Tau Positron-Emission Tomography in Former National Football League Players

N Engl J Med. 2019 May 2;380(18):1716-1725. doi: 10.1056/NEJMoa1900757. Epub 2019 Apr 10.


Background: Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease that has been associated with a history of repetitive head impacts. The neuropathological diagnosis is based on a specific pattern of tau deposition with minimal amyloid-beta deposition that differs from other disorders, including Alzheimer's disease. The feasibility of detecting tau and amyloid deposition in the brains of living persons at risk for CTE has not been well studied.

Methods: We used flortaucipir positron-emission tomography (PET) and florbetapir PET to measure deposition of tau and amyloid-beta, respectively, in the brains of former National Football League (NFL) players with cognitive and neuropsychiatric symptoms and in asymptomatic men with no history of traumatic brain injury. Automated image-analysis algorithms were used to compare the regional tau standardized uptake value ratio (SUVR, the ratio of radioactivity in a cerebral region to that in the cerebellum as a reference) between the two groups and to explore the associations of SUVR with symptom severity and with years of football play in the former-player group.

Results: A total of 26 former players and 31 controls were included in the analysis. The mean flortaucipir SUVR was higher among former players than among controls in three regions of the brain: bilateral superior frontal (1.09 vs. 0.98; adjusted mean difference, 0.13; 95% confidence interval [CI], 0.06 to 0.20; P<0.001), bilateral medial temporal (1.23 vs. 1.12; adjusted mean difference, 0.13; 95% CI, 0.05 to 0.21; P<0.001), and left parietal (1.12 vs. 1.01; adjusted mean difference, 0.12; 95% CI, 0.05 to 0.20; P = 0.002). In exploratory analyses, the correlation coefficients in these three regions between the SUVRs and years of play were 0.58 (95% CI, 0.25 to 0.79), 0.45 (95% CI, 0.07 to 0.71), and 0.50 (95% CI, 0.14 to 0.74), respectively. There was no association between tau deposition and scores on cognitive and neuropsychiatric tests. Only one former player had levels of amyloid-beta deposition similar to those in persons with Alzheimer's disease.

Conclusions: A group of living former NFL players with cognitive and neuropsychiatric symptoms had higher tau levels measured by PET than controls in brain regions that are affected by CTE and did not have elevated amyloid-beta levels. Further studies are needed to determine whether elevated CTE-associated tau can be detected in individual persons. (Funded by Avid Radiopharmaceuticals and others.).

MeSH terms

  • Adult
  • Aged
  • Aniline Compounds
  • Brain / diagnostic imaging
  • Brain / pathology*
  • Brain Chemistry
  • Brain Concussion / complications
  • Case-Control Studies
  • Chronic Traumatic Encephalopathy / diagnostic imaging
  • Chronic Traumatic Encephalopathy / etiology
  • Chronic Traumatic Encephalopathy / pathology*
  • Cognition Disorders / etiology
  • Ethylene Glycols
  • Football / injuries*
  • Humans
  • Male
  • Mental Disorders / etiology
  • Middle Aged
  • Plaque, Amyloid / diagnostic imaging
  • Positron-Emission Tomography*
  • Radiopharmaceuticals
  • Tauopathies / diagnostic imaging
  • Tauopathies / pathology*
  • tau Proteins / analysis*


  • Aniline Compounds
  • Ethylene Glycols
  • Radiopharmaceuticals
  • tau Proteins
  • florbetapir