Study finds CTE in 31 former rugby league players

CTE has been diagnosed in 31 former rugby league players whose brains were examined after death, including players in their 20s, 30s and 40s.

Chronic traumatic encephalopathy, a degenerative brain disease, can only be diagnosed after death. Its sole cause is repetitive impacts to the head and body.

Those diagnosed included former rugby league player and NRL coach Paul Green, who died aged 49, and Manly Sea Eagles player Keith Titmuss, who died aged 20.

Paul Green’s widow, Amanda Green, has called for collision sports to do more to protect the next generation of players and appealed for more people to donate their brains for research.

“Now that we know what we do about this disease I feel a massive responsibility, as we all should, to protect the brain health of the next generation of young athletes,” she said.

“I owe it to my kids and their sports-loving mates.

“We need to ensure they don’t make the same mistakes as our generation did. The key here is to pledge our brains and support the incredible and potentially lifesaving work of the Australian Sports Brain Bank.”

Green said she had “no idea” what CTE was until after her husband died.

“I had been involved in the highest level of professional sport in this country and did not understand this disease we now know as CTE,” she said.

“That was not OK. I didn’t know what CTE was, and since Paul’s diagnosis, I have constantly called for more education on the issue.

“People needed to understand this disease so no-one else suffered in silence.”

The statistics are based on the first 150 brain examinations of people who played contact sports completed at the Australian Sports Brain Bank.

Of 51 donated brains from people who had played rugby league at levels ranging from amateur to professional, 31 were found to have CTE.

Molecular biologist and data scientist Jennifer Cropley presented the findings at the International Sports Concussion Conference in Melbourne on Tuesday.

Symptoms of CTE can include memory loss, impulsivity, anxiety and anger.

The disease has been identified in several athletes who died by suicide, although experts say more research is needed to establish whether there is a causal relationship.

Paul Green died by suicide in 2022.

Amanda Green said she later recognised changes in her husband that she believed were signs of CTE.

“On receiving Paul’s diagnosis from [sports brain bank director] Professor Michael Buckland, he had mentioned that Paul had one of the most severe cases of CTE that he had seen, but due to Paul’s intelligence, there was a possibility that he had masked a number of his symptoms, but the symptoms I had seen were symptoms such as anxiety, impatience, he was impulsive in his decision-making, he definitely had lower levels of tolerance and quite elevated emotions,” she said.

“These were changes that I had seen over time that I put down to the stress of his job.”

Swinburne University professor Alan Pearce, an author of the research, said more needed to be done to protect players.

“Given rugby league is a collision-based sport, it is not surprising that we found over 60 per cent of rugby league donors had CTE, but this tells us we need to start implementing modifications,” he said.

“Introducing contact limits in rugby league is a good start, but rugby league and all contact and collision-based sports must also start modifying to non-contact versions for children to the age of 14 years of age.

“Keith Titmuss’s result, having stage two CTE at 20, tells us that this is not an old person’s disease.

“Keith passed in 2020, and his brain results typify that exposure risk for CTE starts at junior sport level.

“Keith played junior rugby league from the age of five years old, then schoolboy rugby union, and his brain results show the effect of that.”

Titmuss played as a schoolboy at Newington College in Sydney and had substantial exposure to repeated head impacts during around 15 years of junior contact sport.

He died from exertional heat stroke after a Manly Sea Eagles training session in 2020.

His CTE diagnosis was revealed in 2024 and prompted warnings that major football codes were not doing enough to protect young athletes. His parents, Lafo and Paul, donated his brain for research.