Prevention and Wellness

Chronic Traumatic Encephalopathy (CTE)

Michael W. Barrow, MD, Sports Medicine and Family Practice, Premier Health Family Care - North, answers Frequently Asked Questions about the diagnosis and treatment of CTE.

What is CTE?

CTE stands for chronic traumatic encephalopathy. It is damage of the brain due to trauma — essentially, head injuries. It's chronic in nature, so it's not the type of thing you're going to see right after an injury. CTE comes along over time and basically is a degeneration of the brain. Over time the brain will start to shrink up and there will be extra material, called tau protein, laid down. This process chokes off blood vessels and brain cells so that over time the brain starts to shrivel up and deteriorate.

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What causes CTE?

CTE is very distinct in that it is a slowly progressive degeneration of the brain that's due to environmental causes, most often head injuries. Most specifically, we think of it in terms of sports, especially contact collision sports such as football, hockey or rugby, but it also occurs in the military where the soldiers are exposed to blast injuries or falls or other head trauma. In general though, we're going to see it largely just in the athletic population.

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What are the symptoms of CTE?

Symptoms typically occur fairly long after the initial injury. The onset of symptoms usually takes place in middle age, even though someone may have had their injuries, along with an apparently full recovery, in their teen or young adult years. Symptoms can include memory disturbances, changes in behavior or personality, and oftentimes speech or gait difficulties that look like Parkinson's disease. Though it isn’t Parkinson's disease, some of the symptoms can be similar.

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How is CTE diagnosed?

Unfortunately, the only way to make an official diagnosis is on special stains of the brain, which necessitates that it's always a postmortem diagnosis. We can certainly conjecture that someone may have CTE if they were involved in contact collision sports or in the military and had a number of head injuries, even if they weren't considered severe. One could assume that someone might have CTE if they had previous head injuries and go on to develop memory or behavior issues. The first thing that typically appears is a change in behavior that might even be aggressive or violent. We certainly have heard about that with some of the NFL players who have gone on to be diagnosed with this, but the only way to make an official diagnosis is in the autopsy room. We can't otherwise make a final diagnosis since it is different than other forms of dementia.

Oftentimes people think that this is just like Alzheimer's disease or other form of vascular dementia, but it really isn't. It is very specifically caused by something in the environment — head trauma — and the only way we can know this is through pathology stains in the lab. Stains look different if they’re CTE versus Alzheimer's disease versus a vascular dementia versus a stroke, etc. Although from the outside it might seem like these are all somewhat the same, the reality is they're not.

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Can CTE be treated? How?

Typically patients would be treated for whatever symptoms they were manifesting. For example, if they have behavioral or mood issues, we would look at medications, such as antidepressants, which are used for anyone who has a mood disorder to help stabilize it. Antipsychotic drugs might even be prescribed for patients displaying more aggressive behavior. These treatments, however, don’t really cure the problem. You are only managing the manifestations.

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Can CTE be prevented? If so, how?

The simplest answer is to avoid head injuries. You want to try to prevent concussions.  Unfortunately the risk for developing CTE is actually related to the total number of what we call sub-concussive hits. You may not even have to have a concussion that you recognize. Your brain just gets rattled a little bit — enough that it causes damage to the brain, but not enough that it causes obvious symptoms. It's those hits that that add up and cause the problem. It's not necessarily related to a single big hit.

What we want to try to do is reduce this risk of concussions. Some schools have reduced how much hitting they will allow in practice. We know that strengthening the neck helps stabilize the head, which in theory also helps protect the brain. However, we also know that right now we don't have any particular equipment that will completely help prevent that. There's research being done on helmets and mouthpieces, but there's not a lot of data that shows that improvements to either will make a difference. There's also a genetic predisposition for CTE but testing is not currently available. We do know, however, that there's a certain gene that places you at greater risk for CTE, so hopefully we’ll be able to test for it in the future.

When you do get a concussion, you should carefully evaluate if you should continue the activity that helped to cause it. There are certainly many benefits to sports, but it’s wise to consider the various pros and cons of continuing in something that might place your health at greater risk.

    Source: Michael Barrow, MD, Premier Health Family Care - North

    Content Updated: September 17, 2018

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