Definition

Chronic traumatic encephalopathy (CTE) is a deterioration of the brain. It is caused by the buildup of a protein called tau. The brain damage caused by CTE can lead to severe mental and physical disabilities. The condition gets worse over time.

Causes

Researchers have a found a link between repetitive head injuries and CTE. The head injury may involve:

• A blow or jolt to the head
• Severe jarring or shaking
• Abruptly coming to a stop

Over time, these injuries can lead to abnormal groups of tau proteins. These proteins can create tangled masses in the brain. The tangles can block normal brain function. Similar tangles are seen in people with Alzheimer’s disease.

Risk Factors

Having a history of head injuries puts you at risk for CTE later in life. People who may be at the highest risk include those who:

• Participate in contact sports, especially professional boxers, football players, hockey players, wrestlers, and soccer players
• Have been in combat military service
• Have been physically abused
• Have severe seizures
• Have a developmental disability and engage in self-abusive behavior (head banging)

Symptoms

Symptoms include:

• Depression, including feeling suicidal
• Paranoia
• Aggression
• Apathy
• Irritability
• Agitation
• Impulsiveness
• Poor concentration
• Memory problems
• Confusion
• Poor judgment
• Tremor
• Muscle twitching

The symptoms may develop many years after the head injuries.

Diagnosis

Your doctor will:

• Ask about your symptoms.—It is important that you and your family members talk about any behavior or personality changes that you have had.
• Take your medical history.—Your doctor will focus on your history of head injuries
• Do a physical exam.

To gain more information about your brain and to rule out other conditions, your doctor may order tests, such as:

• CT scan
• MRI scan
• PET scan
• Blood tests
• Neuropsychological tests

At the present time, the only way to clearly diagnose CTE is for a doctor to examine the brain after a person has died. This is how researchers are learning more about CTE.

Treatment

Treatment for CTE is an area that is being studied. Depending on your symptoms, though, your doctor may recommend:

• Taking certain medicines (eg, antidepressants, antipsychotics, mood stabilizers)
• Making lifestyle changes, such as exercising regularly, eating a healthy diet, and avoiding alcohol and drugs
• Working with a therapist and joining a support group to help with the emotional challenges

You may be referred to a doctor who specializes in head injuries.

Prevention

When playing sports, you can reduce your risk of CTE by:

• Following your doctor’s instructions after suffering a concussion—This includes waiting to return to sports until your doctor says it is safe to do so.
• Avoiding dangerous game play
• Wearing proper protective equipment (such as helmets)

Other steps that you can take to reduce head injuries off the field include:

• Wear a helmet when doing any at-risk activity, like riding a motorcycle or bicycle, skiing, snowboarding.
• Wear a seatbelt in the car.
• Do not drink and drive or get into a vehicle with someone who is under the influence.
• Make your home safe (eg, remove items that you could easily trip over, install night lights).
• Get help right away if you are in an abusive relationship.

Sports Legacy Institute http://www.sportslegacy.org/

Ontario Brain Injury Association http://www.obia.on.ca/

Chronic traumatic encephalopathy. Sports Legacy Institute website. Available at:
http://www.sportslegacy.org/cte-concussions/what-is-cte/
Accessed May 29, 2012.

Kowall N. Chronic traumatic encephalopathy (CTE) and its connection with ALS. US Department of Veterans Affairs website. Available at:
http://www.va.gov/RAC-GWVI/docs/Minutes_and_Agendas/Minutes_Nov2010_AppendixA_Presentation7.pdf
Published November 2010. Accessed May 29, 2012.

LaVecchia F. Traumatic brain injury. Indian Health Service website. Available at:
http://www.ihs.gov/suicidepreventionsummit/documents/TraumaBrainInjuryLaVecchiaPresentation.pdf
Accessed May 29, 2012.

McKee A, Cantu R, Nowinski C, et al. Chronic traumatic encephalopathy in athletes: progressive tauopathy following repetitive head injury. J Neuropathol Exp Neurol. 2009; 68(7):709-735.

Moderate to severe traumatic head injury. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed/
Updated April 5, 2010. Accessed May 29, 2012.

Navarro R. Protective equipment and prevention of concussion—what is the evidence. Sports Physical Therapy Section website. Available at:
http://www.spts.org/assets/files/CSMR%20Concussion%20equipment.pdf
Published 2011. Accessed May 29, 2012.

NINDS Encephalopathy information page. National Institute of Neurological Disorders and Stroke website. Available at:
http://www.ninds.nih.gov/disorders/encephalopathy/encephalopathy.htm
Updated November 9, 2010. Accessed May 29, 2012.

Prevention: What Can I do to Help Prevent Concussion and other forms of TBI? Centers for Disease Control and Prevention website. Available at:
http://www.cdc.gov/traumaticbraininjury/prevention.html
Updated May 16, 2012. Accessed May 29, 2012.

Traumatic brain injury: hope through research. National Institute of Neurological Disorders and Stroke website. Available at:
http://www.ninds.nih.gov/disorders/tbi/detail_tbi.htm#193693218
Updated May 14, 2012. Accessed May 29, 2012.

What is CTE? Center for the Study of Traumatic Encephalopathy website. Available at:
http://www.bu.edu/cste/about/what-is-cte/
Accessed May 29, 2012.