In the middle of last hockey season, researchers at Boston University School of Medicine made a disturbing discovery: That former NHL player Reggie Fleming, who died the previous July at 73, had developed chronic traumatic encephalopathy - a neurodegenerative disease known to cause cognitive decline, behavioural abnormalities and, ultimately, dementia.
The case of Fleming, who endured multiple concussions during his career, marked the first time a hockey player had been diagnosed with CTE. However, speaking at the World Hockey Summit on Tuesday, Dr. Mark Aubry sounded a note of caution when he was asked how much parents should worry about their concussed children developing CTE in the light of those findings.
"I don't think we have enough research that we can honestly link one to the other," Aubry said. "We have had isolated cases of CTE. The problem is, that may have developed regardless of whether they had concussions in sport. It may be related to aging of the brain or other factors that may not necessarily be raised.
"All we can say is, we can't all of a sudden, go from saying, '[a]concussion gives you CTE.' It's much more complicated than that."
Aubry was one of two physicians speaking at Tuesday's session on player development and said the attention paid to concussions and their fallout in the aftermath of the Fleming diagnosis was a good thing because: "It's made us sit up, stand up and look at those and say, 'Okay, what are we doing? What happens? When is the number of concussions too many to allow that young player to return to play?'
"We talk about concussions all the time. It's not as if there weren't concussions before, but our ability to recognize concussions is a lot better," he said. "Now, we're starting to see the consequences of what we did to treat them. We sent [players]back in perhaps too soon. We didn't recognize it. We didn't pay attention to it. We didn't have the steps that we now have towards proper return to play."
However, Aubry also added it is too soon to read anything definitive into the work being done at Boston University and elsewhere.
"We should only use what science gives us. We need valid scientific studies that proves that concussion in an isolated way gives rise to [CTE]down the road," he said. "We know that if you look at players, many players get concussions and most of them turn out to be decent citizens, with great futures and great families. They age well, they do well, they don't develop CTE.
"We need to be aware of it, it's something that says we need further research, but I think we have to be very careful to say we're linking one to the other."