Until a few years ago, NFL players who struggled with severe
depression, bouts of rage and memory loss in their retirement were often
told they were just having a hard time adjusting to life away from the
game. Doctors have since learned these changes can be symptoms of the
degenerative brain disease CTE -- chronic traumatic encephalopathy,
caused by blows to the head. What we're learning now is that CTE
isn't just affecting athletes, but also showing up in our nation's
heroes. Since 9/11 over 300,000 soldiers have returned home with brain
injuries. Researchers fear the impact of CTE could cripple a generation
of warriors. When Joy Kieffer buried her 34-year old son this past summer, it was the end of a long goodbye. Kieffer's
son, Sgt. Kevin Ash, enlisted in the Army Reserves at the age of 18.
Over three deployments, he was exposed to 12 combat blasts, many of them
roadside bombs. He returned home in 2012 a different man. Joy Kieffer: His whole personality had changed. I thought it was
exposure to all of the things that he had seen, and he had just become
harder. You know, but he was -- he was not happy. Sharyn Alfonsi:
So at this point, you're thinking this decline, this change in my child
is just that he's been in war and he's seen too much. Joy Kieffer: Right. Sharyn Alfonsi: Did he tell you about blasts that he experienced during that time? Joy Kieffer: Uh-huh. Sharyn Alfonsi: What did he--tell you? Joy Kieffer: That they shook him. And he was having blackouts. And -- it frightened him. Ash
withdrew from family and friends. He was angry. Depressed. Doctors
prescribed therapy and medication, but his health began to decline
quickly. By his 34th birthday, Sgt. Kevin Ash was unable to speak, walk
or eat on his own. Sharyn Alfonsi: Looking back on it now, was there anything you feel like he could've done? Joy Kieffer: Uh-uh. Sharyn Alfonsi: Because? Joy
Kieffer: Because it was-- it-- it was his brain. The thing I didn't
know was that his brain was continuing to die. I mean, before he went
into the service he said, "you know, I could come back with no legs, or
no arms, or even blind, or I could be shot, I could die," but nobody
ever said that he could lose his mind one day at a time. His final wish was to serve his country one last time by donating his brain to science -- a gesture he thought would bring better understanding to the invisible wounds of war. Joy reached out to the VA-Boston University-Concussion Legacy Foundation Brain Bank where neuropathologist Dr. Ann McKee is leading the charge in researching head trauma and the degenerative brain disease CTE. McKee
has spent fourteen years looking at the postmortem brains of hundreds
of athletes who suffered concussions while playing their sport. This past summer, her findings shook the football world when she
discovered CTE in the brains of 110 out of 111 deceased NFL players --
raising serious concerns for those in the game today. And when Dr.
McKee autopsied Patriots tight-end Aaron Hernandez who killed himself
after being convicted of murder, she found the most severe case of CTE
ever, in someone under 30. Now she's seeing a similar pattern in
deceased veterans who experienced a different kind of head trauma --
combat blasts. Of the 102 veterans' brains Dr. Mckee's examined, 66 had
CTE. Sharyn Alfonsi: I can understand a football player who keeps,
you know, hitting his head, and having impact and concussions. But how
is it that a combat veteran, who maybe just experienced a blast, has the
same type of injury? Dr. Ann McKee: This blast injury causes a
tremendous sort of-- ricochet or-- or-- a whiplash injury to the brain
inside the skull and that's what gives rise to the same changes that we
see in football players, as in military veterans.
"This is a
disease and a problem that we're going to be dealing with for decades.
And it's a huge public health problem. It's a huge problem for the
Veterans Administration. It's a huge moral responsibility for all of
us."
Blast trauma was first recognized back in World War I. Known
as 'shell shock,' poorly protected soldiers often died immediately or
went on to suffer physical and psychological symptoms. Today,
sophisticated armor allows more soldiers to walk away from an explosion
but exposure can still damage the brain -- an injury that can worsen
over time. Dr. Ann McKee: It's not a new injury. But what's been
really stumping us, I think, as-- as physicians is it's not easily
detectable, right? It's-- you've got a lot of psychiatric symptoms-- and
you can't see it very well on images of the brain and so it didn't
occur to us. And I think that's been the gap, really, that this has been
what everyone calls an invisible injury. Dr. Ann McKee: This is the world's largest CTE brain bank. The only foolproof way to diagnose CTE is by testing a post-mortem brain. Sharyn Alfonsi: So these are full of hundreds of brains... Dr. Ann McKee: Hundreds of brains, thousands really... Researchers
carefully dissect sections of the brain where they look for changes in
the folds of the frontal lobes - an area responsible for memory,
judgement, emotions, impulse control and personality.Dr. Ann McKee: Do you see there's a tiny little hole there? That is an abnormality. And it's a clear abnormality. Sharyn Alfonsi: And what would that affect? Dr.
