It’s on the tip of his tongue. “Um, shit.” He rubs his hands together, trying to find it. “Getting all the, um, what do I want to call it? Not vitamin E. Not vitamin E, but for my brain—” He rubs his hands together again. He gets up and walks to the kitchen. “See, that’s what it is,” he says over his shoulder. “That’s what it does to you. Makes you forget. Can’t remember from two seconds ago.” He opens a cabinet near the refrigerator, under the sign that says “When the queen is happy there is peace in the kingdom.” “DHA. DHA. That’s for my brain. Fish oil. A lot of that fish oil, man. A lot of nuts. A lot of natural stuff. It helps with getting the brain back.”
Dorsett’s plan of attack on his symptoms so far, mostly of his own design, has been natural. Herbs and vitamins, even seasonings on his food.
“I’m a real stickler about medicines, and what I put into my body,” he says. “Some people might not think so, because I might drink every now and then”—he laughs—“but the thing is, when it comes to medicine, man, I’m really careful. Because my liver and kidneys and all that, I don’t want them to start malfunctioning, because of taking too much of some type of medicine, and that could very easily happen.”
There is no formal treatment for CTE at the moment, because there is no formal clinical diagnosis, says Dr. Munro Cullum, director of neuropsychology at UT Southwestern Medical Center. He’s not one of Dorsett’s doctors, but he did collaborate with researchers from the UT Dallas Center for BrainHealth on a study released in 2013 examining the neuropsychological status and brain imaging of 34 former NFL players, including former Cowboys fullback Daryl Johnston. “It does not appear in any diagnostic manual,” Cullum says. “It is not a billable code to insurance.”
Cullum says a variant of CTE was first discovered in the 1920s in boxers; it was named dementia pugilistica or, more simply, punch-drunk syndrome. CTE refers, more or less, to the same phenomenon: a pathological brain state thought to be due to repetitive brain trauma. Its symptoms include cognitive impairment and changes in mood and behavior. A patient with CTE has an accumulation of the protein tau in a particular pattern. Doctors have found this pattern in the autopsied brains of Seau, Duerson, and more than 50 other former NFL players. Tau is also found in the brains of patients with Alzheimer’s disease.
That’s what researchers know for sure about CTE. They don’t know when tau builds up, or if it continues to accumulate past a certain point. They don’t know if the buildup can be reversed. They don’t even know, with absolute certainty, what causes CTE—if anyone with a history of concussions will eventually get it or if some people are genetically predisposed to it. There was only one thing Cullum and his fellow researchers learned for sure during their study of former NFL players.
“I have talked to many of them, and I have never met anyone so far that has said they wouldn’t do it over again,” he says. “I have not met a one. Even guys that retired young, after a concussion, they still—to a man—say I would do the same thing over again.”
Cullum calls the findings in the UCLA study Dorsett participated in “encouraging, but they are extremely preliminary.” In his own study, he found the rate of dementia in former players was “no greater than you’d expect in a sample of people over the age of 60,” but the “incidence of depression and mild cognitive impairment was higher than you’d see in the general population.”
“We really need to get large-scale studies of these guys,” he says. “We’ve got to get college players involved. We’ve got to get detailed histories of concussions, and then do imaging and follow them over time, see what happens.”
Cullum is careful with his words when talking about Dorsett, as he would be with anyone who had received the diagnosis the UCLA doctors gave him. He is a researcher in the field, so his words carry extra weight. There is too much unknown at this point to use them lightly.
So maybe medical science is unprepared to say that Dorsett has CTE. Maybe doctors won’t know for sure until they have his brain under a microscope. But do you want to tell him he doesn’t have it, or that two decades on a football field didn’t cause it? That no one knows why he started yelling at his daughter out of the blue, or why he can’t remember on a Wednesday that the Cowboys played the Chicago Bears on a Monday? Do you need to? Maybe if you’re handling his insurance claims. Maybe if you want to believe that a sport as violent as football doesn’t exact a cost.
Otherwise, what does it matter? The UCLA diagnosis gave Tony Dorsett something that doesn’t come as easy to him as it used to: an answer.