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NFL and retired players settle lawsuit claiming brain injury

Traumatic brain injury remains a bit of a mystery. That may be why 4,500 retired NFL players entered into a $765 million settlement with the NFL as compensation for brain injuries from repetitive concussions. The lawsuit was filed by the former players to obtain compensation for the symptoms of brain injury experienced in retirement and attributed to years of repetitive head concussions. In Massachusetts and elsewhere, the scientific information about traumatic concussion injury remains limited, but there are growing signs of a direct link between concussion and long-term cognitive and psychiatric consequences.

The settlement suggests that players would have had difficulties proving the nature, extent and source of their symptoms. However, at Boston University's Center for the Study of Traumatic Encephalopathy, the autopsied brains of dozens of former athletes have shown clear evidence of degenerative disease not seen in healthy brains. Additionally, dementia and depression are more frequently seen in former contact sport athletes than in other people.

The practical problem, also implicated in trying to prove brain injury from falls and auto accidents, is that brain injury is difficult to pinpoint on tests unless there is evidence of bleeding or swelling inside the brain. CT scans don't detect the metabolic disturbances in the brain or the massive "shearing" of white matter during trauma. And yet these dynamics are reportedly at the core of understanding brain injury.

The settlement will set aside funds for "baseline exams" for all retired NFL players. These are in the nature of neuropsychiatric testing to determine if there is traumatic brain injury and what part of the brain may have been injured. This is a belated remedy and the tests will become much more valuable as they are used on beginning players from early life on, which is now the norm.

Furthermore, in Massachusetts and elsewhere, studies have already yielded evidence that after concussion there is brain injury shrinkage in an area of the brain associated with depression. But it's still not conclusive enough to use for proof. So how you use that information to say anything about the long-term risk of any individual athlete or other closed head injury victim is still difficult to validate.

Source: Los Angeles Times, Concussion settlement highlights difficulty of proving brain damage, Melissa Healy, Aug. 29, 2013

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