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Abstract

Background:

Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disease associated with repetitive head trauma and has been increasingly identified in former contact sport athletes, particularly American football players. Although the relationship between repetitive head impacts and CTE has been well documented, the role of career duration as a measurable exposure variable remains an important area of investigation. Understanding this relationship may provide clinically useful insight for primary care physicians responsible for longitudinal monitoring of individuals with extensive athletic exposure.

Methods:

This literature review examined published studies evaluating the relationship between football career duration, cumulative head impact exposure, and neuropathologic severity of CTE. Relevant peer-reviewed articles were identified and analyzed to assess trends in career length among athletes diagnosed with CTE and to evaluate how exposure metrics such as duration of play and cumulative head impact indices relate to disease severity.

Results:

Across the studies reviewed, a consistent association was observed between longer playing careers and increased neuropathologic severity of CTE. Players with severe CTE (stages 3–4) demonstrated longer average career durations, approximately 15.5 years, compared to those with mild disease (stages 1–2), who averaged closer to 12 years of play. The overall average career duration among players diagnosed with CTE across the included studies was approximately 12.86 years. Findings also highlighted the importance of cumulative sub-concussive impacts and exposure burden beyond reported concussion counts.

Conclusion:

Career duration represents a practical proxy for cumulative exposure to repetitive head trauma and may serve as a clinically useful risk stratification tool analogous to “pack-years” in smoking history. Within an integrated primary care framework, primary care physicians are uniquely positioned to identify patients with significant exposure histories, initiate early cognitive and behavioral screening, and coordinate multidisciplinary care involving neurology, psychiatry, and rehabilitation services. Incorporating exposure-based risk assessment into routine clinical history taking may improve early recognition of neurodegenerative risk and support long-term monitoring of athletes with a history of repetitive head impacts.

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