Chronic Traumatic Encephalopathy: Causes, Effects, And Prevention
Advances in neurology have led to a growing awareness within both the medical community and the general public regarding the dangers posed by traumatic brain injuries. Many observers have become particularly concerned about chronic traumatic encephalopathy (CTE), a progressive neurological disorder that appears to be linked to head injuries in athletes. If you or a loved one plays contact sports, you may be wondering how worried you should be about their cognitive health. This article will review what’s currently known about CTE, including the major risk factors and what can be done to prevent it.
Chronic traumatic encephalopathy is a type of neurodegenerative disease that may lead to cognitive impairment and dementia. Affected individuals typically display signs like disorientation, confused thinking, and problems with mood and memory. Research suggests that CTE results from repeated head injuries sustained over short periods, which can cause progressive damage and atrophy to brain cells. Current evidence points to reducing the number and force of head injuries to at-risk individuals as the best available strategy for preventing CTE. Those who have symptoms of CTE or are experiencing anxiety about developing it may benefit from working with a licensed therapist to learn healthy coping skills.
What are the symptoms of chronic traumatic encephalopathy?
At present, CTE can only be identified by physically examining the brain of an affected individual after their death. This means no combination of symptoms can be used to definitively diagnose a living individual with this condition.
However, a 2014 review of more than 200 confirmed cases of CTE identified many common symptoms of traumatic encephalopathy syndrome, a pathology that could indicate the presence of CTE. The symptoms can be grouped into four categories:
- Cognitive symptoms
- Mood symptoms
- Behavioral symptoms
- Motor symptoms
#1: Potential cognitive symptoms of CTE
- Attention and focus
- Memory
- Keeping track of complex tasks
- Visual and spatial perception
- Speech, writing, and general language use
- Shifting between ideas and concepts
- Self-awareness
These challenges typically worsen over time, and in many cases, they eventually progress to dementia. Cognitive impairments tend to be strongly associated with the brain pathology that defines CTE and may be among its most characteristic signs.
#2: Potential mood symptoms of CTE
Disturbances in mood and emotion can also be commonly observed in people with chronic traumatic encephalopathy, including those listed below:
- Mood swings
- Irritability
- Apathy or loss of interest in activities
- Flattened emotions
- A sense of hopelessness
- Mania or euphoria
- Suicidal thoughts and intentions
In practice, it can be hard to distinguish these changes from the symptoms of psychiatric conditions like depression and anxiety, so they may not be reliable indicators of CTE on their own.
#3: Potential behavioral symptoms of CTE
Atypical patterns of behavior can also be common in people who are later found to have had CTE. Below are several possible symptoms:
- Socially inappropriate behavior
- Lack of impulse control
- Aggression or explosive anger
- Personality changes
- Paranoia
- Social withdrawal
- Exaggerated boastfulness
Behavior changes may also be easily confused with the symptoms of other mental or neurological disorders.
#4: Potential motor symptoms of CTE
Some people with CTE may display difficulties with movement, though these tend to be less common and may represent a distinct subtype of traumatic encephalopathy syndrome. These symptoms can include the following:
- Poor motor control and coordination
- Gait disturbances
- Muscle weakness
- Parkinsonism (tremors, stiffness, and slowed movements)
- Facial paralysis and difficulty speaking
What causes chronic traumatic encephalopathy?
While more research may be needed to fully understand how CTE develops, the existing evidence strongly suggests that one of the most significant risk factors is sustaining multiple instances of head trauma.
CTE seems to be most common in athletes involved in high-contact sports — the earliest medical descriptions of the syndrome applied to boxers who had sustained repeated blows to the head.
A sufficiently forceful impact to the head can result in a traumatic brain injury as the brain rapidly accelerates and slows again, which can cause the nerve cells to stretch and deform. This may lead to tearing and bleeding, potentially disrupting the integrity of cell walls and blood vessels.
The inflammation caused by repeated brain injuries of this kind seems to cause a buildup of malformed proteins and protein fragments in and around the damaged cells. This can interfere with the healthy functioning of the affected neurons, and it can ultimately result in cell death and brain atrophy. The process appears to be similar to the pathology of Alzheimer’s disease, although the specific patterns of protein accumulation may be somewhat different.
