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What is Chronic Traumatic Encephalopathy | Causes | Stages | Symptoms | Risk Factors | Diagnosis | Treatment

Chronic traumatic encephalopathy (CTE) is a condition that causes brain degradation due to repeated trauma to the head. The condition is known to cause symptoms that are similar to those of Alzheimer’s disease, including mood changes and memory loss. Most of the confirmed cases of chronic traumatic encephalopathy are observed in athletes who play contact sports like boxing and American football. However, it can also develop in any person who has a history of getting repeated trauma to the head. Read on to find out everything about chronic traumatic encephalopathy.

What is Chronic Traumatic Encephalopathy?

Chronic traumatic encephalopathy (CTE) is a term used to refer to any form of brain degeneration believed to be caused by repeated trauma to the head. Chronic traumatic encephalopathy is diagnosed only at the time of autopsy when various sections of the brain are studied. This is a rare disorder, and even today, it is not properly understood. Chronic traumatic encephalopathy is known to cause symptoms that are very similar to those caused by Alzheimer’s disease, especially memory loss and sudden changes in mood. It is not surprising that most of the confirmed cases of Chronic traumatic encephalopathy have been observed in athletes playing contact sports, especially boxing and American football, though, of course, it can occur in anyone who has a history of repeated trauma to the head. (1,2,3,4)

The symptoms of Chronic traumatic encephalopathy can take several years to appear, but it is possible that they affect the quality of your life quite dramatically as they may cause mental and physical impairment. There is no cure for chronic traumatic encephalopathy at present, and the treatment revolves around the management of the symptoms.

What are the Causes of Chronic Traumatic Encephalopathy?

Chronic traumatic encephalopathy is a progressive condition caused by repeated trauma or blows to the head. This neurodegenerative condition typically sets in gradually after many years of head trauma. (5) Studies estimate that 17 percent of people who experience repetitive concussions or even mild traumatic brain injury go on to develop chronic traumatic encephalopathy. (6) The severity of the condition is directly associated with the frequency and severity of the brain trauma. However, some people with a history of head trauma never go on to develop Chronic traumatic encephalopathy, but others may end up developing symptoms within just a few months. (7)

The reason behind why Chronic traumatic encephalopathy seems to affect some people, but not others, is still not understood properly. It is believed that repeated head injuries can cause a buildup of an irregular protein known as tau. This irregular protein disrupts the functioning of neurons. The tau protein is also found in people with Alzheimer’s disease. (8,9)

Most cases of chronic traumatic encephalopathy have been observed in contact sports athletes, especially those playing American football and boxing. However, it can even develop in anyone who experiences frequent head injuries.

What are the Stages of Chronic Traumatic Encephalopathy?

Chronic traumatic encephalopathy is divided into four major stages, depending on the extent and severity of brain damage. (10) These include: (11)

  • Stage I: During stage I of the disease, the brain appears mostly normal, and the tau protein can be found in a very small number of places, usually in the frontal and lateral parts of the brain. It can also be found near the small blood vessels in certain grooves of the brain.
  • Stage II: At this stage of the disease, larger irregularities might be observed, including an enlargement of the passages in the brain that are used for cerebrospinal fluid to pass through.
  • Stage III: By stage three of the disease, noticeable brain mass loss can be observed along with shrinking of the temporal and frontal lobes of the brain.
  • Stage IV: By this stage, a dramatic reduction in the weight of the brain is observed, by nearly 1000 grams, as compared to the standard 1300 to 1400 grams. (10)

Contact Sports and the Development of Chronic Traumatic Encephalopathy

In the 1920s, chronic traumatic encephalopathy was often known as the punch drunk syndrome, as boxers used to often develop the condition with neurological symptoms like confusion, speech problems, and tremors. Some boxers would actually experience these symptoms while they were still competing in their 20s or 30s. (12)

It was only in the 1940s that this condition began to be known as chronic traumatic encephalopathy. Most of the confirmed cases of Chronic traumatic encephalopathy were observed in athletes who were playing contact sports that had a high risk of head injuries, such as boxing and American football. (6, 13)

While it still remains unclear as to how common Chronic traumatic encephalopathy is among athletes and exactly what level and frequency of trauma are needed to cause the condition, it is believed that Chronic traumatic encephalopathy develops due to repetitive concussions.

