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Everything you need to know about

Chronic Traumatic Encephalopathy

by

Treatment options and research

CTE vs. Alzheimer's

CTE symptoms and progression

What is chronic traumatic encephalopathy?

CTE has been reported in people as young as

99%

In a study,

of former NFL football players had CTE.

17

Chronic traumatic encephalopathy is a neurodegenerative disease caused by repeated head trauma, including concussions as well as knocks on the head that don't cause immediate symptoms. CTE can cause brain cell death and tissue shrinkage. These brain changes lead to symptoms ranging in severity from headaches to dementia.

SOURCE

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Symptoms of CTE

Early signs and symptoms (appear around age of 40)

Headaches, confusion, disorientation, and dizziness

Short-term memory loss, impulsivity, and erratic behavior

Later signs and symptoms (appear around age of 60)

Aggression, paranoia, depression, and suicidal thoughts

Dementia, movement disorders, and speech difficulties

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What causes CTE?

CTE is a brain disorder characterized by the buildup of an abnormal protein. As a result, neurons starve and die.

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What a concussion does to the brain

A neurologist's perspective

"The brain is a soft organ in a hard case. As well as causing initial damage to brain cells at the time of injury, concussion sets off a cascade of chemical and biological changes which occur within minutes and may last days or even weeks after concussion. The structural scaffolding of cells in the white matter may begin to weaken or break, preventing or reducing the ability of cells to communicate. The recovery period may be different for each person, and may persist even after symptoms go away."

Sarah HellewellNeurology researcher and concussion expert

REAd more

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Diagnosing CTE

Current diagnostic challenges

  • CTE can only be definitively diagnosed through a post-mortem examination of brain tissue, leaving many cases unconfirmed.
  • Symptoms of CTE may overlap with other neurological conditions, leading to misdiagnosis or delayed diagnosis.

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Diagnosing CTE

Promising research and future diagnostic methods

  • Methods to diagnose CTE before death:
    • Blood tests and spinal taps to detect biomarkers such as amyloid and tau.
    • New brain imaging techniques such as specialized MRIs.
    • Neuropsychological tests to evaluate memory and executive function

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Contact sports and CTE

Each head impact can cause microscopic damage to the brain, which accumulates over time and can lead to the development of CTE. In a study of donated brains from 202 deceased American football players, 177 were diagnosed with CTE.

SOURCE

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Genetics and concussions

Do You Have the ‘Concussion Gene’?

A seemingly minor knock on the head can be devastating for some people, and your genes could be the deciding factor. Scientists have found mutations in the CACNA1A and ATP1A2 genes can make a patient more sensitive to head impacts. Even very minor head trauma can lead to concussion, seizures, brain swelling, coma, and sometimes death. People with the APOE4 gene, also known as the “Alzheimer’s gene”, are also more likely to have significant signs of brain degeneration after concussion.

Read more

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It's not just about concussions

When 51-year-old Steven Barbieri started experiencing memory problems, he never expected to receive a dementia diagnosis — particularly not one tied to his lifelong history of practicing martial arts.

“If you [are] sparring, you’re going to get kicked in the head, and like I said there were no pads on your feet at that time, and you had no headgear...I try [to] and tell people all the time, once you get a diagnosis it’s not a death sentence. I made a lot of changes. The biggest thing I started doing was going to the gym on a regular basis. I make sure to get out and get that social engagement..."

Steven BarbieriMartial artist living with CTE

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What's the difference between CTE and Alzheimer's?

Both CTE and Alzheimer's are neurodegenerative diseases that cause cognitive decline, and affect millions of Americans. Both diseases involve the abnormal accumulation of proteins in the brain, leading to progressive damage. But they have different causes, symptoms and ages of onset.

Different causes

Initial symptoms

Age of onset

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Managing symptoms with exercise

Chris Boyce, a Florida hockey player for 28 years, talks about the traumatic brain injuries (TBIs) that left him with severe cognitive impairment, and how regular exercise has helped him control many of his symptoms.

