What Is Chronic Traumatic Encephalopathy?

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Chronic traumatic encephalopathy, also known as CTE, is a brain condition often associated with contact sports that lead to repetitive head trauma. Football, boxing, hockey and rugby top the list of sports most frequently associated with CTE. However, any sport that involves potential contact with other players carries a risk of trauma to the brain. Traumatic brain injuries have also been found after death in survivors of explosive blasts, such as military veterans and those living in wartorn areas. 

What Are the Symptoms of CTE?

The symptoms of chronic traumatic encephalopathy can show in various ways, but typically involve changes in behavior, mood, sleep patterns and cognition. 

Cognitive effects of CTE typically do not begin until a person’s 40s, 50s or 60s, but they can start as early as the third decade of life, particularly in athletes who experienced brain trauma during adolescence. Cognitive changes may include:

  • Confusion or disorientation
  • Difficulty thinking and making decisions
  • Changes in judgment
  • Short- or long-term memory loss
  • Difficulty planning or completing daily tasks

Mood changes from CTE can impact an individual’s behaviors and emotional experiences. They typically include the following: 

  • Mood swings
  • Increased impulsivity
  • Depression or anxiety
  • Paranoia
  • Suicidal thinking

As the degenerative condition progresses, an individual affected by CTE may start to experience more severe symptoms, such as:

  • Slowed or slurred speech
  • Difficulty eating or drinking
  • Tremors 
  • Slowed movements 
  • Muscle stiffness

What Sports and Activities Cause CTE?

Any sport or activity that includes contact or the potential for trauma to the brain can contribute to the development of CTE. Common sports associated with this condition include football, lacrosse, rugby, soccer, hockey and wrestling. The highest number of diagnosed cases are associated with a history of football-related injuries. In American football, players tend to experience brain trauma from helmet-to-helmet or helmet-to-ground impacts. 

In addition, individuals exposed to blast explosions may also be susceptible to residual neurological symptoms. In some cases, repeated head trauma is associated with intimate partner violence or head-banging behaviors seen in certain developmental disorders.

CTE is not the result of a single concussion, or even several repeated head injuries. Research suggests that CTE develops when an individual experiences hundreds or thousands of impacts to the head and brain over a long period of time.

How Do Doctors Diagnose CTE?

Currently, there is no official diagnostic test or examination to confirm chronic traumatic encephalopathy during a person’s life. Diagnoses must be made post-mortem, or after death, at which point a medical examiner can assess the health of an individual’s brain tissue. This is accomplished by obtaining slices of brain tissue that are stained for a particular protein called tau and subsequently examined under a microscope. The presence of tau proteins is supportive of a post-mortem diagnosis of chronic traumatic encephalopathy. 

Researchers and physicians have determined that the changes in brain tissue following CTE appear differently than the changes seen in conditions such as Alzheimer’s disease or Parkinson’s disease. Notably, the brain tissue of individuals with CTE demonstrates the presence of tau protein, which is encapsulated in neurofibrillary tangles, while the brain tissue of patients with Alzheimer’s disease shows the presence of misfolded proteins called amyloid plaques. 

Experts are continuously searching for a method to determine the extent of brain trauma so that treatments can be tailored to an individual’s symptoms. Individuals who believe they may be suffering from the effects of CTE should visit a general practitioner, who may discuss your medical and social history as well as ask you to perform specific actions to demonstrate your neurological capacity. 

If the physical and neurological exam elicits any concerning results, your general practitioner may refer you out to a neurologic specialist, or perhaps a service specializing in assisting those with dementia and memory loss. 

Are There Any Treatments for CTE?

Unfortunately, CTE is as difficult to treat as it is to diagnose. There is no cure for traumatic brain damage. However, an individual’s symptoms can be managed, and supportive care can be offered so as to improve a person’s quality of life. Individuals who experience difficulty sleeping may ask their physicians about pharmaceutical therapy, while those who have speech or motor impairment may seek the services of behavioral therapists. 

How Can You Prevent CTE?

The best way to prevent CTE is to avoid repetitive blows to the head. Any trauma to the brain should be avoided if possible, but recurrent injuries in particular are associated with the degenerative symptoms of CTE. Individuals who have experienced one or more concussions playing a contact sport should stop playing, or take measures to ensure their exposure to further injuries will be minimized. 

Resource Links:

  • “Chronic Traumatic Encephalopathy” via Mayo Clinic
  • “What Is CTE?” via Concussion Legacy Foundation
  • “Chronic Traumatic Encephalopathy” via National Health Service
  • “Lewy Body Pathology and Chronic Traumatic Encephalopathy Associated With Contact Sports” via PubMed.
  • “Association between contact sports participation and chronic traumatic encephalopathy: a retrospective cohort study” via PubMed.