There is only one way of confirming the diagnosis of Chronic traumatic encephalopathy is by looking at the brain of the person in an autopsy after they die. A researcher by the name of Bennet Omalu was the first one to publish evidence of Chronic traumatic encephalopathy in a player of the National Football League (NFL) after an autopsy was carried out. The player was former Pittsburgh Steeler Mike Webster. In one of the largest case series of Chronic traumatic encephalopathy researched in deceased football players, researchers discovered a prevalence of Chronic traumatic encephalopathy in 87 percent across all levels of play, and there was a prevalence of 99 percent in erstwhile NFL players, with 110 out of 111 having the condition. (14)

Symptoms of Chronic Traumatic Encephalopathy

The symptoms of Chronic traumatic encephalopathy vary from person to person. They are, however, quite similar to symptoms of other degenerative brain conditions like Alzheimer’s disease. The symptoms usually develop over a period of time following repeated concussions or blows to the head. Some of the most common ones may include: (15)

  • Headaches
  • Short-term memory loss
  • Mood changes
  • Problems focusing or sustaining attention
  • Erratic behavior, including depression, aggression, and even suicidal thinking.
  • Increased disorientation and confusion
  • Brain fog
  • Slurred speech
  • Tremors
  • Problems with memory
  • Slow movement
  • Difficulty eating or swallowing (this is a rare symptom)

The symptoms of Chronic traumatic encephalopathy tend to get worse as the condition progressions, and the following clinical classifications have been made based on the four stages of the condition:

  • Stage I: No symptoms are usually observed. Mild memory problems and depression may be present.
  • Stage II: Severe depression and behavioral outbursts can be observed.
  • Stage III: Cognitive deficits such as loss of executive function and memory loss may be observed, including self-control and flexible thinking.
  • Stage IV: By this stage, advanced language problems may be observed, along with severe cognitive deficits, psychotic symptoms, as well as issues with movement.

What are the Risk Factors of Chronic Traumatic Encephalopathy?

Any person who repeatedly receives blows or trauma to the head is at a high risk of developing Chronic traumatic encephalopathy. The condition is most commonly observed in athletes who play contact sports like:

  • American football
  • Boxing
  • Soccer
  • Martial arts
  • Rugby
  • Lacrosse
  • Hockey

Some other people can also be at a greater risk of the condition, including:

  • People who have received repeated head injuries due to recurrent assault, self-injury, or poorly controlled epilepsy.
  • Military veterans who have a history of repetitive head injuries.

It is also believed that there are certain genes that make some people more prone to developing chronic traumatic encephalopathy. According to a recent 2021 study, a gene known as the ApoE e4 allele, which is known to inhibit the growth of neurons after any type of brain injury, is believed to be responsible for triggering Chronic traumatic encephalopathy in certain people after repeated brain injury. (16) Another research from 2020 found that the chances of developing CTE at the time of death amongst American football players doubled with every 2.6 years of playing the sport. (17)

Diagnosis and Treatment of Chronic Traumatic Encephalopathy

At present, Chronic traumatic encephalopathy can only be diagnosed by analyzing the brain tissue after the death of the person. CTE, just like Alzheimer’s disease, is associated with a reduction in the size and weight of the brain along with the formation of neurofibrillary tangles that show the presence of the tau protein.

Your doctor may suspect you have Chronic traumatic encephalopathy if you experience the typical symptoms and also have a history of head injuries.

Research is ongoing on finding new techniques that can be used to diagnose Chronic traumatic encephalopathy in people while they are alive.

There is no cure for Chronic traumatic encephalopathy, and treatment revolves around the management of the symptoms. Supportive measures for managing the symptoms may include:

According to studies carried out in 2020, monoclonal antibody therapy, which is a form of immunotherapy, might be promising for targeting tau proteins and helping people with Chronic traumatic encephalopathy, but more research is still needed to confirm this. (18)

Conclusion

Chronic traumatic encephalopathy is a type of rare and progressive brain condition that is caused by repeatedly getting injured on the head. Most of the confirmed cases of Chronic traumatic encephalopathy have so far been in athletes of contact sports, though anyone who experiences repeated head trauma can develop the condition. Chronic traumatic encephalopathy can only be diagnosed after death, and there is no cure for the condition. Treatment revolves around the management of the symptoms. If you or your doctor suspects that you have Chronic traumatic encephalopathy, they will help you come up with a plan that will help maximize your quality of life while managing your symptoms with treatments like memory exercises, speech therapy, or behavioral therapy.

