First Hockey Player Diagnosed with Degenerative Brain Disease Caused by Repetitive Brain Trauma

13-year NHL Veteran Died at 73 with Progressive Dementia

BUSM’s Center for the Study of Traumatic Encephalopathy (CSTE) announced that a recently deceased former National Hockey League (NHL) player suffered from the degenerative brain disease Chronic Traumatic Encephalopathy (CTE) when he died, becoming the first former hockey player diagnosed with the disease.

Reggie Fleming was a defensemen and forward for six NHL teams from 1959 to 1971, including the New York Rangers, Chicago Blackhawks, Boston Bruins, Montreal Canadiens, Buffalo Sabres and Philadelphia Flyers. His 13 seasons and 749 NHL games spanned a professional career that lasted more than twenty years. Fleming is remembered for his hard-nosed play and combative style that led to 108 NHL goals, 1468 penalty minutes and a Stanley Cup with the 1961 Chicago Blackhawks.

Fleming was diagnosed with CTE by neuropathologist and CSTE co-director Ann McKee, MD who has also recently diagnosed the disease in twelve deceased football players and five boxers. CTE can only be diagnosed by examining brain tissue post-mortem. Fleming died on July 11, 2009, at the age of 73 after years of declining health, including a heart attack and strokes. Mr. Fleming’s brain tissue revealed the typical pathology of CTE that was unrelated to the strokes or other ailments.

“This is the first time we have found CTE in the brain of a retired professional hockey player and the changes in his brain were very similar to the changes we’ve found in football players and boxers. This case also points out that individuals who suffer from CTE are often misdiagnosed during life and may be told that they are suffering from a psychiatric disorder, such as bipolar disease, or later in life, from Alzheimer’s disease,” explained McKee.

According to his family, Fleming suffered approximately 20 concussions playing hockey, 10 while he played in the NHL and two that led to loss of consciousness on the ice. He may have suffered additional concussions after his hockey career as the result of fistfights and a motor vehicle accident.

Fleming’s family believes that he had been exhibiting symptoms of CTE for decades prior to his strokes. In his early 40s he was diagnosed with manic depression, due to frequent and extreme behavioral outbursts. After leaving professional hockey, Fleming was described by his family as “out of control” and as having significant problems controlling his eating, drinking, gambling, and temper. He also had significant attention, concentration, and memory impairment, along with problems with planning and organization. Full dementia did not set in until the final two years of his life.

Fleming’s son Chris, a filmmaker, interviewed his father multiple times during his final years and has made videos publicly available. The footage provides powerful clinical evidence of dementia characteristic of CTE, and can be viewed on the website of the Sports Legacy Institute, a CSTE partner, at www.sportslegacy.org/.

Chris Fleming said, “For 5 years, I filmed my father and our discussions involving his fondest memories of hockey, family, and friends. We wanted to show the world that regardless of his condition, he could still reach out to people and make an impact. In his last year, he shared what really matters in life is not what we have, but how we contributed, and what we do for others. I know if my heart and soul that he is now in a better place smiling that he could contribute in this world one last time with this research. I pray his legacy as well as the positive impact he made on others will guide and help future generations to come.”

Former hockey players hope this research will immediately inform policy to protect the brains of current hockey players. Keith Primeau, a retired NHL star who has committed to donate his brain upon death to the CSTE Brain Donation Registry, said, “We urgently need awareness and recognition of the consequences of repetitive head trauma, especially CTE, in the sport of hockey. Primeau, now a youth hockey coach who mandates concussion education for coaches and athletes in his program, added, “It is imperative that we continue to create awareness and educate our children and parents on head trauma and post concussion if we are to see a difference.”

The CSTE was recently in the national spotlight when three co-directors McKee, Robert Cantu, MD and Chris Nowinski, testified in front of the US House of Representatives Judiciary Committee on football brain trauma. Within a month of the hearings the NFL announced sweeping changes to their concussion and brain trauma policies that should make the game safer, and the research from the CSTE Brain Bank is often cited as the primary evidence for that change.

In light of the growing concern about brain injuries in hockey, the CSTE will ramp up efforts to advance understanding of the effects of brain trauma in hockey, a sport played by millions of children in Canada, the US and Europe. Robert Stern, PhD, co-director of the CSTE, said, “We are having initial discussions with our Canadian colleagues about potential collaboration on this important work. These collaborations will allow us to reach our goal of curing and treating this devastating disease.”

Hockey is a unique sport that sanctions fighting within the game. Researchers cannot be certain whether the game of hockey or the fighting within the game are more responsible for the CTE Fleming developed. Cantu a leading expert on sports concussions and CSTE co-director, said, “In susceptible individuals, the brain responds to repetitive concussive and subconcussive blows with the development of CTE. The diagnosis of CTE in this NHL hockey player, and the destructive role it appeared to play in his life for decades, should play a prominent role in the current discussion of hits to the head in hockey. In addition, some of the brain trauma Mr. Fleming incurred came from fighting, and this discovery should help inform the ongoing debate about the role of fighting in the game of hockey.”

CTE is characterized by the build-up of a toxic protein called tau in the form of neurofibrillary tangles (NFTs) and neuropil threads (NTs) throughout the brain. The abnormal protein initially impairs the normal functioning of the brain and eventually kills brain cells. Early on, CTE sufferers may display clinical symptoms such as memory impairment, emotional instability, erratic behavior, depression and problems with impulse control. However, CTE eventually progresses to full-blown dementia. Although similar to Alzheimer’s disease, CTE is an entirely distinct disease. CTE is caused by repetitive concussive or subconcussive blows to the head, but the symptoms of the disease may not be evident for years or decades after the head trauma.