Ann McKee: Well, it's part of the memory circuit. You can see that
clear hole there that shouldn't be there. It's connecting the important
memory regions of the brain with other regions. So that is a sign of
CTE. Thin slivers of the affected areas are then stained and
viewed microscopically. It's in these final stages where a diagnosis
becomes clear as in the case of Sgt. Kevin Ash. Sharyn Alfonsi: So this is Sergeant Ash's brain? Dr.
Ann McKee: Right. This is-- four sections of his brain. And what you
can see is-- these lesions. The, and those lesions are CTE And they're
in very characteristic parts of the brain. They're at the bottom of the
crevice. That's a unique feature of CTE.Sharyn Alfonsi: And in a healthy brain, you wouldn't see any of those kind of brown spots? Dr.
Ann McKee: No, no, it would be completely clear. And then when you look
microscopically, you can see that the tau, which is staining brown and
is inside nerve cells is surrounding these little vessels. Sharyn Alfonsi: And explain, what is the tau? Dr.
Ann McKee: So tau is a protein that's normally in the nerve cell. It
helps with structure and after trauma, it starts clumping up as a toxin
inside the nerve cell. And over time, and even years, gradually that
nerve cell dies. Dr. Lee Goldstein has been building on Dr. McKee's work with testing on mice. Inside
his Boston University lab, Dr. Goldstein built a 27-foot blast tube
where a mouse - and in this demonstration, a model - is exposed to an
explosion equivalent to the IEDs used in Iraq and Afghanistan. Dr. Lee Goldstein: When it reaches about 25 this thing is going to go. Dr.
Goldstein's model shows what's going on inside the brain during a
blast. The brightly colored waves illustrate stress on the soft tissues
of the brain as it ricochets back and forth within the skull. Dr.
Lee Goldstein: What we see after these blast exposures, the animals
actually look fine. Which is shocking to us. So they come out of what is
a near lethal blast exposure, just like our military service men and
women do. And they appear to be fine. But what we know is that that
brain is not the same after that exposure as it was microseconds before.
And if there is a subsequent exposure, that change will be accelerated.
And ultimately, this triggers a neurodegenerative disease. And, in
fact, we can see that really after even one of these exposures. Sharyn
Alfonsi: The Department of Defense estimates hundreds of thousands of
soldiers have experienced a blast like this. What does that tell you? Dr.
Lee Goldstein: This is a disease and a problem that we're going to be
dealing with for decades. And it's a huge public health problem. It's a
huge problem for the Veterans Administration. It's a huge moral
responsibility for all of us. A responsibility owed to soldiers like 33-year-old Sgt. Tom Bates. Sgt. Tom Bates: We were struck with a large IED. It was a total devastation strike.Bates miraculously walked away from a mangled humvee -- one of four
IED blasts he survived during deployments in Iraq and Afghanistan. Sharyn Alfonsi: Do you remember feeling the impact in your body? Sgt. Tom Bates: Yes. Yeah. Sharyn Alfonsi: What does that feel like? Sgt. Tom Bates: Just basically like getting hit by a train. Sharyn Alfonsi: And you were put back on the frontlines. Sgt. Tom Bates: Yes. Sharyn Alfonsi: And that was it? Sgt. Tom Bates: Uh-huh When Bates returned home in 2009, his wife Libby immediately saw a dramatic change.Libby Bates: I thought, "Something is not absolutely right here.
Something's going on. For him to just lay there and to sob and be so
sad. You know, what do you do for that? How do I-- how do I help him?
He would look at me and say, "If it wasn't for you, I would end it all
right now." You know, I mean, like, what do you-- what do you do-- and
what do you say to somebody who says that? You know I love this man so
much. And -- Sharyn Alfonsi: You're going to the VA, you're getting help, but did you feel like you weren't getting answers? Sgt. Tom Bates: Yes. Sharyn Alfonsi: And so you took it into your own hands and started researching? Sgt.
