What are the other Names for this Condition? (Also known as/Synonyms)

• CTE (Chronic Traumatic Encephalopathy)
• Dementia Pugilistica (DP)
• Punch-Drunk Syndrome

What is Chronic Traumatic Encephalopathy? (Definition/Background Information)

• Chronic Traumatic Encephalopathy (CTE) is a progressive degenerative disorder of the brain. It occurs when an individual sustains repeated brain trauma
• Athletes, who participate in contact sports or those who undergo repeated contact and trauma to the brain, are at higher risk for CTE. Sometimes, military personnel who undergo blast injuries or repeated head trauma, can also be at risk
• Chronic Traumatic Encephalopathy is thought to develop over a period of years and decades. However, the exact mechanism that causes CTE is unknown at this time
• Individuals with Chronic Traumatic Encephalopathy are known to slowly develop the signs and symptoms. Over a period of time, the brain tissue loses its mass due to atrophy. As the result of atrophic changes, other parts of the brain may become bigger to compensate for the atrophy that occurred. Due to atrophy, the brain function is affected
• Protecting the brain from repeated trauma by wearing a protective helmet can potentially reduce an individual’s risk for developing Chronic Traumatic Encephalopathy
• However, research in this area is still ongoing and many questions remain, such as what amount of force over what time period would increase the risk for CTE, among others
• The prognosis of Chronic Traumatic Encephalopathy depends on the severity of the signs and symptoms and the extent of brain damage. In a majority of cases, the disorder is progressive, meaning that it continues to deteriorate until death

Who gets Chronic Traumatic Encephalopathy? (Age and Sex Distribution)

• Chronic Traumatic Encephalopathy may occur in both males and females. The primary risk factor appears to be an exposure to head trauma rather than any other factor
• All ethnic groups and races can be equally affected
• The signs and symptoms usually occur in individuals over the age of 40 years old, depending upon the period when repeated brain trauma occurred. Sometimes, it may take decades for onset of symptoms after repeated trauma to the brain

What are the Risk Factors for Chronic Traumatic Encephalopathy? (Predisposing Factors)

The risk factors of Chronic Traumatic Encephalopathy may include:

• Athletes, who participate in contact sports, such as American football, rugby, boxing, and ice hockey
• Occupations that involve repeated physical stress or trauma to the brain may also result in CTE
• Military personnel who sustain head trauma or blast injuries

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Chronic Traumatic Encephalopathy? (Etiology)

The exact mechanism that causes Chronic Traumatic Encephalopathy (CTE) is unknown at this time.

• It is believed that CTE is caused by brain degeneration that occurs due to repeated trauma. Head trauma can cause damage to the neurons causing atrophy
• Studies have found that repeated trauma to the brain results in accumulation of an abnormal protein in the brain called “tau protein”
• Sports, such as American football, rugby, boxing, and ice hockey, are known to result in such types of brain injury
• Current medical research shows that not every individual who undergoes repeated trauma to the brain develop Chronic Traumatic Encephalopathy. The reason why some individuals develop CTE and others do not is still being researched

What are the Signs and Symptoms of Chronic Traumatic Encephalopathy?

The signs and symptoms of Chronic Traumatic Encephalopathy (CTE) may include (but are not limited to):

• Loss of memory (dementia), which occurs gradually over a period of time
• Personality changes such as inconsistent emotions and impulsive behavior
• Mild or severe depression
• Difficulty in maintaining posture and balance
• Speech difficulties
• Vision deficits
• Difficulty in swallowing
• Abnormal sense of smell
• Headaches
• Depression

Currently, medical researchers use a staging system to determine the degree of progression of Chronic Traumatic Encephalopathy. There are four stages as explained below:

• Stage I Chronic Traumatic Encephalopathy:
  • Loss of attention
  • Difficulty concentrating
  • Constant headaches
• Stage II Chronic Traumatic Encephalopathy:
  • Signs of depression
  • Impulsive behaviors
  • Short-term memory loss
• Stage III Chronic Traumatic Encephalopathy:
  • Impaired thinking process
  • Impaired decision-making process
• Stage IV Chronic Traumatic Encephalopathy:
  • The individual has severe dementia
  • Difficulty in expressing one’s thoughts
  • Severe changes in personalities including frequent impulsive and aggressive behaviors 

In many individuals, the signs and symptoms are attributed to the aging process and are hence, often under-diagnosed or misdiagnosed. The most common disorders that can be confused with Chronic Traumatic Encephalopathy include Alzheimer’s disease and Parkinson’s disease. 

How is Chronic Traumatic Encephalopathy Diagnosed?