“You know, I wish I would have stuck with diet and exercise first. Medications really masked all my symptoms, so I really didn’t understand them until I got off the medications, and only now am I starting to really dissect what each of them do...It helps with the depression, it just makes me feel better in the morning, and I feel better about myself."

Chris Boyce Hockey player living with traumatic brain injury

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Treatment and management

Although there is currently no cure for CTE, there are ways for affected individuals and their families to manage symptoms and cope with the progression of the disease. Most treatments focus on providing support, resources, and strategies to improve quality of life.

Medication
Therapy
Lifestyle changes

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When a concussion becomes concerning

Most people recover from a single concussion, even years later. Symptoms can range from mild to severe, including vision problems, loss of consciousness, or abnormal reflexes. The biggest concern arises when recovery time gets longer with each subsequent injury.

“When we start getting worried about

repetitive concussions is when recovery time for each subsequent injury is getting longer and longer. Those are the ones we’re most concerned about, and that’s when we start thinking about ‘How many is too many?’ The answer to that is: we really don’t know. No two brains are alike. A force that might produce concussion symptoms in one individual may not produce those symptoms in the individual beside them, even given the same exact injury. The saying in the field is: ‘If you’ve seen one concussion, you’ve seen one concussion.’ We really start to get worried when the symptoms last longer or are  worse.”

Dr. Munro CullumNeuropsychologist, University of Texas Southwestern Medical Center

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What should you do if you think you have a concussion?

“Athletes often don’t want to report a concussion, for their fears of being removed from play. That’s where education comes in really important... If you’re not feeling okay after a hit, you need to report that to somebody. The risk is going back into play too soon, before the brain has recovered... What we’ve learned is that getting people back to their normal routine as soon as possible is best... Light exercise after that initial day or two is a good thing. If symptoms get worse, the you just back down, and then progressively reengage in normal activities. A slow, progressive return to normal activity — without exacerbating symptoms — is the key.”

Dr. Munro CullumNeuropsychologist, University of Texas Southwestern Medical Center

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Life after a traumatic brain injury

“The journey was like double vision, my mind is not my mind, and really bad sleep. At 5 p.m. I’d be wide awake, and at 3 a.m. I’d go to sleep. Then, the cognition stuff was the biggest, also sound sensitivity, depersonalization, and derealization... [Over] seven years, those things changed and somewhat improved. I got into neuroscience to understand what happened to my mind, but I didn’t find many people to talk to. After my PhD, I started feeling the emotions around everything that happened, it was about 17 years after my brain injury.”

Daniel Avesar, PhDSuffered a severe TBI

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Prevention of CTE

Reduce risks in sports:

Get a cognitive baseline assessment, which involves answering simple question and performing simple tests Practice proper tackling and hitting techniques to reduce head impacts, promoting safer play. Encourage athletes to report concussion symptoms and allow adequate recovery time, prioritizing brain health.

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Want to keep learning?

Visit

beingpatient.com

for the latest news and information on brain health and Alzheimer's disease

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Symptoms typically appear years or even decades after the initial head trauma, making early diagnosis challenging.

Prescription drugs can address specific symptoms, such as depression or anxiety.

With CTE

Normal

Repeated head trauma triggers a cascade of biological events leading to brain cell death and tissue shrinkage, particularly in regions responsible for mood, behavior, and cognition.

Image source: Boston University Center for the Study of Traumatic Encephalopathy

Maintaining a healthy diet, exercising regularly, and engaging in mentally stimulating activities.

The initial symptoms of Alzheimer's disease primarily revolve around memory issues, whereas CTE starts with problems related to judgment, reasoning, impulse control, and aggression.

CTE symptoms tend to manifest earlier in life, typically around your 40s, compared to Alzheimer’s disease, where symptoms usually appear in your 60s.

CTE is caused by repeated head trauma, while Alzheimer's disease has multiple risk factors, including age and genetics.

Counseling, cognitive behavioral therapy, and support groups offer emotional support and coping strategies.