Almost every former National Football League player who died between 2016 and 2021 and allowed their brains to be evaluated was found to have chronic traumatic encephalopathy, stark evidence of the toll repeated head impacts can take on athletes.

Researchers obtained personal information and causes of death for 878 players who died during the five-year period, when brain donations were highest. Of the 235 athletes whose brains were subject to the postmortem neurological examination, 215 had confirmed CTE, according to findings published Tuesday in the British Medical Journal.

CTE, a progressive brain disease tied to repeated head trauma that’s common in contact sports like football and boxing, can only be definitively diagnosed by examining the brain after death. When the researchers included all the football players who died in their analysis, they determined a “conservative minimum” of nearly 25% had CTE.