:10:08
We are seeing now that exercise after concussion is a good thing. We used to say, go lock yourself in a dark room, have no stimulation, just let the brain rest and heal. And we were wrong. You know, now we know our evidence shows that increasing blood flow to the brain increases all of the good things for the brain that we need to heal. And it has shortened recovery time. So by exercise, it’s important to know this isn’t just go out and keep playing. This means go for a walk for 20 minutes or go on a stationary bike. And the recommendations are it’s okay if it makes the symptoms a little bit worse. And that recommendation is two points on a ten point scale. So if your symptoms were what you would rate as a five before you start to get to a seven, you know, that may be okay, but definitely don’t let them get any worse at that point. Either lower the intensity or stop. Hmm. I think another important thing to mention is we used to say Waka trialed up, you know, at night if they have a concussion and we don’t say that anymore because sleep is also beneficial for recovery. And most concussions don’t result in a bleed in the brain. The vast majority don’t. So monitoring your child, you can still go in and check on them, make sure they’re doing okay. But we recommend sleep can be a helpful thing. You know, you don’t have to wake them up during the night.
Dr. Sanjay Gupta
00:11:35
And it sounds like the vast majority of patients don’t need to go then to the emergency room.
Prof. Julie Stamm
00:11:40
Yeah, I would say the vast majority don’t. But getting care is a good thing.
Dr. Sanjay Gupta
00:11:46
Care is a good thing, no doubt. But this is where we run into one of the biggest problems when we talk about the concussed brain. First of all, Professor Stamm says there is no objective test to conclusively diagnose the concussion. Sideline tests can serve as good screening tests, but they’re not always clear cut. In recent years, the FDA has cleared a number of blood tests that can deliver more reliable, relatively quick results. They are looking for certain proteins that spill into the blood when the brain is injured. But the thing is, they need to be run in the lab. And then when it comes to diagnosing CTE, well, that’s even more complicated. It can only be diagnosed after death, such as with Nathan Stiles, who I talked about earlier. He was diagnosed with CTE on autopsy at age 17. But again, the point is that most people won’t develop CTE. But at the same time, it’s also becoming more common.
Prof. Julie Stamm
00:12:41
A lot of people think it’s just a disease of professional football players or other professional athletes. And it’s not. It can affect anyone who has this exposure to repetitive brain trauma.
Dr. Sanjay Gupta
00:12:53
So who is most at risk and what can be done to protect them? We got more Chasing Life after this.
Dr. Sanjay Gupta
00:13:06
‘And now back to Chasing Life and my conversation with the University of Wisconsin-Madison Professor Julie Stam.
We also want to focus on your health this morning. Researchers have now found CTE, a brain disease often associated with NFL players and concussions in younger amateur athletes. That’s according to a striking new study from Boston University.
Dr. Sanjay Gupta
00:13:29
Yesterday, I’m sure you saw the news stories. Basically the headline was that CTE, chronic traumatic encephalopathy, could start at a very young age, 17 years old. They had 150 or so brains that had been donated. Sadly, many of them had died by suicide. But when they examined these brains in around 40% of them, they found evidence of these changes in the brain associated with CTE. These are typically things like plaques and tangles in the brain that you’d often associate with things like Alzheimer’s disease and in people much older. But they were finding these in very young people. Again, not all of them had symptoms, but they had these changes in their brain. When people hear that the headline is 40% of young athletes, many of whom never played professional sports, had CTE when their brains were examined. What is that? What is the takeaway for you?
Prof. Julie Stamm
00:14:26
Well, first, it’s important to know that this is a biased sample. So the families of these individuals who donated their brains, they donated because they thought that something was going on. So they had some sort of sign or symptom or some sort of concern that led the family to donate their brain. That means that you’re more likely to find the disease in a group, that there was concern that something was going on. So it doesn’t mean that 41% of all amateur athletes have the disease. We don’t know what that incidence or prevalence is yet, and we have a lot of research to do to figure that out. But it is concerning. I think a lot of people think it’s just a disease of professional football players or other professional athletes, and it’s not. It can affect anyone who has this exposure to repetitive brain trauma. And you can have years of exposure to repetitive brain trauma just playing youth and high school football, for example. And some of these athletes played hockey, soccer, wrestling.
