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Photo on the left shows abundant tau tangles (dark brown dots) in the cerebral cortex in a pattern unique to chronic traumatic encephalopathy (CTE). A higher magnification image on right shows a closer view of the tangles in nerve cells. ((Center for the Study of Traumatic Encephalopathy) )

A now deceased NHL player had a brain condition linked to concussions — the first time a professional hockey player has been diagnosed with the disease.

Reggie Fleming played 13 crushing seasons as a defenceman and forward during the 1960s and 1970s. Fleming was one of the National Hockey League's hardest hitters in the days before helmets.

After Fleming died on July 11 at the age of 73, he became the first NHL player to have his brain examined by the Sports Legacy Institute, which is studying the long-term impact of concussions.

"We discovered that Mr. Fleming was suffering from chronic traumatic encephalopathy when he died," said Chris Nowinski, co-director of the institute in Boston. "It's a progressive degenerative disease." 

Chronic traumatic encephalopathy

CTE is characterized by a build-up of a toxic protein called tau — the same abnormal protein found in Alzheimer's disease. At first, the abnormal protein impairs normal brain function and eventually kills brain cells.

The symptoms — memory impairment, emotional instability, erratic behaviour, depression and problems with impulse control and eventually dementia — are similar to Alzheimer's, which is why athletes may be misdiagnosed. But the proteins are distributed in different parts of the brain.

CTE is caused by repetitive concussive or subconcussive blows to the head, but the symptoms of the disease might not appear for years or decades after the head trauma.

Source: Center for the Study of Traumatic Encephalopathy at Boston University School of Medicine

Chronic Traumatic Encephalopathy, or CTE, is commonly referred to as being punch drunk. The condition is well documented in boxing and football, where even young athletes who have taken repeated blows to the head can show signs of mental impairment usually seen in much older people. It can only be diagnosed after death when pathologists examine the brain.

"Today's news is rather revolutionary," said Dr. Charles Tator of the Krembil Neuroscience Centre in Toronto. It's "the first proven case that this can occur in a hockey player. So, it's like a watershed."

While players' heads are now better protected, the hits are harder, said former NHLer Keith Primeau, who became a staunch advocate of rule changes after a concussion ended his career three years ago.

"I think this will have an impact," said Primeau. "Those that suggest this isn't relevant aren't understanding the facts."

The NHL won't comment on Fleming until it has a chance to review the institute's report. The league plans to review its rules in March. Primeau said he's pleased that the NHL plans to tackle the issue, and he recognizes the game can't be changed overnight.

Nowinski said he hopes the findings will be included in the NHL's discussions to make the game safer.

Tator also wants to see tougher rules to reduce the battering on players' brains, including young ones.

"We have to be much more vigilant about repeated blows to the head," Tator said. "We have to get hits to the head out of hockey."

Helmets alone won't necessarily prevent concussions, since the injury is caused by the brain going back and forth inside the skull, said Todd Jackson, a spokesperson for Hockey Canada.

"What we can do to prevent is educate our players on playing safe and educate on no head checking and no hitting from behind," he said.