What is Chronic Traumatic Encephalopathy (Long-Term Brain Injury and Contact Sports)?
Over the years, there has been growing interest in the study of brain injuries caused by sports activities, known as traumatic brain injury (TBI). The reference to this type of brain damage dates back to the 1920s when it was observed in boxers who often appeared “punch drunk”. In the following decade, it was named “dementia pugilistica”, or “boxer’s dementia”. However, in the 1940s, a new term, chronic traumatic encephalopathy (CTE), was introduced and has since become the preferred term.
The shift to using CTE in modern research was because it became known that brain injuries could occur from any sport or event, not just boxing, and could increase the risk of the neurodegenerative disease first seen in boxers. While initial attempts were made to differentiate “dementia pugilistica” from CTE or to label it as a subtype, they are now believed to be the same.
So, while “dementia pugilistica” is an important term historically, this discussion primarily targets the neurodegenerative disease that mostly results from sports-related brain injuries, now frequently referred to as CTE.
What Causes Chronic Traumatic Encephalopathy (Long-Term Brain Injury and Contact Sports)?
Chronic Traumatic Encephalopathy (CTE) is a condition predominantly linked to environmental factors, specifically the recurring head injuries sustained over years of playing contact sports like boxing, American football, rugby, hockey, or lacrosse. Given its similarities to Alzheimer’s disease, another brain disease that causes memory loss and affects behavior, it has been suggested that both might share some genetic risk factors.
One gene, known as apolipoprotein E (ApoE) e4 allele, has received a lot of attention as it may play a role in stopping the growth of nerve cells after brain injury. Besides potential genetic involvement, a range of other factors have been suggested to contribute to the development of CTE. These include various psychological and social factors, the age at which a person starts playing contact sports, and even the use of performance-enhancing drugs.
Risk Factors and Frequency for Chronic Traumatic Encephalopathy (Long-Term Brain Injury and Contact Sports)
Nearly two-thirds of Americans participate in some kind of organized sport. It’s estimated that between one and a half to four million concussions happen each year due to sports in the US. About 17% of people who have experienced multiple concussions or mild traumatic brain injuries (TBIs) may develop a condition called Chronic Traumatic Encephalopathy (CTE). A 2009 study showed that 90% of confirmed cases of CTE were among athletes. Out of these athlete cases, 85% were boxers, and 11% were football players. However, our understanding about how widespread CTE is continues to develop as we study more data from post-mortem examinations.
Signs and Symptoms of Chronic Traumatic Encephalopathy (Long-Term Brain Injury and Contact Sports)
Chronic Traumatic Encephalopathy (CTE) can only be diagnosed after death through a thorough examination of the brain tissue. As a result, all the information we have about its symptoms comes from looking back at the lives of people who were diagnosed with the condition after they died and talking to their family members. There are a number of behavioral, mood, cognitive and motor issues that have been linked to CTE:
- Behavioral problems like acting out aggressively or impulsively, or having explosive reactions
- Mood changes like feeling anxious or depressed, experiencing mood swings, or having thoughts of suicide
- Cognitive problems such as difficulties with focusing, memory problems, dementia, and trouble with tasks that require planning, organizing and making decisions
- Motor problems such as loss of coordination, trouble walking, and experiencing symptoms similar to Parkinson’s disease
Testing for Chronic Traumatic Encephalopathy (Long-Term Brain Injury and Contact Sports)
Currently, we don’t have any biological markers, or “biomarkers,” that can help diagnose Chronic Traumatic Encephalopathy (CTE), a brain condition. Right now, medical professionals can only confirm this diagnosis after an examination of brain tissue, which only happens after a person has passed away.
Although studies have found a significant decrease in certain proteins (ApoE and amyloid beta) in the cerebrospinal fluid (the fluid around the brain and spine) after traumatic brain injuries, we do not know whether the same can be said for CTE yet.
Therefore, these fluid biomarkers might become a tool for diagnosing CTE in the future. There’s also been talk of using neuroimaging techniques (like functional magnetic resonance imaging or MRI, diffusion tensor imaging, volumetric MRI, and a test known as a positron emission tomography) together with these fluid biomarkers to improve the way we diagnose CTE.
Treatment Options for Chronic Traumatic Encephalopathy (Long-Term Brain Injury and Contact Sports)
In efforts to reduce the number of concussions in team sports, stricter penalties for intentional head blows and “return to play” guidelines have been introduced. However, there’s a lack of evidence-based information on the best way to monitor an athlete’s brain function after a concussion, and there is no agreement on the right time for an athlete to return to play. Most advice suggests waiting until symptoms are completely gone before letting an athlete return to the field. Various psychological tests have found abnormalities in athletes who’ve had concussions, even up to five weeks after the injury. As a result, it might be necessary to wait at least a month before return to play, as the chances of experiencing another injury are higher right after a traumatic brain injury.
What else can Chronic Traumatic Encephalopathy (Long-Term Brain Injury and Contact Sports) be?
- Emergency treatment of stroke
- Urgent treatment of acute subdural hematoma in the ER
- Imaging techniques for Alzheimer’s disease
- Stroke affecting the front part of the brain
- Spread of cancer to the brain
- Brain aneurysms or weak spots in blood vessels in the brain
- Mental confusion conditions
- Different types of epilepsy causing brain disorders
- Excessive fluid in the brain known as Hydrocephalus