Study: CTE found in at least a quarter of deceased former NFL players

A new study published Tuesday in the journal BMJ estimates that at least one in four former National Football League (NFL) players who died between 2016 and 2021 had chronic traumatic encephalopathy (CTE), a degenerative brain disease linked to repeated head impacts.

Researchers examined brain donations from 235 of the 878 former players who died during that period and detected CTE in 215 of those brains—a rate of 91.5 percent among donors. Because not every player donated their brain, the team calculated that at minimum 24.5 percent of all 878 deaths involved CTE, with a maximum estimate of 97.7 percent.

The study, conducted by researchers from Mass General Brigham, Boston University, and the Concussion & CTE Center (also identified as the Concussion & CTE Foundation in some coverage), is described in an accompanying editorial as "one of the most informative estimates to date of CTE burden among former NFL players."

CTE link to dementia and head impacts

Among brain donors diagnosed with CTE, 61.3% met the clinical criteria for dementia before death. Looking from the other direction, 95.5% of donors who had dementia also had CTE pathology. Players with Stage IV CTE, the most advanced form, had a 44% higher risk of dementia compared to those with lower stages.

Lead author Dr. Daniel Daneshvar, chair of physical medicine and rehabilitation at Mass General Brigham and associate professor at Harvard Medical School, told sources that NFL players have "about a four times higher rate of death from neurodegenerative disease than the general population." He also emphasized that most head impacts occurred before players entered the NFL. "The bulk of the head impacts that these former NFL players experienced didn’t occur at the NFL level," he said, noting that many happened during college, high school, and youth football.

CTE is a condition that can only be diagnosed after death. It is characterized by an abnormal buildup of the tau protein and has been linked to contact sports such as football, hockey, and soccer, as well as military blast exposure and domestic violence. Symptoms can include memory loss, impulse control problems, anxiety, depression, anger, difficulty walking, emotional instability, and suicidal thoughts.

Methodology and limitations

The researchers analyzed the total number of NFL deaths between 2008 and 2021, using death certificate data and comparing it to brain donors with confirmed CTE. They narrowed the window to 2016–2021, the period with the highest number of brain donations. Many of the donated brains were analyzed at Boston University and the University of California, San Francisco.

The authors acknowledged limitations, including that not all deaths during the period were captured and that family members may have inaccurately recalled or overstated symptoms when providing medical histories. The study also focused on players from the mandatory plastic helmet era beginning in 1949.

Calls for safer practices

The findings highlight risks from head impacts that begin long before athletes reach the professional level. Daneshvar said that "nearly 70 per cent of head impacts are occurring in practice," and suggested that reducing contact in practices to less than once per week—a measure already implemented in the NFL—could benefit athletes if adopted more broadly. An NFL spokesperson said in response: "The NFL continues aim to make the game of football safer, including by implementing strategies to reduce concussions and head impacts."

In 2011, the NFL and the players' union agreed to a collective bargaining agreement that restricted full-contact practices. The league's current CBA, ratified in 2020 and running through March 2031, limits such practices further. The U.S. Supreme Court in 2016 allowed the NFL's settlement of concussion-related lawsuits with thousands of retired players to proceed.

Researchers urged expanding safety rules and reducing contact during practice at all levels to lower the risk of CTE and other neurodegenerative diseases.