Dr. Sanjay Gupta
00:15:28
The CDC says this: research suggests CTE is associated with long term exposure to repeated hits to the head. But even a statement as seemingly simple as that turns out to not be so clear cut. For example, Professor Stamm was pretty surprised when an influential group known as Concussion in Sport put out their most recent consensus statement. Now, keep in mind, this group is made up of experts on concussion and head trauma, but they stopped short of definitively linking CTE with repeated head trauma.
Prof. Julie Stamm
00:16:02
They were very, very specific in the consensus statement about the studies that they included. They did not include any of Dr. McKee’s work in that consensus statement, even though she studied more brains than anyone in the world and has published some very good case studies. They also didn’t include other brain bank studies from other groups that have looked at community samples. All of the evidence that we see in these brain, big studies really show that the repetitive brain trauma is necessary. And the few studies that have suggested that there may be a couple of people who were diagnosed without repetitive brain trauma history, they got the repetitive brain trauma history from yearbooks in obituaries. My grandfather donated his brain to the brain bank. He didn’t have CTE, but he had Parkinson’s disease and Lewy body dementia, which have also been linked to repetitive brain trauma. And he boxed amateur. That was not in his yearbook because he didn’t do it in high school. It was not in his obituary because it wasn’t that big of a part of his life. So I think that those methods may have missed some. And even if there are few people who have it without that, the vast majority of people who have been diagnosed have a history of repetitive brain trauma.
Dr. Sanjay Gupta
00:17:19
There’s, I think, this emerging narrative that there is a a real concern about repetitive head injuries and CTE, and yet we still seem to get these types of consensus statements from the concussion and sports group that it really seems to minimize. It really seems to to throw water on the and the associations between head injuries and CTE. Instead, trumpet the idea that the game is safer for all the people out there who don’t follow this as closely. What would you say to them?
Prof. Julie Stamm
00:17:52
I would say in some ways that’s safer. We don’t see as many catastrophic injuries as we used to. We don’t see as many skull fractures as we used to. And that’s really important. We don’t see the spinal injuries we used to, although they still happen. And so that’s an important step forward. But I think we have to ask ourselves, even if it is. Stay for the never. Is that safe enough?
Dr. Sanjay Gupta
00:18:18
Is it safe enough? I know many parents have that exact question. I’ve had that question about my own daughters who are cheerleaders. Yes. Cheerleading. I mean, there are a lot of concussions in cheerleading and a lot of them occurred during practice. In fact, a 2019 study in the journal Pediatrics found that among 20 high school sports, coed cheerleading was the only one where the concussion rate was higher during practice than during competition. But in that same study, perhaps no surprise, boys football had the highest overall concussion rate. So the question remains for parents across the country. With all that we now know about concussions and CTE risks, should I let my kids play football? I asked Professor Stam what she would say to that.
Prof. Julie Stamm
00:19:03
I would say, first off, sports are really important. They have so many benefits for kids. So we want kids to play sports. It’s the version of the sports that we can adjust to be safer. So in middle school, I would definitely say don’t play tackle football. You know, before high school, ideally don’t play tackle football, play flag football or alternatives like tackle bar football where there are bars on the back that instead of tackling, you tear the bars off. Versions like that can teach about the game without the repetitive head impacts. There’s not a known age of brain development that all of a sudden it becomes significantly less risky or safer. But there is a lot happening in the brain, really in that 8 to 12 range, and there is a lot that happens in high school in the teen age range, too. If we really wanted to let the brain fully develop. They wouldn’t play football until 25, But that’s not really realistic. So by, you know, delaying it, we’re allowing for more brain development to happen. I think limiting the number of years to if you start, you know, at age seven or eight, you’ve already got so many years in seven years maybe before you play high school. And that’s years of impacts, hundreds of impacts, even thousands of impacts that you’re sustaining. So that’s another benefit is just minimizing the total number of impacts over a lifetime.
Dr. Sanjay Gupta
00:20:28
I want to be really responsible. There’s benefits to youth sports. I think we can say that for sure. But when it comes to a sport where you are going to get banged in the head over and over again, even if you’re not getting concussions, even if you’re getting these subconcussive hits, I think it’s I think it’s really hard to justify kids playing those sports.
