What can be fixed right now?
A Harvard-led study of nearly two thousand living former NFL players has surfaced a quiet crisis: one in three believe they carry the mark of CTE, a disease that can only be confirmed after death. The research, published in JAMA Neurology during the opening weeks of the 2024 NFL season, reframes the conversation not as a verdict on an unknowable fate, but as an invitation to treat what can be treated — depression, sleep disorders, hypertension — while science works toward a diagnosis that does not require dying first. It is a study about football, but more deeply, it is about what men carry long after the crowd has gone home.
- One in three former NFL players surveyed believe they have CTE, and among them, suicidal ideation runs five times higher than among those who do not share that belief.
- The disease exists in a diagnostic limbo — real in its symptoms, unconfirmable in the living — leaving thousands of former players without answers and, until now, without a clear path to care.
- Researchers are pushing a critical reframe: rather than waiting for a posthumous verdict, many CTE-associated conditions like depression and sleep apnea are treatable today, and that shift in thinking could save lives.
- The study lands as Tua Tagovailoa suffers his third concussion in five years, reigniting pressure on the NFL, which has introduced new protective equipment but has yet to respond to the latest findings.
- Scientists are racing to identify biomarkers that could make CTE diagnosable in living patients, a breakthrough that would transform both treatment and accountability in professional sports.
When nearly two thousand former professional football players were asked whether they believed they had CTE, one in three said yes — reporting depression, cognitive fog, and the unresolved weight of years of head trauma. The study, published in JAMA Neurology and led by Harvard's Rachel Grashow, is unusual in that it centers living players rather than autopsies, drawing on data collected between 2017 and 2020 from men who played in the NFL between 1960 and 2000.
The mental health findings are stark. Among the 681 players who believed they had CTE, a quarter reported suicidal thoughts — compared to just 5 percent among those who did not. CTE, characterized by nerve cell death in the brain, can produce mood swings, cognitive decline, and depression, sometimes not surfacing until decades after the original trauma. The risk compounds when players return to the field before a prior concussion has healed — a pattern common in professional football.
What distinguishes this research is its pivot toward the actionable. Grashow's team found that many conditions reported by players with suspected CTE — depression, sleep apnea, hypertension — are treatable. The question shifts from 'do you have an incurable disease?' to 'what can we address right now?' Dr. Thor Stein of Boston University's CTE center called the approach sound, while noting the study's reliance on self-reporting as a limitation. Researchers are now working toward identifying biomarkers that could allow CTE diagnosis in living patients.
The study's publication in the opening weeks of the NFL season, days after quarterback Tua Tagovailoa sustained his third concussion in five years, sharpened its cultural resonance. The league acknowledged a link between football and CTE in 2016 and has since introduced updated helmets and an optional padded guardian cap for practices. Few players have chosen to wear the cap in games — though those who have, like Colts tight end Kylen Granson, are unambiguous about why. The NFL did not respond to the study.
Nearly two thousand former professional football players were asked a straightforward question: do you think you have CTE? One in three said yes. They reported depression. Cognitive fog. The lingering weight of hits to the head that never quite healed. The study, published this week in JAMA Neurology, arrives at a moment when the conversation around brain injury in football feels both urgent and stuck—urgent because the damage is real, stuck because CTE cannot be officially confirmed until after death.
The research comes from Harvard University's Football Players Health Study, a project that surveyed roughly four thousand men who played professional football between 1960 and 2000. Rachel Grashow, the study's lead author and director of epidemiological research at Harvard, emphasized what makes this work different from most CTE research: it is based on living players, not autopsies. "Most of the studies that have been done on CTE are much smaller studies on deceased players," she said. "We are studying, really, how they lived their lives, not postmortem." The respondents came from across the country, represented different races, and had varying amounts of playing time. Data collection ran from 2017 to 2020.
Of the 1,900 players who provided detailed responses, 681—roughly 34 percent—reported believing they had CTE based on symptoms they had experienced. The number carries weight partly because of what it suggests about mental health. Among those who thought they had CTE, a quarter reported suicidal thoughts. Among those who did not believe they had the disease, that figure dropped to 5 percent. The gap is stark and speaks to something beyond neurology: it speaks to how former players are living, what they are carrying, how they are coping.
