Las Vegas has made a name for itself in the combat sports industry, with many considering it to be “The Fight Capital of the World.” Home to the UFC headquarters, several renowned promoters and training centers and host to some of the biggest fights to-date, Las Vegas has become the destination for many professional fighters.
However, despite the hopeful dreams of many combatants, the harsh reality is that a certain number of them will pay a steep price, being left with permanent and progressive brain damage, termed chronic traumatic encephalopathy (CTE). This risk applies to not only fighters, but others exposed to repetitive head trauma including athletes involved in other contact sports, as well as military serviceman. A recent report that former New England Patriots player Aaron Hernandez had an advanced stage of CTE at the age of 27 is clearly alarming.
While it is now well recognized that repetitive blows to the head are a risk factor for CTE, we are still in our infancy of understanding why this condition occurs in some people and not others, how it progresses in the brain, and if there are means of detecting it early. To address these questions, the CCLRCBH launched a landmark study in 2011. Termed the Professional Fighters Brain Health Study (PFBHS), the goals are to increase our knowledge of CTE and by doing so, improve the safety of combat sports and advance treatment of the disease.
Through autopsy studies of individuals with CTE, we have learned that the disease is characterized by an abnormal buildup of a protein called tau in the brain, which can years later lead to memory loss, confusion, impaired judgment, depression, rage and eventually dementia. However, we still do not know how common it is. A study of retired NFL players who passed away conducted at Boston University found CTE in 99 percent of the brains donated. Yet, other investigators have pointed out that the group that donated their brain may not be representative of all professional football players.
Only so much information can be obtained from autopsy studies. Like other progressive brain diseases such as Alzheimer’s disease, CTE probably begins in the brain years before the first symptoms are obvious. Therefore, to truly understand the course of CTE, a study needs to begin tracking individuals when they are actively being exposed to repetitive head trauma.
The PFBHS is unique in that we are examining both active and retired fighters, allowing us to study the entire spectrum of repetitive head trauma. It’s important to note that this study is aimed at monitoring athlete’s brains over an extended period so that we can learn how CTE evolves. Currently, the PFBHS is the largest study of its kind with more than 700 professional boxers and mixed martial arts (MMA) fighters (men and women) currently enrolled, along with a comparison group of individuals who were never exposed to head trauma. We are in the sixth year of the study, but hope to continue for as long as possible.
Participants in the PFBHS undergo an annual checkup which includes state of the art brain imaging, blood sampling for genetic analysis and possible diagnostic markers, a variety of cognitive and behavioral assessments, and speech and balance tests. Through the advanced brain imaging utilized in the study, we can measure the size of many structures in the brain, the integrity of the millions of fibers that course across the brain and their functional connection, and the amount of the tau protein in the brain.
One of our most exciting outcomes thus far of the PFBHS happened in 2016 when the Nevada State Athletic Commission approved a requirement that all professional fighters undergo C-3 testing, an iPad based test of brain function used in the PFBHS. This was a major step toward fighter safety, as it is now the first sport to require that brain health be tracked over an athlete’s career.
Another important result had to do with two brain injury markers in the blood; one is a brain protein called neurofilament light chain, the other is tau. Both are components of nerve fibers that can be detected in the blood when the fibers are injured. The new findings showed that active fighters had higher levels of both proteins compared to retired fighters and non-fighters. For example, neurofilament light chain levels were 40 percent higher in active boxers than non-fighters. The more a fighter sparred in the two weeks before blood samples were taken, the higher the levels of neurofilament light chain. In addition, tau levels increased in many active fighters but not retired fighters or non-fighters. By continuing to follow the progress of the study participants, we hope to determine if these blood markers might be an indicator of progressive brain damage.
Lastly, by combining several features from the MRI scan we have developed a method that can predict which fighters are likely to have impairment on memory and other mental tests. If this method can be replicated in other types of athletes exposed to head trauma, we might have a useful tool to identify those at higher risk of CTE.
We’ve had many great successes, but we could not have done it alone. The PFBHS has received tremendous support from the combat sports industry, from the regulatory agencies, to the fighters, to the promoters. We’ve received donations from the UFC and Viacom’s Bellator MMA/Spike TV, as well as Bob Arum’s Top Rank Boxing and Haymon Boxing.
UFC Chief Operating Officer Ike Lawrence Epstein voiced the sentiment of all the study supporters when announcing in 2016 a five-year extension of support saying “Preventative measures including research and awareness are absolutely necessary in setting new standards for the health and safety of athletes. UFC prides itself in providing resources to industry leading health and wellness programs, as well as research, and is continuously seeking opportunities to invest in the development of athletes inside and outside the Octagon.”
Donations like these are crucial in keeping the PFBHS going, but even more so are the number of athletes these organizations have referred to us for study participation; it is important to recognize the investments these organizations have made to keep their athletes safe.
From our end, the aim is to apply what we learn from the data collected to help make contact sports safer, and to provide information to the athletes that empowers them to make informed decisions for their career. When I talk to the fighters involved in the study, I’ve found that most of them are more than aware of the risks associated with repetitive head trauma and want to be as proactive as possible when it comes to their brain health. An example is Gina Mazany, a professional UFC fighter and PFBHS participant who has been a part of the study for two years. Growing up in Alaska, she started MMA 10 years ago when she quickly fell in love with the sport. “I have had some moments that have scared me before” explained Mazany, “Sometimes you do things that are off and you don’t know why. For example, I’ve lost my keys and then later found them in a rice jar with no recollection as to how they got there and I question myself ‘why did I do that?’”
“I’m not going to pretend that there’s not risk in this sport, because that’s not true. But there are a lot of things we do in life that carry risk. I want to have a life after my career and that’s why I’m making sure I am being proactive about my brain health and taking every precaution that I can to stay safe. I think it’s important for fighters to know that there are resources available right here in Las Vegas. The more you know the more options you have.”