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Health Update: What is Chronic Traumatic Encephalopathy (CTE)?

Chronic traumatic encephalopathy (CTE) is a brain condition linked to repeated blows to the head. It is also correlated with the development of dementia. Possible signs of CTE are problems with thinking and memory, personality changes, and deviations in behavior including aggression and depression. People may not experience signs of CTE until years after brain injuries transpire. A definitive diagnosis of CTE can only be made after death, when an autopsy can disclose whether the recognized brain changes of CTE are present.

Causes

When analyzing available studies data indicates that the greatest risk factor for developing CTE connected brain changes is repetitive brain trauma or repeated, forceful blows to the head, such as those that may occur playing contact sports that may not however, individually, cause symptoms. Most documented cases have occurred in athletes involved in contact sports such as boxing, American football, wrestling, ice hockey, rugby and soccer. Other risk factors include being in the military, prior domestic violence, and repeated banging of the head. The exact amount of trauma required for the condition to occur is unknown.

Concussion

A concussion also known as, mild traumatic brain injury, either doesn't render you unconscious or you become unconscious for 30 minutes or less. Short-term symptoms often appear at the time of the injury, but also can progress days or weeks later. Traumatic brain injuries also can be categorized as moderate or severe, contingent on symptoms and the length of time of unconsciousness that the brain injury resulted in.

Symptoms & Treatments

The signs of CTE may sometimes be similar to those of other conditions that involve substantial loss of brain cells, including Alzheimer's disease and Parkinson's disease. Possible general signs include:

  • Memory loss
  • Confusion
  • Personality changes including depression and suicidal thought.
  • Erratic behavior (including aggression)
  • Problems paying attention and organizing thoughts
  • Difficulty with balance and motor skills

More specifically, symptoms of CTE occur in four stages, commonly appearing eight to ten years after an athlete experiences repetitive mild traumatic brain injuries.

First-stage symptoms include:

  • attention deficit hyperactivity disorder
  • confusion
  • disorientation
  • dizziness
  • headaches

Second-stage symptoms include

  • memory loss
  • social instability
  • impulsive behavior
  • poor judgment

Third and fourth stages include

  • progressive dementia
  • movement disorders
  • hypomimia (reduced degree of facial expression)
  • speech impediments
  • sensory processing disorder
  • tremors
  • vertigo
  • deafness
  • depression
  • suicidality

Additional symptoms include dysarthria (speech disorder), dysphagia (difficulty swallowing), cognitive disorders such as amnesia, and ocular abnormalities, such as ptosis (drooping eyelids). Patients with CTE may be prone to inappropriate or explosive behavior and may display pathological jealousy or paranoia.

Like Alzheimer’s dementia, CTE is distinguished by tangles of an abnormal form of the protein in the brain. It is not clear how the brain changes that associated with CTE are related to cognitive or behavioral dysfunction. There's no evidence that a single concussion increases CTE risk, and not everyone with a history of recurring concussions will go on to develop CTE. Researchers strongly suspect that CTE is most likely to occur following a large number of traumatic brain injuries — even without loss of consciousness, a small number of more severe traumatic brain injuries, or some other pattern of head trauma. There is evidence linking moderate and severe traumatic brain injuries to a greater risk of developing other brain conditions, such as Alzheimer’s disease.

Diagnosis

Currently, there are no tests available to diagnose if someone has CTE. Because CTE is a comparatively new health issue, formal clinical guidelines for diagnosing and managing CTE have not been established. A definitive diagnosis can only be made through an autopsy after death. However, when CTE is suspected, a detailed medical history, mental status testing, neurological exams, brain imaging and additional diagnostic tests may be employed to rule out other conceivable causes.

Treatment

Presently, there is no treatment and no cure for CTE. The only known way to prevent it is to avoid repeated head injuries. Those with potential signs of CTE may benefit from some of the similar types of care provided for people with Alzheimer’s disease and other types of dementia, for example the initiation of behavioral therapy approaches utilized to deal with aggressive behavior.

Being a caregiver for someone with CTE is not unlike being a caregiver for those with dementia and can be exhausting and overwhelming. Those who are caring for someone with signs of CTE may find it beneficial to know what to expect as this condition progresses and from having a support network in place.