Tom Bates: I knew the way everything had gone and how quick a lot of
my neurological issues had progressed that something was wrong. And I
just-- I wanted answers for it. That led him to New York's Mount Sinai Hospital
where neurologist Dr. Sam Gandy is trying to move beyond diagnosing CTE
only in the dead by using scans that test for the disease in the
living. Dr. Sam Gandy: By having this during life, this now gives
us for the first time the possibility of estimating the true prevalence
of the disease. It's important to estimate prevalence so that people can
have some sense of what the risk is. In the past year, 36 veterans and athletes have been tested for the disease here. Tom Bates asked to be a part of it. That
radioactive tracer - known as t807 - clings to those dead clusters of
protein known as tau, which are typical markers of the disease. Through
the course of a 20 minute PET scan, high resolution images are taken of
the brain and then combined with MRI results to get a 360 degree
picture of whether there are potential signs of CTE. Scan results confirmed what Tom and Libby had long suspected. On
the right, we see a normal brain scan with no signs of CTE next to
Tom's brain where tau deposits, possible markers of CTE, are bright
orange.Dr. Sam Gandy: Here these could be responsible for some of the
anxiety and depression he's suffered and we're concerned it will
progress. Sgt. Tom Bates: My hope is that this study becomes more
prominent, and gets to more veterans, and stuff like that so we can
actually get, like, a reflection of what population might actually have
this. There is no cure for CTE. Dr. Gandy hopes his trial will lead to drug therapies so he can offer some relief to patients like Tom. Dr. Ann McKee believes some people may be at higher risk of getting the disease than others. While
examining NFL star Aaron Hernandez's brain she identified a genetic
bio-marker she believes may have predisposed him to CTE. A discovery that could have far-reaching implications on the football field and battlefield. Sharyn Alfonsi: Do you think you will ever be your old self again? Sgt. Tom Bates: I don't ever see me being my old self again. I think it's just too far gone. Sharyn Alfonsi: So what's your hope then? Sgt. Tom Bates: Just to not become worse than I am now. Produced by Ashley Velie. Associate producer, Dina Zingaro. For families who wish to donate a brain for research please contact the CTE Center/Brain Bank Directly: Bobbie Abdolmohammadi - 617-414-1184 Laney Evers - 617-414-1187 To sign up to pledge to donate your brain to Dr. Ann McKee's research, please visit https://concussionfoundation.org/pledge
Editor's Note: Since this story aired, we have received many
inquiries about how to contact Dr. Daniel Perl and The Center for
Neuroscience and Regenerative Medicine. Here is that information: http://www.researchbraininjury.org or 1-855-366-8824.A new medical discovery has profound implications for wounded warriors.
It's a previously unknown type of brain injury uncovered in veterans
who are exposed to the invisible wave of energy that erupts from high
explosives. The evidence was found in the brains of veterans who died.
And tonight, we have a rare opportunity to introduce you to one of the
vets who made the discovery possible. Retired Army Sergeant First Class
Brian Mancini killed himself in 2017 after descending into psychosis.
But we met Mancini years before, in 2011, after he made a nearly
miraculous recovery from the impact of a roadside bomb in Iraq. There's
no one better to begin this story, than the late Brian Mancini himself.
Brian Mancini in 2011
CBS News
Brian
Mancini: I got hit in the face. I knew pretty early that I had lost my
eye. I didn't know how severe my injuries were, but I knew I was hurt
very bad. We met Brian Mancini six years before his suicide. We
had followed a group of wounded vets back to Iraq on a therapy program,
endorsed by the Pentagon, designed to help them come to terms with the
day they were wounded and leave that day behind. Brian Mancini:
You know, we often hear about guys that carry these heartaches their
whole lives. And it slowly erodes them. I don't want to be that guy, you
know? I want to be able to have a successful life and not burdened with
the demons that I see here. Brian Mancini: I'm glad I'm alive. On that return trip to Iraq, Mancini visited the field hospital that saved him. Brian Mancini: My whole face has been rebuilt. I used to look like Brad Pitt but this is what I got stuck with. Brian
Mancini: I have a titanium mesh plate in my forehead. They rebuilt my
whole orbital socket. My sinuses were replaced or rebuilt. Scott Pelley: How many surgeries did that come to? Brian Mancini: I have no idea. I have no idea.
