CTE has been diagnosed in a female athlete for the first time, and the director of Australia’s brain bank wants to see the government direct policy for sporting codes as a result.
Heather Anderson, who passed away in November 2022, was found to have clear signs of chronic traumatic encephalopathy – CTE – in her brain, in post-mortem examinations.
CTE is a neurodegenerative disorder associated with repeated impacts to the brain.
Associate Professor Michael Buckland is the director of the Australian Sports Brain Bank in Sydney. He performed the examination on Anderson’s brain, donated to the ASBB by her family.
“In terms of what the brain looked like under the microscope, it looked like any other case of CTE that I’d seen,” Buckland says.
“It looks like exactly the same disease.
“She’s one of the younger cases we’ve diagnosed with CTE, we’ve only diagnosed a couple of people in their twenties, so the fact that she was so young is quite significant as well.”
Buckland says greater responsibility for the management of risks associated with CTE needs to be taken.
Following the publication of Anderson’s CTE diagnosis, he has called for the implementation of distinct protocols and government direction in the management of brain injury risk.
“Every sporting code should have a CTE minimisation policy, in addition to a concussion policy – they’re related but they’re not the same issue,” Buckland says.
“From a societal point of view, we need government oversight, we need to take the regulation of these issues away from sporting codes.
“We need the government to step in, that’s what we really need.”
Last year, the Australian Sports Brain Bank published findings that of the 21 athlete brains studied in its first three years of operation, all but one had shown signs of any form of neurodegeneration.
Professional athletes were more likely to have signs of neurodegeneration, particularly those with extensive playing careers, which is similar to data in US athletes.
About 3 in 5 of the brains studied at the Australian Sports Brian Bank were diagnosed with CTE.
But while concussion is increasingly cited by sporting organisations – and even a recent senate inquiry – as a form of traumatic brain injury worth investigating, neuroscientists are increasingly warning of the risks of sub-concussive impacts.
Over time, low-level impacts on the brain increase the risk of tau protein – important structural molecules inside brain cells – abnormally accumulating within neurons and leading to a range of neurodegenerative problems, including CTE.
Frequency and force – not the number of concussions – is the driver behind the disease, a finding recently published by the field’s leading CTE research institutions Boston University and Harvard Medical School.
“It’s not only about the number of hits, including sub-concussive hits – those without symptoms – but the force, the total cumulative burden of force exposure, that counts for the severity of CTE and is correlated,” says Dr Rowena Mobbs, a neurologist at Macquarie University Hospital.
“The risk of CTE is due to those tens of thousands of repetitive hits that build up microscopically for damage in the brain and trigger this tau protein cascade, as opposed to a single isolated concussion.”
Emerging data suggests female athletes are more susceptible to neurodegeneration than males.
But research is comparatively limited, particularly in contact sports which have only professionalised – or semi-professionalised – for women in the past decade.
Sadly, it’s likely Anderson’s diagnosis will be the first of many.
“Certainly for concussion [in women] we see greater incidence rates, worse symptom reporting and longer recoveries,” says Professor Alan Pearce, a neuroscientist from Latrobe University who co-authored the study on Anderson’s brain.
“What it tells us is that CTE doesn’t discriminate on sex or age. The longer the exposure is experienced, the increased risk is of CTE.”
Pearce and Buckland recently contributed to the publication of a CTE Prevention Protocol through the Concussion Legacy Foundation – an American-originated not-for-profit that has an Australian affiliate advocating for the protection of athletes from neurodegenerative risk.
Separately, Mobbs says greater transparency and collaboration on the management of athletes in relation to brain injury is required.
“My concern is my patients, and my patients come first, and I’ll continue to advocate until I see that there is major change,” Mobbs says.
“It’s a shared responsibility here, it’s a community, societal and government issue – it doesn’t rest with one sport or one code.
“I think the sooner that those doors are open, that the codes become much more collaborative, transparent and seeking independent advice and research, the better.
“Think of the tens of thousands of Australians out there – let alone the legends of these sports – and we really must look after them. There are people living with CTE today.”
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