Understanding CTE: What You Need to Know About Chronic Traumatic Encephalopathy

Chronic traumatic encephalopathy, or CTE, is a serious brain condition caused by repeated head injuries. It is often discussed in the context of high-contact sports like football and boxing, but it can also affect people in other activities that involve repeated brain trauma, such as cycling or military service.

CTE was first identified in 1949 by neurologist Dr. MacDonald Critchley. Despite years of research, many questions about CTE remain. It’s still not clear how to diagnose it in living people, or if specific genetic or environmental factors increase the risk of developing it. However, what we do know is that CTE can arise from both concussions and subconcussive blows — those minor impacts that don’t seem harmful at first.

Dr. Ann McKee, who leads Boston University’s CTE Center, emphasizes the risk associated with these smaller, frequent impacts, which often occur during sports. She points out that the damage might come not just from severe injuries but from a long history of less severe ones.

The development of CTE is linked to the cumulative effects of head injuries. This means that the risk increases with more years of exposure to trauma. Key factors include how often a person gets hit and their age when they first sustained head injuries. Younger athletes may be more at risk because their brains are still developing, making them more vulnerable to damage.

Researchers also suggest that genetics could play a significant role. The ApoE4 gene variant seems to increase a person’s chances of developing severe CTE significantly compared to those with other variants.

CTE causes distinct changes in the brain. One notable feature is the buildup of tau proteins, which accumulate in specific patterns around blood vessels. This differs from similar proteins seen in Alzheimer’s disease. In CTE, tau tends to cluster in the areas most affected by repeated impacts.

As CTE progresses, people might start showing symptoms in their 20s, like depression or anxiety. More severe symptoms, such as memory problems and difficulties with decision-making, tend to emerge later, often in a person’s 60s or 70s. Some may experience symptoms much earlier, emphasizing the need for awareness and understanding of this condition.

Currently, CTE can only be reliably diagnosed after death through an autopsy. To identify it during life, doctors look at symptoms and medical history, but this can be complicated because CTE symptoms overlap with other disorders. Researchers are working hard to find better methods for diagnosing CTE while patients are still alive, including advanced brain scans and blood tests.

There is no cure for CTE right now. Treatment focuses on managing its symptoms, such as headaches, anxiety, or sleep problems. This might include therapy, lifestyle changes, and monitoring specific symptoms closely.

Contact sports like football, boxing, and ice hockey see the highest rates of CTE, especially among those who have had lengthy careers or positions with frequent impacts. Military veterans exposed to blast injuries and individuals experiencing repeated trauma due to violence are also at risk.

To help reduce the risk of CTE, many safety measures have been introduced in sports. These include limiting full-contact practices, improving helmet technologies, and enforcing stricter concussion protocols. For example, in hockey, the age for players to start full-contact has been raised to help young athletes develop stronger neck muscles before engaging in such physicality.

While there’s no way to completely eliminate the risk of CTE, raising awareness about the dangers of repetitive head trauma and recognizing concussion symptoms early can help. Ongoing studies continue to explore new diagnostic and treatment options, aiming for better outcomes for those affected by this condition.

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