Toward the end of his pro football career, Dave Herman would often wake up the morning after a game and not remember which team he’d played against, much less the score. When his son would ask him what had happened in the previous day’s game, Herman wouldn’t have a ready answer.
“I’d say, ‘Give me the paper and we’ll find out,’” Herman remembers. “I’d have some recollection, but not of the score or who had a great game.”
Even the highlight of his career, 1969’s Super Bowl III, in which he played a major role helping the New York Jets pull off one of the greatest upsets in football history, is a blur. “I don’t remember the end of the game,” says the 73-year-old former offensive lineman, whose tenacious blocking enabled quarterback Joe Namath to engineer the stunning victory over the Colts. “I remember reading about it because that was a huge, huge game.”
Not until decades later did these and other lapses lead Herman into the midst of research on — and debate about — a degenerative neurologic disease called chronic traumatic encephalopathy.
For years Herman thought the game-related episodes of amnesia were benign, just his “normal.” But as he got older he began to develop problems with his short-term memory. His wife, Roma, started noticing how, during dinner with friends, he’d often repeat questions they’d answered before.
Roma thought he might be developing Alzheimer’s disease, and eventually she and Dave went to Mount Sinai Medical Center hoping to get him enrolled in a clinical trial testing therapies for the disease.
But when a panel of doctors at the center evaluated Herman, they couldn’t agree on the diagnosis. Two brain injury experts thought that Herman’s innumerable hard hits to the head might have sparked CTE.
“Five experts who focus on memory disorders couldn’t agree on whether it was Alzheimer’s,” says Dr. Sam Gandy, a professor of neurology and psychiatry and director of the Center for Cognitive Health and NFL Neurological Care at the Mount Sinai Medical Center.
Gandy figured that one way to differentiate between the diseases was to scan Herman for the presence of beta-amyloid, the sticky protein that gunks up the brains of Alzheimer’s patients. While the brains of some players found to have CTE have spots of beta-amyloid, many have no trace of it. Their symptoms are caused by the accumulation of another protein, called tau.
A PET scan showed no signs of beta-amyloid, which meant that Herman didn’t have Alzheimer’s.
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To confirm the CTE diagnosis, Gandy did one more scan, this time using a radiotracer that would home in on tangles of tau. Sure enough, Herman’s brain had plenty of the abnormal protein and much of it was in an area crucial for short-term memory.
Gandy’s findings were published last month in Translational Psychiatry, making Herman the sixth living player to be diagnosed with CTE via brain scan. Five other players were scanned by researchers from the University of California, Los Angeles, in 2013 using a different radiotracer.
Up until the UCLA study, CTE had only been diagnosed by autopsy.
But ever since CTE became an issue with football players, scientists have wanted a way to diagnose the condition while the athletes are still alive. One of the biggest issues that could be resolved by such research is what percentage of concussed players end up with permanent brain damage.
Thus far, Boston University’s Center for the Study of Chronic Traumatic Encephalopathy has found evidence of CTE in brain tissue from 76 of the 79 deceased former NFL players the center’s researchers have examined. But most of the brains autopsied up to this point have come from players who had pronounced symptoms of the disease before their deaths. So, there’s no telling how often concussions turn into permanent brain damage.
While calling the new study interesting, experts underscored the fact that it presented just one case of CTE.
“I do think it is a fair first step,” says Luke Henry, a clinical instructor at the Sports Concussion Program at the University of Pittsburgh Medical Center. “If you’ve got one case of CTE, it’s dangerous to stretch those findings.”
Part of the problem is that the diagnosis itself hasn’t been completely hashed out among brain experts, says Dr. Paul B. Rosenberg, an associate professor of psychiatry and behavioral sciences and associate director of the Memory and Alzheimer’s Treatment Center at the Johns Hopkins School of Medicine.
“We suspect there is something called CTE, but the media, the NFL and popular opinion has sort of settled on the idea that there must be something called CTE,” Rosenberg says. “While it looks like there are people with a lot of concussions who have brain damage, it’s hard to prove that there is really a new disease here — but this paper pushes it in that direction.”
The idea that multiple concussions in football could lead to permanent brain damage has gained real traction only in the last decade or so. In the past few years, the National Football League has adopted new rules aimed at preventing helmet-first contact.
But back when Herman was playing in the ’60 and ‘70s, nobody was worried about long-term fallout from concussions. They were thought to be just a normal part of the game, especially for players like Herman whose style was to launch himself head first, like a missile, into his opponents. Herman has no idea how many times he was concussed. “They didn’t talk about it as a concussion,” he says. “You just got your bell rung.”
Still, it’s not like the amnesia was the only symptom he experienced in his playing days.
"If I knew back then what the implications were, I’m not sure I would have played 10 years, or if I would have played at all. "
“I know I used to drive back and forth to practice and some days I’d have to go very slow because I wasn’t thinking as fast,” he remembers.
But Herman, like many others, thought those symptoms would pass. These days, Herman thinks a lot about how he played the game back when no one knew anything about concussions and long-term brain damage.
“I’m not angry about it,” he says. “But if I knew back then what the implications were, I’m not sure I would have played 10 years, or if I would have played at all. Especially since back in those days you didn’t make enough money off of football to live through the entire year. You needed an offseason job.”
After a moment of reflection, Herman adds, “I would have wanted to play. But I’d have known full well that I couldn’t go in and bang heads, but would have used my shoulders instead.”
These days Dave and Roma work around his deficits by creating a schedule for him that is very repetitive. “Having a strict routine is very helpful,” Roma says. “I work full time. And he calls me whenever he’s going to do something. I tell him if I don’t think it’s a good idea. And I write things down that I want him to do.”
So far, the memory problems are Dave's main issue. He doesn't seem to have developed any of the personality changes that have plagued some former NFL players. And it helps that he's got some insight into his situation. “I do have a sense of my limitations,” he says. “There are certain things I do and most things I don’t do. The things I do are repetitive. I do our shopping at the same store every time. When I buy gas I get it at the same gas station every time.”
Linda Carroll is a regular contributor to NBCNews.com and TODAY.com. She is co-author of "The Concussion Crisis: Anatomy of a Silent Epidemic” and the recently published “Duel for the Crown: Affirmed, Alydar, and Racing’s Greatest Rivalry.”