Chronic traumatic encephalopathy, or CTE, has become a frequent topic in the news as it relates to football and specifically the NFL. Most recently a study that was lead by Dr. Bennet Omalu, (he is widely credited with the diagnosis of CTE postmortem) using an experimental radioactive tag while the study subject underwent Positron Emission Tomography/Computed Tomography (PET/CT) specifically looking for Tau proteins consistent with CTE was successful in identifying Tau proteins in a living subject. CNN article here, front page article on the DN by Chris here, original study here.
CTE was first identified in 1928, when Dr. Harrison Martland described a group of boxers as having "punch drunk syndrome." The most significant initial research occurred in 2005, when pathologist Dr. Bennet Omalu published the first evidence of CTE in a former NFL player, Mike Webster. If you haven't seen the move "Concussion" I highly recommend, wikipedia link.
What causes CTE?
Contrary to popular belief, repeated full impact concussions with loss of consciousness are probably not the only source of CTE, instead the most recent research also points to repeated blows to the head with high impact over several years that do not cause full blown concussions are also potentially a source. That means anyone who suffered repeated blows to the head is at risk, however risk does not necessarily mean a person will develop the detrimental stages of CTE.
Who is most at risk for CTE
CTE is most often found in contact sport athletes and military veterans, likely because these are some of the only roles in modern life that involve purposeful, repetitive hits to the head. CTE has been found in individuals whose primary exposure to head impacts was through tackle football (200+ cases confirmed at the VA-BU-CLF Brain Bank), the military (25+ cases), hockey (20+ cases), boxing (15+ cases, 50+ globally), rugby (5+ cases), soccer (5+ cases, 10+ globally), pro wrestling (5+ cases), and, in fewer than three cases each, baseball, basketball, intimate partner violence, and individuals with developmental disorders who engaged in head banging behaviors. (this paragraph and the chart was essentially lifted from concussion foundation.org)
|CTE has been found in...||Source of head impacts|
|Boxers||Punches to the head|
|Tackle football players||Hits to the helmet|
|Soccer players||Headers and collisions|
|Ice hockey players||Fighting, checking|
|Military veterans||Blast injuries, combat|
|Victims of domestic abuse||Repeated violence|
Importantly, not everyone who has suffered repetitive hits to the head will develop CTE. There are several risk factors at play that make some people more prone to develop CTE than others, including:
Age of first exposure to head impacts
Athletes who begin playing contact sports at younger ages are at greater risk for CTE. Several published studies show that exposure to head impacts before age 12 is associated with worse outcomes than starting after age 12.
Length of exposure to head impacts
Athletes with longer careers playing contact sports are at greater risk than athletes with shorter careers. Among those diagnosed with CTE, athletes with longer careers are more likely to have more severe pathology than those with shorter careers.
There are very likely other risk factors that have yet to be discovered, including possible genetic differences that make some people more prone to develop CTE than others. More research will help scientists determine what those factors might be, and could help us understand how to prevent and treat the disease.
Are there any treatments for CTE at this time?
Not unlike dementia which mimics the symptoms of CTE, there are no definitive treatments at this time. Treatment consists of symptom management particularly mood changes, headaches and memory problems. These center around cognitive behavioral therapy, headache identification with medication management and memory management. Sadly as I indicated earlier, there are limited medications for memory.
So why did I write this fanpost?
A lot of my job is to provide and share information to patients and their families so they can make an informed decision on medical treatments and medications. As we all visit the Daily Norseman to talk football (or naps, barbecue recipes or just to post gifs) I would like everyone to be able understand the risks associated with sports and make an informed decision for them self or as a parent. Also, I played high school football and was in the military for 24 years. I know I had at least three concussions playing football and I was way to close to multiple mortar and artillery blasts during my service. I have some of the symptoms of CTE, but not all. I've decided to donate my brain after my death, if you want more information about brain donation go here.