Chronic Traumatic Encephalopathy may be diagnosed using the following methods:

• Complete physical examination and thorough medical history
• Thorough neurological examination
• X-ray of the head and neck
• Computerized tomography (CT) scan of the head and neck region: With this radiological procedure, detailed three-dimensional images of the structures inside the head and neck region are created
• Magnetic resonance imaging (MRI) of the brain: An MRI is a more detailed scan that uses a magnetic field to produce images, which allows a physician to view any damage to the bones and soft tissue to confirm the diagnosis. Researchers believe that as the following functioning MRI studies improve over time, it may be another diagnostic tool to help understand Chronic Traumatic Encephalopathy better:
  • Susceptibility-weighted imaging (SWI): Susceptibility-weighted imaging is a special type of MRI. In this technique, areas of small bleedings (micro-hemorrhages) are detected that can be caused by many different reasons
  • Diffusion tensor imaging (DTI): Diffusion tensor imaging is a type of MRI that helps to show any disturbance of white matter fibers and tracks
  • Magnetic resonance spectroscopy (MRS): Similar to MRI, magnetic resonance spectroscopy is a radiology procedure that helps provide additional information on disruption of signaling pathways (neurotransmitters) in the brain
• Positron emission tomography (PET) scan: A PET scan is a nuclear medicine imaging technique that uses three-dimensional images to show how tissue and organs are functioning. A small amount of radioactive material may be injected into a vein, inhaled, or swallowed. Currently, researchers are working on developing PET markers that can help detect tau abnormalities associated with neurodegenerative disease
• Event-related potentials (ERPs) and quantitative EEG: These are noninvasive tests that use electroencephalography (EEG) monitoring method. During these tests, a mesh cap covered with electrodes is place on an individual’s head, helping the healthcare provider to document and study brain waves. This may help detect any neurophysiological changes that result from head trauma
• Single photon emission computerized tomography (SPECT): SPECT is a nuclear imaging test that helps the healthcare provider analyze the function of internal organs by using a radioactive substance and a special camera to create 3-D pictures of the insides of the body
• Many other tests are in development, including potential blood tests
• Other conditions that cause similar signs and symptoms should be ruled out. Some of such conditions include:
  • Alzheimer’s disease
  • Parkinson’s disease
  • Frontotemporal dementia
  • Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease

Note: 

• Biopsies of the brain are required to make a definitive diagnosis of Chronic Traumatic Encephalopathy. It can be typically presumed through clinical examination in conjunction with the above tests
• However, in nearly all instances, a diagnosis of CTE is established during an autopsy, while examining the brain

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Chronic Traumatic Encephalopathy?

The complications of Chronic Traumatic Encephalopathy may include:

• Dementia may occur which can severely affect an individual’s quality of life
• Dementia can lead to other complications such as depression
• Repeated trauma to the brain can result in early retirement for athletes and other such professionals causing reduced income and reduced quality of life
• Individuals with CTE are more prone to substance abuse

How is Chronic Traumatic Encephalopathy Treated?

There is no definitive treatment for Chronic Traumatic Encephalopathy.

• The current known methods are to treat the symptoms as best as possible with a variety of treatment options
• Once an individual is diagnosed with CTE, close monitoring by a healthcare provider is necessary

How can Chronic Traumatic Encephalopathy be Prevented?

Presently, there is no medical consensus on how much trauma a brain would have to experience to develop Chronic Traumatic Encephalopathy. However, certain guidelines are available to help protect the brain from repeated trauma, which include:

• Wearing appropriate safety equipment, such as a protective helmet, while participating in certain high-impact sports, such as American football, rugby, and ice hockey. However, individuals may still develop concussions when a protective helmet is worn
• Using suitable safety gear including protective helmet while handling certain industrial tools and equipment

What is the Prognosis of Chronic Traumatic Encephalopathy? (Outcomes/Resolutions)

The prognosis of Chronic Traumatic Encephalopathy depends on the severity of the signs and symptoms and the extent of brain damage.

• In the majority of cases, the disorder is progressive and the condition gradually worsens until death
• In individuals with severe signs and symptoms, the prognosis is typically poor

Additional and Relevant Useful Information for Chronic Traumatic Encephalopathy:

• Here are some questions to ask your healthcare provider regarding Chronic Traumatic Encephalopathy:
  • What is the cause of Chronic Traumatic Encephalopathy?
  • Are the symptoms progressive?
  • Is there a cure for Chronic Traumatic Encephalopathy?
  • Are there clinical trials that one can enroll in?
  • Will my signs and symptoms get worse over time?
  • Is it safe to engage in vigorous non-contact activities?
• In 2002, forensic pathologist Dr. Bennet Omalu conducted an autopsy on former NFL player Mike Webster, which led to the discovery of a new disorder that the physician named Chronic Traumatic Encephalopathy (CTE)