Chronic Traumatic Encephalopathy (CTE) is a brain condition usually associated with boxers and football players. Recent American Medical Association Journal (JAMA Neurology) revealed surprising evidence: Of 152 brain examinations from contact sports athletes under the age of 30, more than 40% had evidence of CTE, suggesting that it can start much earlier than expected.
What happens in the brain? When the head receives a blow or a sudden stop and acceleration as happens with a football tackle, the brain moves inside the skull, creating shearing forces that could damage tiny blood vessels (microhemorrhages), and nerve connections (axonal injuries).
As the brain bounces back and forth, the damage causes an abnormal protein called Tau to build up inside the folds of the brain surface called the cerebral cortex sulci. Tau protein eventually builds up in the sulci and is diagnostic for CTE. The cortex is the part of your brain responsible for thinking, memory, reasoning, emotions, and learning.
Who is at risk? There are 4 million sports-related concussions occurring in the US each year, and about 70% of people with repeated concussions may develop CTE. A big question is why some people develop it and others do not. It may be that some athletes are at higher risk genetically.
Diagnosis
Researchers are developing guidelines for before-death diagnosis based on history and symptoms called Trauma Encephalopathy Syndrome (TES). To diagnose TES, an athlete must have:
- A history of repeated head trauma.
- CTE symptoms, at least 12 months.
- A history of symptoms getting worse.
- No other diagnosis that could cause the symptoms.
CTE develops in stages. The earliest symptoms are subtle cognitive, emotional, and behavioral changes. These stages include:
- Mood symptoms – Depression, anxiety, and paranoia.
- Behavioral symptoms – Impulsive or aggressive, and anger.
- Cognitive systems include confusion, short-term memory, and poor judgment.
- Motor signs walking and balance problems, and trouble speaking.
There is no cure for CTE, but symptoms can be treated. Here at NRS|LS, we are one of the seven original programs treating concussion and traumatic brain injury, extending back to 1978. The following are the stages that need to be applied in order to help the individual:
1. Consultation. The athlete needs to understand the nature of his/her changed profile.
2. A neuropsychological examination. This is a “blueprint” that describes the functional expression of the physical changes that have occurred in the brain in the form of thinking changes, and behavior. It enables a rehabilitative program to help the athlete understand what they have, what the adjustment strategies are, an understanding of the functional expression of these problems in daily functioning, and what they can do about it.
3. Biofeedback. Many of the athletes develop significant adjustment reactions in the form of depression, as well as agitation.
4. Cognitive rehabilitation. These are cognitive exercises enabling the athlete to develop compensatory strategies adjusting to their thinking problems.
5. Medication. There are medications for mood changes, depression, and anxiety. Some medications used for Parkinson’s and Alzheimer’s may help memory and movement problems.
In closing, untreated CTE may increase the risk of accidental death or suicide. Life expectancy for people with CTE is about 70 years old. Education and intervention is critically needed for this population.
If you have a history of repeated head traumas, be it sports, accidents, etc., please call us and we will certainly be able to help you understand your situation and what you can do about it.
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Robert B. Sica, Ph.D., ABN
Board-Certified in Neuropsychology
Director, Neuropsychological Rehabilitation Services|LifeSpan
Director, Post-Doctoral Fellowship Supervisor
Jersey Shore University Medical Center, Neuroscience Division
Department of Neurology and Psychiatry
Clinical Assistant Professor, Rutgers-Robert Wood Johnson Medical School
Clinical Assistant Professor, Hackensack Meridian School of Medicine