References:

  1. Omalu, B., 2014. Chronic traumatic encephalopathy. Concussion, 28, pp.38-49.
  2. McKee, A.C., Stein, T.D., Kiernan, P.T. and Alvarez, V.E., 2015. The neuropathology of chronic traumatic encephalopathy. Brain pathology, 25(3), pp.350-364.
  3. Saulle, M. and Greenwald, B.D., 2012. Chronic traumatic encephalopathy: a review. Rehabilitation research and practice, 2012.
  4. McKee, A.C., Stein, T.D., Nowinski, C.J., Stern, R.A., Daneshvar, D.H., Alvarez, V.E., Lee, H.S., Hall, G., Wojtowicz, S.M., Baugh, C.M. and Riley, D.O., 2013. The spectrum of disease in chronic traumatic encephalopathy. Brain, 136(1), pp.43-64.
  5. (no date) NHS choices. NHS. Available at: https://www.nhs.uk/conditions/chronic-traumatic-encephalopathy/ (Accessed: December 19, 2022)
  6. Inserra, C.J. and DeVrieze, B.W., 2017. Chronic traumatic encephalopathy.
  7. Frequently asked questions about CTE (no date) Frequently Asked Questions about CTE | CTE Center. Available at: https://www.bu.edu/cte/about/frequently-asked-questions/ (Accessed: December 19, 2022).
  8. McKee, A.C., Stein, T.D., Nowinski, C.J., Stern, R.A., Daneshvar, D.H., Alvarez, V.E., Lee, H.S., Hall, G., Wojtowicz, S.M., Baugh, C.M. and Riley, D.O., 2013. The spectrum of disease in chronic traumatic encephalopathy. Brain, 136(1), pp.43-64.
  9. McKee, A.C., Stein, T.D., Kiernan, P.T. and Alvarez, V.E., 2015. The neuropathology of chronic traumatic encephalopathy. Brain pathology, 25(3), pp.350-364.
  10. Fesharaki-Zadeh, A., 2019. Chronic traumatic encephalopathy: a brief overview. Frontiers in neurology, p.713.
  11. Hay, J., Johnson, V.E., Smith, D.H. and Stewart, W., 2016. Chronic traumatic encephalopathy: the neuropathological legacy of traumatic brain injury. Annual review of pathology, 11, p.21.
  12. Iverson, G.L., 2020. Retired National Football League players are not at greater risk for suicide. Archives of clinical neuropsychology, 35(3), pp.332-341.
  13. Safinia, C., Bershad, E.M., Clark, H.B., SantaCruz, K., Alakbarova, N., Suarez, J.I. and Divani, A.A., 2016. Chronic traumatic encephalopathy in athletes involved with high-impact sports. Journal of vascular and interventional neurology, 9(2), p.34.
  14. Mez, J., Daneshvar, D.H., Kiernan, P.T., Abdolmohammadi, B., Alvarez, V.E., Huber, B.R., Alosco, M.L., Solomon, T.M., Nowinski, C.J., McHale, L. and Cormier, K.A., 2017. Clinicopathological evaluation of chronic traumatic encephalopathy in players of American football. Jama, 318(4), pp.360-370.
  15. What is chronic traumatic encephalopathy (CTE)? (no date) What is CTE? | Traumatic Brain Injury | IU School of Medicine. Available at: https://medicine.iu.edu/expertise/traumatic-brain-injury/what-is-chronic-traumatic-encephalopathy (Accessed: December 19, 2022).
  16. Yi, J., Padalino, D.J., Chin, L.S., Montenegro, P. and Cantu, R.C., 2013. Chronic traumatic encephalopathy. Current sports medicine reports, 12(1), pp.28-32.
  17. Mez, J., Daneshvar, D.H., Abdolmohammadi, B., Chua, A.S., Alosco, M.L., Kiernan, P.T., Evers, L., Marshall, L., Martin, B.M., Palmisano, J.N. and Nowinski, C.J., 2020. Duration of American football play and chronic traumatic encephalopathy. Annals of neurology, 87(1), pp.116-131.
  18. Breen, P.W. and Krishnan, V., 2020. Recent preclinical insights into the treatment of chronic traumatic encephalopathy. Frontiers in Neuroscience, 14, p.616.
Team PainAssist
Team PainAssist
Written, Edited or Reviewed By: Team PainAssist, Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:December 31, 2022

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