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ROCK HILL, S.C. (AP) — An autopsy revealed unusually severe brain disease in the frontal lobe of the former NFL player accused of fatally shooting six people in Rock Hill, South Carolina, before killing himself in April, authorities announced Tuesday.

The 20 years Phillip Adams spent playing football “definitively ... gave rise” to a diagnosis of stage 2 chronic traumatic encephalopathy, said Dr. Ann McKee, who examined his brain.

Authorities have said that on April 7, Phillip Adams killed Rock Hill physician Robert Lesslie; his wife, Barbara; two of their grandchildren, 9-year-old Adah Lesslie and 5-year-old Noah Lesslie; and two HVAC technicians working at the Lesslie home, James Lewis and Robert Shook, both 38. Police later found Adams with a self-inflicted gunshot wound to the head.

The degenerative disease known as CTE is linked to head trauma and concussions that has been shown to cause a range of symptoms, including violent mood swings and memory loss.

“There were inklings that he was developing clear behavioral and cognitive issues,” McKee said. “I don’t think he snapped. It appeared to be a cumulative progressive impairment. He was getting increasingly paranoid, he was having increasing difficulties with his memory, and he was very likely having more and more impulsive behaviors. ... It may not have been recognized, but I doubt that this was entirely out of the blue.”

McKee, who directs the CTE Center at Boston University, said that of 24 NFL players diagnosed with the disease after dying in their 20s and 30s, most had stage 2, like Adams. The disease has four stages, with stage 4 being the most severe and usually associated with dementia.

The second stage is associated with progressive cognitive and behavioral abnormalities such as aggression, impulsivity, explosivity, depression, paranoia, anxiety, poor executive function and memory loss, McKee said.

But Adams’ CTE diagnosis was different from the other young players because it was “unusually severe” in both frontal lobes, she said.

McKee compared Adams’ brain to that of Aaron Hernandez, the former football star also posthumously diagnosed with CTE after he hanged himself in prison at the age of 27 while serving a life sentence for a 2013 murder.

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