Is Dave Duerson's Suicide a Result of Brain Disease?

What do Andre Waters of the Philadelphia Eagles and Arizona Cardinals, Owen Thomas of the University of Pennsylvania, and Dave Duerson of the Chicago Bears have in common? Aside from each of these individuals being star football players, each of these individuals also committed suicide. Waters, age 44, died by self-inflicted gunshot wound in 2006, Thomas age 21, died by hanging himself in 2010, and more recently, Dave Duerson, age 50, died by self-inflicted gunshot wound on February 17, 2011.

However, there is a third, more elusive similarity between these three football players: Andre Waters, Owen Thomas, and Dave Duerson all suffered from a degenerative brain condition called chronic traumatic encephalopathy (CTE).

CTE is a controversial and new diagnosis being given to a host of football players who, after years of being hit on the head, descend into depression, behavioral issues stemming from lack of impulse control, business and financial difficulties, and quite often, death resulting from either suicide or some other violent altercation.

Dr. Bennet Omalu, who performed the neuropathological examination on the brain of Andre Waters, found that it contained small neurofibrillary tangles akin to the brain of an 85-year old suffering from Alzheimer's Disease. In fact, Dr. Omalu even stated that had Andre Waters lived an additional 10 to 15 years, he "would have been fully incapacitated."

The brain of Mike Webster, or "Iron Mike," of the Pittsburgh Steelers was also examined by Dr. Omalu after Webster's death in 2002. While Mike Webster died of a heart attack, not suicide, his later years were plagued by depression and suicide attempts. After retiring from football, Webster also had financial issues severe enough to result in homelessness and the need to sell his Super Bowl rings.

Dr. Omalu found extensive neurofibrillary tangles in the neocortical region of Webster's brain upon autopsy. Within these tangles lay large deposits of tau, a protein that helps maintain the microskeleton (i.e., microtubules) of neurons. In a normal brain, the tau protein remains soluble and barely noticeable upon microscopic examination. However, in the brains of Alzheimer's or Pick's Disease patients, the tau protein becomes hyperphosphorylated, forms paired helical and straight filaments, and precipitates (falls out of solution). This leads to microskeletal defects in neurons and their early death. The inevitable result, as seen upon neuropathological examination, is a series of darkly stained spots inside of the neocortex that contain tau and neuronal tangles. In many cases, these neurofibrillary tangles are found primarily in the frontal lobe areas of players' brains, the same brain areas responsible for socialization, abstract thinking and reasoning, and impulse control.

At Boston University, there is an institute for brain injury research called the Center for the Study of Traumatic Encephalopathy (CSTE). The CSTE was created in 2008 via collaboration between the medical school and the Sports Legacy Institute (SLI) in response to the alarming number of incidents involving football players who were discovered, post mortem, to have CTE. The SLI also operates a brain bank that has accepted numerous brains from different football players, including the brain of Owen Thomas. More recently, upon examining the brains of 13 professional football players, several of whom committed suicide, the Center concluded that all 13 players had suffered from CTE. Such a finding supports all current data showing that all cases of CTE involve individuals who have suffered repeated trauma to the head, especially though sports such as football and boxing.

Incidentally, Dave Duerson also specified that his brain be donated to the CSTE's brain bank in a note he wrote shortly before his suicide, which stated "Please, see that my brain is given to the NFL's brain bank."

References:

Pathologist says Waters' brain tissue had deteriorated http://sports.espn.go.com/nfl/news/story?id=2734941

Pro-Bowl Player's Suicide Renews Head Trauma Debate http://www.medpagetoday.com/Orthopedics/SportsMedicine/25064

Dave Duerson: Football's First Martyr Can't Die in Vain http://www.time.com/time/arts/article/0,8599,2055437,00.html

College football player who killed self had brain disease http://www.foxnews.com/health/2010/09/14/college-football-player-killed-self-brain-disease/

Center for the Study of Traumatic Encephalopathy
http://www.bu.edu/cste/