For a long time it was known as boxer syndrome, but it is now also considered a football disease: chronic traumatic encephalopathy, or CTE for short. The repeated blows to the head trigger severe symptoms. CTE is considered a form of dementia. The backgrounds.

At the latest since the NFL game in Munich, the football hype has also reached Germany. Thousands flocked to the stadium, millions sat in front of the television to cheer for the NFL players around superstar Tom Brady. But American football has a (health) downside: chronic traumatic encephalopathy, or CTE for short.

In December, CTE once again made headlines in connection with the death of NFL star Demaryius Thomas. The disease was diagnosed postmortem in the then 34-year-old. Even if it was not considered the cause of death, it caused a flare-up of criticism. The danger of CTE in football players is discussed again and again. But what is behind the disease?

CTE is triggered by repeated, even light, blows and bumps to the head. That happens in American football, ice hockey or boxing. The CTE risk is also discussed in connection with football.

Bio-medically, it was recently examined by the scientist Mai Thi Nguyen-Kim. She clearly explains how CTE develops in a short video that was shared on the show’s Instagram page.

In summary: hits to the head lead to problems with the tau proteins in the nerve cells. “One can imagine tau proteins as guardrails for the flow of information,” says scientist Nguyen-Kim. When hit or hit to the head, the tau proteins can clump together and form protein nodules that float around the brain. “So the guard rails of the information flow collapse and lie across the street and that causes a traffic jam in the brain.”

This clumping of tau is called tauopathy. It is also the cause of neurodegenerative diseases such as Alzheimer’s or Parkinson’s. CTE, like Alzheimer’s, is a form of dementia.

It is still unclear why a large number of traumatic events lead to CTE in some athletes, while in others a few injuries are sufficient. Genetic factors may play a role in the different resilience, but immunological and inflammatory influences are also discussed.

CTE often occurs years or decades after the end of a sporting career, but sometimes it affects younger athletes in their 20s to 30s. The symptoms differ according to the severity of the changes occurring in the brain. According to the German Alzheimer Society, four stages can be distinguished:

Stage 1 usually presents with headaches, decreased attention and concentration, and problems remembering and organizing, planning, and making decisions. Some of those affected also experience aggressiveness, depressive moods and emotional outbursts.

Stage 2 is characterized by depression, mood swings, headaches, and memory problems. Some of those affected develop the symptoms of a muscle disease. It can also lead to restricted emotion control as well as attention and concentration disorders.

Stage 3 is characterized by problems with memory and organization and planning, impaired emotion control, and problems with attention and concentration. Depressive moods or mood swings, impairment of visual-spatial functions and aggressive behavior are also common.

In stage 4, the picture of dementia develops in all cases with pronounced memory impairment, problems with organizing, planning and making decisions, reduced attention and concentration. Disorders of speech, emotion control, and visual-spatial functions, as well as aggressive behavior, paranoia, depressive moods, and walking problems are usually also present.

Thomas also suffered from numerous symptoms, including memory loss, paranoia and other erratic behavior, his mother reported. “His mood would change and he would also isolate himself at times. He said, ‘Mom, I don’t know what’s going on with my body. I have to pull myself together. I don’t feel like myself anymore'”.

There is still no specific treatment option for suspected CTE. However, some symptoms can at least be alleviated. The German Alzheimer Society recommends four points.

The frequency of CTE is not exactly known. However, it is estimated that around 15 percent of all athletes who have played contact sports in their lifetime have been diagnosed with CTE.

CTE can only be proven with certainty after death, through an autopsy of the brain. It’s not possible in living humans because the tau proteins, and even the clumps, are too small to detect with a scan.

A 2017 study by the University of Boston also paints a frightening picture: CTE was detected in 110 of the 111 NFL professionals who died. Commenting on Thomas’ death, NFL player Dez Bryant wrote on Instagram: “DT88 my heart is heavy bro. It’s a lot of us who live with CTE.” Athletes who have symptoms shouldn’t be afraid to speak up.

The NFL has responded and banned dangerous maneuvers under the Helmet Rule. However, collisions, falls and thus blows and hits to the head are still the order of the day. The so-called Concussion Protocol has therefore been in place since 2013. In summary, so-called spotters observe the game and intervene if head injuries are suspected. Affected players will be removed from the game, subjected to a test and may not be allowed back onto the field. Further investigations follow and there are regulations that state when they can be used again. However, there appeared to be gaps. It was tightened again in 2022.