"Brian would often say, 'I don't know if this is real... or if I dreamt it.'"
Years of surgeries, pain and struggle were witnessed by Brian Mancini's brother and sister, Michael and Nichole. Michael Mancini: Oh, he was a patriot. He loved this country. He loved this country. Nichole
Mancini: He was a natural leader, and I think that the military was a
natural fit for him. And he was good at his job, and he loved it. After his recovery, he created a new job for himself. At home in Phoenix, he founded "Honor House" to provide wounded vets with therapies that helped him—including yoga, acupuncture, and especially fly-fishing. Brian Mancini: He came leaps and bounds. And Brian two years ago was the best Brian I've ever known in my life. But
as he reached his peak in 2015, Mancini suddenly began to suffer
delusions. He imagined the government was spying on him, that members of
the Honor House board were with the CIA. And he thought he was being
tracked with cell phones. Michael Mancini: It was delusional, it was irrational, it was like, a progression. Nichole Mancini: He wouldn't let us have our cell phones around him. Michael Mancini: Very paranoid. Nichole Mancini: His mind had started to almost turn against him. And people that— Scott Pelley: His mind had turned against him? Nichole Mancini: Yeah. Brian would often say, "I don't know if this is real or if I had if I dreamt it." The
Honor House board took control of the charity from Mancini. He had been
depressed before, but not insane. Last year, Mancini donated his life
savings to his church, drove to this remote canal, and shot himself in
the head. The betrayal of his mind had been so sudden, so shocking, that
his family was certain there must be a cause that no one understood. Michael Mancini: And the first initial thought to me was, "I need to find someone who would take my brother's brain tissue for further study and further research."
The Mancini's found neuropathologist Dr. Daniel Perl.
Correspondent Scott Pelley with Dr. Daniel Perl
CBS News
Perl oversees the brain tissue repository at the Uniformed Services University of the Health Sciences,
the military medical school in Bethesda, Maryland. Perl also wondered
whether some torments of war might be rooted in an undiscovered kind of
brain injury caused by the supersonic pressure wave of high explosives. Dr.
Daniel Perl: That started in World War I and we had the whole issue of
shell shock. And then in World War II, we had battle fatigue. Then in
Korea, we had PTSD. I mean, these were all expressions of responses to
being in warfare, much of it being exposed to blast. And we knew nothing
about what was going on in the brain. Perl's team sliced brain tissue from eight veterans and examined the tissue under a microscope. Rare for its power. Scott Pelley: That doesn't look like the one I had in high school. Dr. Daniel Perl: No, it's not. Perl
says his microscope is thousands of times more powerful than the best
MRI. And it helped them discover this previously unknown form of brain
injury when Perl compared the brains of the vets to civilians who had
injured their brains in car wrecks. Dr. Daniel Perl: The difference is just so dramatic. Scott Pelley: These on the left are people who suffered-- Dr. Daniel Perl: A single individual's brain who suffered an automobile accident. A single individual who was exposed to blast.Stained identically for scarring. Scott
Pelley: The brown--area is the stain that reveals the scarring and you
don't see it in the person who hit their head in the automobile
accident. Dr. Daniel Perl: That's right. Dr. Daniel Perl:
When an IED goes off there's a tremendous explosion. And with the
explosion comes the formation of something called the blast wave. And it
is sufficiently powerful to pass through the skull and through the
brain. And when it does that-- it does damage the brain tissue. Scott Pelley: Do you have a slide of Brian Mancini's brain? Dr. Daniel Perl: Yes, we do. The
dark brown is scarring, running along lines where two types of brain
tissue meet, the so-called gray matter and white matter. Dr.
Daniel Perl: The locations were areas of the brain that had differing
densities. This was the interface between gray matter and white matter,
between brain and fluid, such as spinal fluid, or brain and blood. Scott Pelley: Why do you see the scarring where the white matter and the gray matter come together? Dr.
Daniel Perl: The white matter have a somewhat higher density than the
gray matter. And that's where the energy of the blast wave is released. Scott Pelley: They bang together. Dr. Daniel Perl: In a sense, yeah. Scott Pelley: Do you see the scarring at these interfaces throughout the entire brain? Dr. Daniel Perl: We're looking at that now, okay? By and large, yes. Evidence of this scarring was found in all of the veterans - none of the civilians. Scott Pelley: Do you believe that you're going to find a connection between this and post-traumatic stress disorder?