Many kinds of head injury may put people at risk for chronic traumatic encephalopathy. The most well-known cases involve sports where high-speed head collisions are common, such as those listed below:
- American football
- Rugby
- Soccer (particularly in players who frequently headbutt the ball)
- Boxing
- Wrestling
- Mixed martial arts
- Ice hockey
Exposure to explosive blasts in military or law enforcement work may also be a significant risk factor for traumatic brain injuries and CTE, though research in this area is still developing. Survivors of physical domestic abuse and other forms of repeated violence could also be at higher risk.
Do concussions cause CTE?
Media discussions of chronic traumatic encephalopathy often associate it with concussions, a specific type of minor brain injury that typically involves symptoms like dizziness, nausea, slurred speech, and blurred vision. Yet the evidence suggests that sustaining concussions is not a necessary precondition for developing CTE. Many people develop neurological signs of chronic traumatic encephalopathy with no concussion history.
In other words, it’s likely possible to develop CTE even from mild traumatic brain injuries that aren’t severe enough to cause concussions. The number of repetitive head impacts seems to be a better predictor of disease pathology than the number of concussions.
Can CTE be treated or cured?
Chronic traumatic encephalopathy can be described as a chronic and progressive neurodegenerative condition, with symptoms that normally continue to worsen over time. Current brain injury medicine has no treatment that can prevent or reverse a patient’s decline.
Researchers are investigating treatments that might one day be able to halt the progress of this condition. Examples include medications targeting the malformed proteins or harmful inflammatory responses that contribute to the neurological degeneration involved in CTE. These methods are still highly experimental, and it’s not clear yet whether they’ll be effective.
Current treatment approaches typically focus on managing symptoms and helping individuals retain as much functional capacity as possible. This can include supportive therapies meant to improve cognitive and motor capacities. Certain medications might also help with mood and memory symptoms.
Preventative measures for chronic traumatic encephalopathy
Based on current knowledge, the best strategy for reducing the problems associated with CTE appears to be reducing the incidence of brain injury. This may require limiting participation in high-impact activities, such as certain kinds of sports.
For example, one study examining football players found that the only factors affecting the prevalence of CTE were the number of years an individual played and the frequency and strength of head impacts they experienced. Researchers estimated that each additional year of play raised the risk of CTE by about 15%.
Without changes to play style that reduce the number and forcefulness of collisions, players might need to limit the lengths of their active careers to lower their risk of encephalopathy. No protective equipment currently available appears to make a difference.
Taking sufficient time to rest after a blow to the head could be an additional preventive measure. Sustaining multiple injuries in a short period without allowing the brain to fully recover might contribute to CTE risk. That said, it’s not yet clear how much time for recuperation is needed.
Another measure that might help is improving cognitive reserve, meaning the complexity and flexibility of neuronal networks. Evidence from dementia research indicates that engaging in cognitively stimulating activities may increase the number of pathways by which the brain can process information and tasks, slowing down the rate of mental decline in conditions like Alzheimer’s disease.
Some studies have found evidence that this process might also slow the progression of CTE. Enriching activities like the following may contribute to cognitive reserve:
- Reading
- Learning new skills
- Participating in creative hobbies
- Getting regular exercise (without head collisions)
- Socializing and meeting new people
What should you do if you think you might have CTE?
If you’re concerned about your cognitive health after a history of activities that pose a risk for CTE, you may want to ask your primary care doctor for a referral to a neurologist. An examination by a medical specialist can give you a firmer idea of how well you’re functioning and what your options may be.
Remember that CTE can’t be definitively diagnosed during an individual’s lifetime. Even if you’re experiencing cognitive challenges, it doesn’t necessarily mean you have a neurodegenerative disease. Some forms of cognitive impairment can be reversed or prevented from worsening.
You might also benefit from talking with a mental health professional, since symptoms of psychological conditions like anxiety and depression, as well as signs of physical conditions like sleep apnea, can be mistaken for CTE symptoms.
If you’re unsure where to start looking for assistance, online therapy may be a good option. Internet mental health care services can quickly match you with a licensed professional who fits your individual preferences.
Evidence suggests that online psychotherapy can manage a variety of mental health complaints. A 2020 review of 19 different clinical trials found that online cognitive behavioral therapy could be an effective treatment for depression and anxiety, which suggests that it could reduce some of the symptoms that commonly mimic CTE.
Takeaway
Some mental health conditions can mimic the symptoms of CTE, and online or in-person therapy can be an effective way to address them. In addition, individuals who are experiencing stress or anxiety about possibly developing CTE may benefit from working with a licensed mental health professional.
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