Chronic traumatic encephalopathy (CTE) is a problem that can be seen mainly in amateur or professional athletes and military personnel engaged in contact sports such as boxing, American football, hockey, soccer. It is associated with repetitive head injuries. Repetitive traumas cause brain damage and accumulation of proteins called tau. Although the causal relationship is clear, the mechanism of formation is not yet fully understood.
Chronic traumatic encephalopathy is a neurodegenerative disease. It occurs during the retirement years of athletes.
Concussion is the temporary inability of the brain to perform its normal functions as a result of trauma. Although there are no external signs of head trauma in concussion, the brain is affected by the impact. Impacts that do not cause any symptoms are called subconcussive head bumps.
Chronic traumatic encephalopathy has also been reported in individuals without a history of concussions, but who were exposed to subconcussive head blows. The more years of exposure to such impacts, the greater the risk of developing an RTE. On the other hand, occasional blows to the head, such as when a child is learning to walk, do not lead to RTE.
It is thought that a complex series of events are triggered in the brain as a result of repetitive traumas. Abnormal, hyperphosphorylated tau proteins (p-tau) accumulate in white matter. Widespread neurodegeneration develops with the spread of P-tau proteins to large areas of the brain.
Changes in the brain can affect a person’s thoughts, feelings, and actions. Not everyone has the same symptoms. For some people, the first symptom may be depression and anxiety. Then memory and other cognitive skills may be impaired. This situation can be severe enough to affect the person’s daily life, work and social life. Memory and cognitive skills may be affected first, and mood and personality changes may occur later. Irritability and impulsive behavior can be seen. There may be loss of coordination, tremors, and a tendency to fall.
Symptoms of CTE show mainly two different patterns. In early-onset disease, the first symptoms appear before the age of 35. It is characterized by personality and emotional changes. Cognitive disorders occur in the later stage of the disease.
The average age for late-onset disease is around 60 years. The first symptoms are cognitive disorders. Most people have a combination of cognitive, emotional, and personality disorders. Although there is a clinical picture similar to Alzheimer’s disease in advanced disease, Alzheimer ‘s disease findings are not observed in neuropathological examination of the brain.
The first step in diagnosis is questioning symptoms (medical history) and physical examination in people with risk factors. Additional investigations such as imaging and blood work may be done to rule out other possible causes. In fact, the definitive diagnosis of chronic traumatic encephalopathy can only be made by examining the changes in the brain after death. For this reason, it may not be possible to make this diagnosis to people in life. CTE does not occur in everyone who has had recurrent head trauma, and the symptoms of this disease can also be seen in other neurodegenerative diseases.
There is no definitive treatment. Depending on the nature of the symptoms, supportive treatments may be recommended. Physical therapy can be helpful in movement disorders. It may be possible to reduce the incidence of the disease by preventing head trauma.