Dr.
Daniel Perl: In a sense, we already have. Every case that we've looked
at has been diagnosed with PTSD And what that connection is, the nature
of that connection, whether the scarring in the brain leads one to be
more apt to develop PTSD, or whether there's so much overlap between the
symptoms that one gets with the damage in the brain that it looks like
PTSD, we don't know yet.
Earlier this season we reported
on research by another laboratory into vets who showed evidence of
"CTE" the kind of brain injury found in football players. Dr. Perl says
his team has discovered something distinct from CTE. Dr. Daniel
Perl: Very different, okay? One is a huge blast wave that almost
destroys his face, passes through his brain. It's a one-time thing. OK?
It's not the sorta daily and weekly impact injury that an NFL player
has. The other thing is that our service members are coming home from
deployment symptomatic. By and large, CTE in the football player, for
instance, occurs in their retirement, after they've played. Scott Pelley: Years later? Dr. Daniel Perl: Years later, right. They become symptomatic. So the timing of it seemed to be a very different proposition. Scott Pelley: But it's absolutely clear to you that Brian Mancini did not have CTE? Dr. Daniel Perl: That's right. We looked very carefully for CTE in Brian's brain. And he just did not have it. Scott Pelley: So what you and your colleagues have discovered is something new? Dr. Daniel Perl: Yes. Yes. This is new. This, this has changed thinking about blast exposure and its consequences.
We
were able to add something to Dr. Perl's research that he rarely sees, a
description of the blast that wounded one of his deceased subjects.
Brian
Mancini: Most of my forehead was blasted out, I had a basal skull
fracture along with some fractured vertebrae in my back and some burns
and shrapnel. When I was doing the assessment of my injuries, I remember
laying down and opening my mouth as wide as possible and reaching in
and scraping the debris that had been knocked loose, and the blood, from
my airway so I could breathe. And shortly after that, I lost
consciousness. Dr. Daniel Perl: It's just stunning to see
this it's not something I normally get to experience. I mean that he
survived this injury is just remarkable, much less what happened
afterwards. Now that the discovery is known, Perl hopes research
can begin into improving the lives of those who suffer with this hidden
wound of war. Scott Pelley: What's your theory today on how this damage manifests itself in a living human being? Dr.
Daniel Perl: Well, obviously wherever there is damage, there must be
some loss of function. Persistent headaches. They have problems with
sleep. They have problems concentrating, memory problems swings of mood,
anger management problems. The discovery is a lone fact that
raises many questions; can the scarring ever be seen in a living
patient? How do the scars affect the mind? And what can be done? Scott Pelley: If Brian Mancini had come to you in the last year of his life, would you have been able to do anything for him? Dr.
Daniel Perl: No, I don't think so. I don't think so. We're not there
yet. We have a lotta people now beginning to take it seriously and begin
work on it. It's not just us in our lab. It's really been a game
changer in terms of our approach to this problem. Dr.
Perl is now searching for preserved brains of World War I veterans to
see if the scarring dates to the beginning of widespread use of high
explosives in war. Brian Mancini's life was devoted to wounded
warriors—first as an Army medic, then in rehabilitation. And now, even
in death, his work to heal continues. Scott Pelley: And this is what Brian would've wanted? Michael Mancini: Oh, absolutely. Nichole Mancini: Without a doubt. Scott Pelley: Brian is still serving his country. Michael Mancini: Amen. Brian
Mancini: I wouldn't trade any of these horrendous and horrific
experiences for anything there's a lesson in everything that we endure
in life, And if we can clear all the chaos away and all the heartache
away, we can receive that lesson "Why was I here? What was this for?
Why did this happen?" And kind of get some of those answers. And I think
that helps in healing long-term. Produced by Henry Schuster. Associate Producer, Rachael Morehouse.
Brian Mancini: Most of my forehead was blasted out, I had a basal skull fracture along with some fractured vertebrae in my back and some burns and shrapnel. When I was doing the assessment of my injuries, I remember laying down and opening my mouth as wide as possible and reaching in and scraping the debris that had been knocked loose, and the blood, from my airway so I could breathe. And shortly after that, I lost consciousness.
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