Prof. Julie Stamm
00:20:49
I, I agree. I think it is really hard. There is no age or no number of repetitive hits, the head, repetitive brain trauma that we know to be safe. Right. That none of that is good for the brain. We’re going to hit her head my if it’s going to happen. But, you know, we really need to minimize eliminate as much as possible those impacts. And it’s it’s very hard, I think, to to balance that benefit of sport and protecting the brain and trying to prevent the long term consequences. I wouldn’t be here talking to you without my experience as a three sport athlete and my love of sports. So it is something that’s very hard to balance. And the number one thing is just eliminate as many impacts as possible. Eliminate impacts in practice. That’s where most of them happen. Be responsible and in coaching and creating a culture that values health. That’s another important piece. But it is a very difficult thing to to balance those two pieces.
Dr. Sanjay Gupta
00:21:53
Like most things in life, it is a balance. Balancing the benefits of sports, which are real with the risks of repeated head impacts, which are also real. And Stamm says that if you do make that decision and allow your kids to play and they do get hurt, then you’ve got to take the recovery seriously.
Prof. Julie Stamm
00:22:13
Really give the brain time to heal. I know there’s always this push that you want to get back as soon as possible from any injury as an athlete, but this is your brain and you only get one. So we need to protect our brain as much as possible. The risk we don’t know the exact number, you know, for the risk, but the risk is not zero. And to me, that’s enough for my kid. You know, I want to I would want to protect my child.
Dr. Sanjay Gupta
00:22:37
This may sound like a little bit of a silly question, but obviously we’ve focused almost the entire discussion on sports and trying to reduce the likelihood of having a brain injury when playing these sports. But what about the rest of us? Is there are there things that we can do to just lower the chance that we would have a brain injury? Should we be in a car accident or a fall or something like that? Like, what is the the best way to prevent concussions, the concussed brain? Like, how do I how do I game my chances of not having a brain injury in daily life?
Prof. Julie Stamm
00:23:09
Yeah. You know, unfortunately, the best way to prevent a concussion is to not hit your head or not have that affect. But we can’t always control that. My husband hit his head on a cupboard door, putting dishes away and had a mild concussion. I have permission to say that.
Dr. Sanjay Gupta
00:23:26
‘That’s exactly what I was talking about by the way. I dropped something recently in the bathroom and then I when I was standing back up quickly, I bang my head on the bottom of the sink and I was seeing stars for a while now. That kind of stuff. I was just that was that was me, obviously. But I’m just wondering, things like fish oil or anti-inflammatories or brain sort of healthy things that we could be doing. It’s not going to avoid me being a nitwit and banging my head on the sink or your husband on the cover door. But how do we improve our likelihood that those types of things won’t lead to more significant problems?
Prof. Julie Stamm
00:24:03
Yeah, I think anything that’s good for brain health is good for, you know, recovery and putting a brain in the best possible position if something like that does happen. So exercising your brain and exercising your body are both really good for your brain. So exercise for your body. Like we said, it increases blood flow and that is really good for your brain health, exercising your brain, you know, reading, doing puzzles, doing things that involve critical thinking. That’s also really important. We have seen in studies that increased cognitive reserve or, you know, that exercising of your brain throughout your life that individuals with a higher cognitive reserve had a delayed onset of symptoms, too. So whether it’s short term or long term, those are all good things you can do for your brain.
Dr. Sanjay Gupta
00:24:52
This is so important to think about this idea of exercising our brain and you don’t have to be a five star athlete to do it. In fact, you don’t have to be an athlete at all. Stamm says not only can exercising your brain make it stronger, but it can put you in a better position to avoid some of the worst consequences of concussions. Look, we’re not going to be able to prevent every little bump on the head, of course, but being mindful of the risks, knowing what to look for in our kids as they move through the world. And again, taking recovery really, really seriously could make all the difference. Now, next week, as we continue this journey through the brain, some food for thought as we consider the nourished brain.
Prof. Julie Stamm
00:25:34
Most of my patients would rather reach for a yogurt than, you know, in an antidepressant.
Dr. Sanjay Gupta
00:25:40
That’s next time on Chasing Life. Thanks for listening. Chasing Life is a production of CNN Audio. Our podcast is produced by Eryn Matthewson, Madeleine Thompson, David Rind and Grace Walker. Our senior producer and showrunner is Felicia Patinkin. Andrea Kane is our medical writer and Tommy Bazarian is our engineer. Dan Dzula is our technical director and the executive producer of CNN Audio is Steve Lickteig. Special thanks to Ben Tinker, Amanda Seeley and Nadia Kounang of CNN Health.