
Written by Lucas Shen '27
Edited by Thomas Wang '26
High school star football player Wyatt Bramwell looked forward to starting college like many of his classmates. However, two months after graduating high school, his behavior drastically changed, becoming angry and impulsive, and he was recorded explaining having “demons” inside his head. He later tragically took his own life. His brain was donated for research on behalf of his request, and he was diagnosed with stage 2 CTE (chronic traumatic encephalopathy), the most severe case ever found in a high school athlete (1). Unfortunately, Wyatt’s story is not an isolated one: he and 151 other brain donors were part of a new study conducted by BU Chronic Traumatic Encephalopathy (CTE) Center, researching the prevalence of CTE in young athletes (2).
CTE is a neurodegenerative disease associated with repeated head injuries and is not well understood by researchers who are still trying to understand the factors that cause it (3,4). The study found that in young (<30 years old) deceased athletes who were exposed to contact sports, 41% had CTE (5). For many families and athletes, this is a surprising finding; amateur-level sports are commonly thought to feature collisions that are too light to result in concussions or CTE. There is also a public misconception that only concussive-level injuries result in CTE. Although they certainly can, sustained exposure to subconcussive injuries and repetitive head impacts, like those experienced by football linemen as they collide with each other, are also associated with CTE (6). Many professional athletes such as NFL players have been posthumously diagnosed with CTE, as another study from BU’s CTE Center found that out of the players studied, 91.7% were diagnosed (7). This doesn’t mean that approximately 90% of all NFL players have CTE, as the study is subject to selection bias, as families who donate players' brains are often already suspicious of CTE. Additionally, the true prevalence of CTE in the population is unknown as it can only be diagnosed during autopsy or after death.
Symptoms of CTE may include cognitive impairment, behavioral changes, mood disorders, and motor symptoms(8). Symptoms progress over time and take time to eventually develop in patients. Usually, symptoms are categorized into two stages, in early life (typically 20s-30s) in which mental health and behavior are affected, and in later life (~60s) in which memory and thinking are affected which can progress to dementia. The BU study on young athletes found symptoms of CTE in around 70% of the cases studied, regardless of whether the athlete was diagnosed or not. The clinical symptoms observed were depression (70.0%), apathy (71.3%), difficulty with behavior control (56.8%), and impaired decision-making (54.5%). Substance abuse was also common, with alcohol misuse in 42.9% of cases and drug misuse in 38.3% (2). These results suggest that some of these symptoms may not be specific to low-stage CTE and highlight the need for more research in the clinical characterization of athletes who may be at risk due to exposure to repeated head impacts.

Figure 1: Control Age 27 Brain (2)

Figure 2: Young Athlete’s Brain with CTE (2)
Efforts to eliminate head-to-head collisions in football have been made after more research has come out over time about the risks of CTE. For example, the implementation of the targeting rule in College football and the use of guardian caps, which are padded helmet covers, aims to help reduce concussions in athletes (9,10). However, it is too soon to determine the effectiveness of these strategies in reducing the prevalence of CTE in athletes, young or professional.
Woven into the fabric of American culture, sports play an integral part in many communities throughout the nation. For a lot of athletes, their sport enables them to build community, attend college, or even establish their career by playing it. Football, and other contact sports, aren’t going anywhere in the current future. However, families and athletes should be informed of the potential risks they are taking by deciding to play, and the very real consequences that are affecting young amateur athletes across the nation.
References
1. Musa A. ‘A living hell inside of my head’: For first time, more advanced stage of CTE diagnosed in teen football player. CNN [Internet]. 2023 Nov 20 [cited 2024 Oct 8]; Available from: https://www.cnn.com/2023/11/20/health/cte-teen-football-player/index.html
2. Mayo Clinic Staff. Chronic traumatic encephalopathy. Mayo Clinic [Internet]. 2023 Nov 8 [cited 2024 Oct 8]; Available from: https://www.mayoclinic.org/diseases-conditions/chronic-traumatic-encephalopathy/symptoms-causes/syc-20370921
5. Umoh N. CTE identified in brain donations from young amateur athletes. NIH [Internet]. 2023 Aug 28 [cited 2024 Oct 8]; Available from: https://www.nih.gov/news-events/news-releases/cte-identified-brain-donations-young-amateur-athletes
6. Doctrow B. Chronic traumatic encephalopathy in young athletes. NIH [Internet]. 2023 Sep 12 [cited 2024 Oct 8]; Available from: https://www.nih.gov/news-events/nih-research-matters/chronic-traumatic-encephalopathy-young-athletes#:~:text=In%20a%20study%20of%20brains,CTE%20relates%20to%20clinical%20symptoms
7. Most D. BU Finds CTE in Nearly 92 Percent of Ex-NFL Players Studied. The Brink, Boston University [Internet]. 2023 Feb 7 [cited 2024 Oct 8]; Available from: https://www.bu.edu/articles/2023/bu-finds-cte-in-nearly-92-percent-of-former-nfl-players-studied/
9. Jenkins K. What is the targeting rule in college football? ESPN [Internet]. 2024 Sep 6; Available from: https://www.espn.com/college-football/story/_/id/41152488/what-targeting-ncaa-rule-college-football
10. Dodd D. Guardian Caps, helmet add-ons could reduce concussions by nearly 50%, so why isn’t everybody wearing one? CBS Sports [Internet]. Available from: https://www.cbssports.com/college-football/news/guardian-caps-helmet-add-ons-could-reduce-concussions-by-nearly-50-so-why-isnt-everybody-wearing-one/
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