Home > Diagnosis, Types of dementia > What Is Chronic Traumatic Encephalopathy?

What Is Chronic Traumatic Encephalopathy?

Chronic traumatic encephalopathy is a term that’s being heard more and more in the news media lately, after first being documented in medical literature in 1996.  It was formerly known as dementia pugilistica, because it was frequently seen in boxers considered to be “punch drunk” with slurred speech and gait/balance problems.  But in recent years it has become associated with football and soccer players, and others who incur repeated head traumas.  This is true for professional athletes as well as youngsters and casual participants.  It is also now being recognized in some individuals with certain kinds of experiences in the military, and in persons with epilepsy or some victims of abuse.

CTE is a progressive disease typically seen in persons who are exposed to head injuries due to explosive blasts or repeated concussions.  It results in a characteristic decay of brain tissue and a build-up of the protein tau.  Recent evidence shows that even injuries not serious enough to cause a concussion (known as “sub-concussions”) can cause sufficient damage to trigger the changes that take place in CTE.  The number of cases of this disease in younger athletes has been on the rise in the last several years.  Because the cause of this disease is environmental, it has been called the only form of dementia that is preventable.

Some of the physical changes that take place include a shrinkage and atrophy of a number of structures within the brain.  There are also microscopic changes that take place within the brain cells, such as the depositing of some irregular proteins, white matter changes, and other abnormalities.  As with many other forms of dementia, a definite diagnosis is possible only upon autopsy.  A brain biopsy can be conducted while the patient is still living, but this is an extremely risky procedure and the results are often inconclusive.

A person with CTE shows symptoms that are fairly characteristic of most other diseases causing dementia:  memory problems, disorientation, and difficulty concentrating in the initial stages.  As the disease progresses difficulty with judgment, behavior problems, characteristics resembling Parkinson’s disease (impaired speech and motor skills, slow movements, and a loss of balance) are seen.  In the latter stages, patients demonstrate tremors, more advanced Parkinsonism, gait difficulties, deafness, and pronounced dementia.  Psychological problems are not uncommon (for example depression, agitation, aggression and violence, loss of inhibitions, sexual compulsiveness, euphoria, drug and alcohol abuse, and suicide).

Many persons with CTE often do not show symptoms of the disease until several years or even decades after they have stopped participating in their particular sport.  It is theorized that the severity of the disease is related to the length of time spent competing.  One study performed in 2009 showed that persons with CTE had an average lifespan of 51 years.  There are simply a lot of things that are still unknown about the disease at present, but research is on-going.

Diagnosis of CTE follows a pattern similar to that used with other forms of dementia.  A complete medical history, including a record of previous injuries and secondary symptoms, is often the first course of action.  Brain imaging studies may also yield useful information.  There are no biomarkers for the disease that have yet been identified.

Efforts toward prevention of CTE have focused primarily on protection of the head from concussions and sub-concussive injuries.  It has been suggested that 85% of concussions require three weeks to fully heal, which is a longer period than was once thought.  It is recommended that the concussed athlete progress gradually from light to more intensive activity, with careful monitoring to see if symptoms re-develop.

Since 2002, autopsies on the brains of a number of professional and collegiate football players have shown evidence of CTE.  The youngest of these was 21 years old at the time of his death, however it has been reported that his suicide was due to factors other than CTE.  Several hockey players and at least two professional wrestlers have also been found to have evidence of the disease in their brains.

In 2009, the NFL Players Association announced that it would cooperate with research into repetitive brain injuries in athletes.  In addition, the NFL has awarded a $1 million grant to aid in research.  To date, dozens of active and retired professional athletes, from several different sports, have agreed to donate their brains for post-mortem research.

Lawmakers are also stepping in to propose measures to better protect our young athletes.  Increased training has been proposed for coaches, administrators, parents, and others as to early warning signs and their treatment.  Changes have also been proposed as to how the various sports are played.

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