Joseph Maroon, a neurosurgeon, began working for the Pittsburgh Steelers as a consulting physician starting in 1977 and spent more than 46 years examining and treating stars from the notoriously hard-hitting dynasty, including Hall of Famers Terry Bradshaw, Mean Joe Greene, and Lynn Swann.
Many of them, he said, are concerned about their brain health because they played while concussions were seen as “dings,” full-contact practices were common and the most violent blows were still allowed.
“Certainly, anyone who has participated at that level is concerned,” Maroon said last week in his office at the University of Pittsburgh Medical Center Presbyterian Hospital. “But we haven’t seen the epidemic you would expect from playing in those days with fewer protective helmets, fewer rules and harder pitches. There are so many unknowns.”
A growing body of scientific research conducted over the past 15 years has found links between repetitive head trauma and chronic traumatic encephalopathy, a degenerative brain disease. Many of these come from Boston University’s CTE Center, which has examined the brains of hundreds of former NFL players and other athletes and military personnel.
But Maroon, who has historically measured rates of CTE in football players a “rare” phenomenon And “very exaggerated“felt more research was needed into why some athletes have few or none of the symptoms associated with CTE, including memory loss, impulse control problems and depression, while others are overwhelmed by them.”
So five years ago, the owner of Maroon and the Steelers, Art Rooney II, approached doctors at the University of Pittsburgh Alzheimer’s Disease Research Center to talk about creating a sports-focused brain bank that studies the roles that age, genetics, substance abuse, number of head hits, and other factors play into the development of CTE
The result is the University of Pittsburgh’s National Sports Brain Bank, which officially opens Thursday. After being delayed for several years by the Covid-19 pandemic, the center has accepted pledges of brains from athletes, including former Steelers running backs Jerome Bettis and Merril Hoge.
CTE can’t be diagnosed until after death, and doctors are years away from developing a test to detect the disease in the living, so posthumous donations to brain banks are still the primary method of advancing research.
The center will also begin recruiting volunteers — athletes of all sports levels, as well as non-athletes to serve as a control group — to provide their health histories and be monitored for years to come. That information will be compared to the state of their brains after they die to determine what, if any, factors played a role in whether or not they had CTE
“We don’t know where the threshold is for CTE,” said Julia Kofler, the director of the department of neuropathology at the University of Pittsburgh, who will oversee the sports brain bank. “You certainly see cases with very minimal pathology that had symptoms, and that’s the question. I think we really need to have as many cases as possible to answer these epidemiological questions.”
The National Sports Brain Bank will rely on the infrastructure of the Alzheimer’s Disease Research Center, which already has more than 2,000 brains, though most of them don’t belong to athletes. The Sports Brain Bank will use seed money from the Chuck Noll Foundation, the Pittsburgh Foundation and the Richard King Mellon Foundation to find volunteers for the long-term study and people willing to put their brains to work.
Maroon, Kofler and others in Pittsburgh recognized the work of Boston University physicians who have been the undisputed leaders in CTE research. Researchers there have sampled more than 1,350 brains not only from football players, but also from athletes who played hockey, rugby, soccer and other sports, as well as members of the military. So far, about 700 of those brains have been found to have CTE
But Maroon said some of the Boston group’s studies were biased because families typically donated the brains of relatives who showed symptoms consistent with CTE when they were alive. When asked to provide details of their loved ones’ head traumas, those families’ memories of the former players’ concussion histories may be inaccurate.
The long-term study conducted by researchers in Pittsburgh should “reduce, eliminate and prevent that kind of bias,” Maroon said.
Ann McKee, the neuropathologist who directs the CTE Center at Boston University, said her group has recognized selection bias among families for many years. She also said doctors at Boston University were already conducting several longitudinal studies.
“We’re all doing this,” McKee said, adding that “it’s always great to get another group involved, and it will accelerate research and scientific discoveries, especially with regard to treatment. So that’s fantastic .”
Unlike Boston University, the National Sports Brain Bank does not shy away from ties to the NFL. The Chuck Noll Foundation for Brain Research, named after the former Steelers head coach who was diagnosed with Alzheimer’s disease before his death in 2014, has provided seed funding to the bank. Founded in 2016, in part with a donation from the Steelers charitable arm, the foundation has provided more than $2.5 million in research grants to explore the diagnosis and treatment of brain injuries, primarily sports-related brain injuries.
“It was important to the Steelers that we got behind this,” Rooney said in a telephone interview. “Obviously we are in the early stages, but we hope it gets the attention it needs to be really successful.”
Hoge, the former Steelers running back who has agreed to donate his brain, said he chose the National Sports Brain Bank because the University of Pittsburgh and other institutions in the city were centers of innovation in brain health, including the development of helmet technology. He also noted that Noll, his former coach, had pushed for the developing a test to evaluate a player’s cognitive abilities that can be used as a basis to identify concussions. It was a precursor to the Immediate Post-Concussion Assessment and Cognitive Test (IMPACT) used worldwide.
Hoge, who co-authored the 2018 book “Brainwashed: The Bad Science Behind CTE and the Plot to Destroy Football,” added that he believed in the integrity of the research at the Pittsburgh Brain Bank.
“There’s so much misunderstanding and fear,” Hoge said. “Helping them find that right information and giving them other information and resources to help them with the thought process, I think, is very important.”
Gil Rabinovici, the director of the Alzheimer’s Disease Research Center at the University of California, San Francisco, said “this type of research is best conducted when the funders and researchers are free of potential conflict,” referring to NFL links from the Pittsburgh group. .
He added that the Boston researchers had done an “excellent job” in describing the pathology of CTE, “but in science you look for independent replication with different groups studying the same scientific questions using different methods and hopefully arriving at similar conclusions come.”