Part 3: What is CTE?

'I would suspect that drivers are at risk'

Questions and answers with CTE expert Chris Nowinski

By Godwin Kelly

Chris Nowinski is co-founder and CEO of the Concussion Legacy Foundation. Nowinski, 38, has a Ph.D. in behavioral neuroscience and has helped spearhead brain injury awareness. Nowinski has written two books about brain injury. The first was in 2006 titled “Head Games: The Global Concussion Crisis.” The second was released in 2014 called “Football’s Concussion Crisis.” News-Journal Motorsports Editor Godwin Kelly interviewed Nowinski by telephone.

What is CTE?

“CTE is a degenerative brain disease, not unlike Alzheimer’s Disease, which appears to be triggered by brain trauma.”

This disease seems to strike people across the board, not just athletes, and young and older.

“I don’t think there is any evidence of any age restrictions from the start. The youngest athlete identified with symptoms has been a 17-year-old football player.”

When was CTE discovered?

“It is a very old disease. It was first described by doctors in 1928 when it was called ‘punch drunk.’ The first case series were boxers, who had brain damage more than 60 years ago. In 2005 the first NFL player was found with it, but it has been around in other sports.”

It seems like medicine can’t pinpoint the disease with accuracy until a person dies and their brain is studied. Is that right?

“You need to put some context to that. We can’t predict anyone’s nerve degenerative diseases with 100 percent accuracy while people are alive. The only way to be sure is by looking at the brain. There’s been enough research that doctors can diagnose things like Alzheimer’s disease at the office because there is published criteria that will allow them to have over 90 percent accuracy. We haven’t done that work yet with CTE. We won’t be at 100 percent, but hopefully in the next five years, we can give doctors guidelines to help them diagnose it with a similar rate.”

It seems like the symptoms for CTE are wide ranging.

“Attributing specific behaviors to a neurogenic disease is difficult. What we do know, at the end stages of the disease, 90 percent of the people have dementia; over 90 percent have cognitive complaints; 90 percent have behavioral or mood disorders. Loss of impulse control is a common symptom and that can lead to some extreme behaviors.”

Muhammad Ali boxed his whole life and developed Parkinson’s disease, so is there a thread there?

“Motor symptoms are common among boxers with CTE, less common than other exposures like football. We see damage in the motor cortex, upper spinal cord motor neurons. It’s possible that CTE can cause motor symptoms.” (Editor’s note: The motor cortex is the region of the cerebral cortex involved in the planning, control, and execution of voluntary movements.)

Do you know of any CTE cases involved NASCAR drivers?

“I don’t.”

Dale Earnhardt Jr. has offered to donate his brain. Is that the kind of information you need to start building data on a certain sport?

“That is correct. At this point, we would need to review and study the brains of people who are involved (in the sport). For example, (former driver) Fred Lorenzen has pledged to donate his brain. He’s dealing with dementia right now. He wants to help us learn why (this happens).”

There don’t seem to be many reported cases of CTE from the racing community.

“The answer is simple. No brains have been studied from that community (racing). I do think it is great that this discussion is raising awareness in racing and that this is an area of interest to drivers and families of drivers. They want to know if there is a problem and how we can help those who have been affected.”

Do you think the type of head injuries that drivers suffer lend themselves to CTE?

“Based on understanding the exposure history — I would suspect that drivers are at risk to develop CTE. There’s a wide range of risk for those who race and crash a couple times a year. That’s the kind of thing we need to look at.”

Do you know of any other drivers besides Dale Jr. and Lorenzen who have pledged their brains to research?

“There is one more driver that we have talked to about pledging publicly, but he has not done that yet.”

Are drivers more or less susceptible to concussions and CTE than other athletes?

“We just don’t know. We haven’t done the studies. Some automobile accidents create G-forces that are worse than you can create on a football field. It has a lot to do with the safety of the car. There are a lot of variables that we are only beginning to understand. We do believe that one of the risk factors to CTE is repetition of brain trauma, so a football player might take 2,000 hits in one season. We don’t understand what the minimum threshold is to put you at risk. What we need to understand is what the head is experiencing in a year of driving, what the brain is experiencing.”

NASCAR does have a concussion protocol, which I guess is a step in the right direction as far as keeping track of head incidents?

“Yes. That is the right step. Unfortunately, a large percentage of the auto racing community doesn’t have that. At the lower levels of the sport, they may not be getting the same levels of support. At the (grassroots) levels, especially with younger drivers, I don’t think they get the same care as the drivers at the top levels of the sport.”

So if you have a series of concussions, it doesn’t necessarily mean that you will develop CTE, correct?

“You can look at CTE like smoking and lung cancer. There are people who smoke every day but don’t get lung cancer. We would not expect everyone to get CTE, but we do want to understand who gets it and how fewer people can get it.”

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