CTE itself is characterized by the death of nerve cells in the brain. It can produce cognitive impairment, difficulty managing emotions, mood swings, and depression. Symptoms may not appear for years or even decades after the initial head trauma. Researchers believe the risk intensifies when a second injury occurs before the first one has fully healed—a scenario common in football, where players often return to play before concussions have resolved.
But here is where the research takes an unexpected turn. Grashow and her team found that many of the conditions reported by players with perceived CTE are treatable. Depression responds to treatment. Sleep apnea can be managed. Hypertension can be controlled. The shift in framing matters. Instead of asking whether a player does or does not have an incurable, unknowable neurodegenerative disease, the question becomes: what can we fix right now? "Once you start to talk about treating these different conditions and getting them to go to the doctor and asking about them, the conversation totally shifts," Grashow said. She noted that treatment and management have largely been absent from the CTE discussion until now.
Dr. Thor Stein, director of molecular research at Boston University's CTE center, called the approach viable. "There are a lot of symptoms that sometimes are thought to be CTE, but they can still be treated," he said. He cautioned, however, that the study relied entirely on self-reported responses and lacked clinical follow-up to validate the findings. Still, he called it an important first step. Looking forward, researchers hope to identify biomarkers—measurable indicators in living patients—that could help diagnose CTE before death.
The study's timing is significant. It was published in the first month of the NFL season, just days after Miami Dolphins quarterback Tua Tagovailoa sustained his third concussion in five years. The incident reignited debate about the league's responsibility to its players. The NFL acknowledged a link between football and CTE in 2016 and settled thousands of player lawsuits over head injuries for $765 million in 2013. In recent years, the league has introduced new helmets and a padded protective layer called a guardian cap, worn over the helmet during contact practices. The cap is optional in games this season, and few players have chosen to wear it—though Indianapolis Colts tight end Kylen Granson is one exception. "For me, it was a no-brainer," he said. "Anything I can do to mitigate any sort of brain injury or long-term health effects that would be detrimental to me takes precedent." The NFL did not respond to requests for comment on the new study.
Citações Notáveis
We are studying, really, how they lived their lives, not postmortem.— Rachel Grashow, lead author, Harvard University's Football Players Health Study
Once you start to talk about treating these different conditions and getting them to go to the doctor, the conversation totally shifts from an incurable disease to what can be fixed now.— Rachel Grashow
A Conversa do Hearth Outra perspectiva sobre a história
Why does it matter that one-third of these players think they have CTE rather than know they have it?
Because the difference between thinking and knowing changes everything about how you live. A player who suspects CTE but can't confirm it lives in a kind of limbo—grieving something that might not be there, or might be there and untreatable. But if you shift the conversation to what can actually be treated, depression and sleep problems and pain, suddenly there's a path forward.
The study mentions that 25 percent of players with perceived CTE reported suicidal thoughts. That's a staggering number. What does that tell us?
It tells us that the psychological weight of believing you have an incurable brain disease is itself a health crisis. Whether or not CTE is present, the fear and despair are real and they're killing people. That's why Grashow's point about treatment matters so much—you don't have to wait for a biomarker to help someone who is suicidal.
But the researchers acknowledge the study has gaps. Players self-reported their symptoms without clinical follow-up. Doesn't that undermine the findings?
It limits them, but doesn't erase them. You're right that self-reported data is weaker than clinical diagnosis. But it's also the only data you can get from living players, since CTE can only be confirmed after death. The study is honest about that limitation. It's a starting point, not a final answer.
The NFL has introduced guardian caps and new helmets. Why aren't more players wearing them?
Because in football, there's a culture that equates toughness with risk-taking. Wearing extra protection can feel like admitting vulnerability. Kylen Granson is the exception precisely because he's willing to say that protecting his brain matters more than looking tough. That's a shift in thinking that hasn't spread yet.
What happens next? What are researchers actually looking for?
Biomarkers—measurable signs in the blood or brain of living players that could indicate CTE. If they find those, you could diagnose the disease before death and potentially intervene earlier. That's the real prize. Right now, you're flying blind.