Within the past two decades a relatively recently discovered disease has become more well known and rapidly increased in diagnosis amongst athletes across the world, Chronic Traumatic Encephalopathy (CTE). CTE is a neurodegenerative disease that causes progressive cognitive and motor impairment (Brain Injury Research Institute, n.d.). Dr. Bennet Omalu is primarily credited in the discovery of the disease in 2002 after examining the brain of the late ex-Pittsburgh Steeler and National Football League Hall of Famer, Mike Webster.
CTE is often characterized by the cognitive decline that often follows in those who have it. This decline can include memory loss, changes in behavior (most notably increased aggression), emotional instability, and confusion (Alzheimer’s Association n.d.). Prior to 2021, there was no official diagnostic criteria for CTE in individuals that were alive; it was exclusively only diagnosed in deceased individuals through autopsy. The diagnosis was marked by brain tissue degeneration and Tau protein buildup commonly seen in Alzheimer’s disease. These can be visually determined through brain imaging techniques like Magnetic Resonance Imaging (MRI) and Positron Emission Technology (PET) scans (Mayo Clinic, n.d.). The new diagnostic criteria that has been outlined by the National Institute for Neurological Disorders and Stroke (NINDS) includes: repeated exposure to head impacts and “progressive cognitive impairment”, or “neurobehavioral dysregulation” (ex. impulsivity, rage) or both (Boston University School of Medicine, 2021). Additionally, there can be no other medical, psychiatric, or neurological conditions linked to the presented symptoms (Boston University School of Medicine, 2021). Though CTE is commonly seen in individuals who have played high-contact sports (ex. American football), as more than 315 former NFL players have been diagnosed with the condition (Shpigel, 2021), it is not exclusive to athletes and can develop from accidents or combat in the military.
Though CTE was made widely known by Dr. Omalu in 2002, the disease did not originate in 2002. In fact, what is now known as CTE was previously called “punch drunk syndrome”. “Punch drunk syndrome” was used and cited in records as early as 1928 by Dr. Harrison Martland (Youmans, & Winn, H. R, 2011). Dr. Martland observed the disorder in boxers that obtained repetitive injuries, and considered it a form of dementia. The syndrome was subsequently named “dementia pugilistica” and was observed to show loss of neurons and Tau buildup as early as 1973 (Youmans, & Winn, H. R, 2011). There are four defined stages of CTE development (Fesharaki-Zadeh A, 2019). In stage 1, individuals may be asymptomatic or have “mild” behavior outburst and depression (Fesharaki-Zadeh A, 2019). Stage 2 and 3 mark severe depression, outburst and cognitive impairments (ex. memory) (Fesharaki-Zadeh A, 2019). In the final Stage 4, advanced language and motor movement impairments and psychosis are noted to occur. Though it was not determined which stage Mike Webster was in at the time of his death, he reportedly experienced memory loss and depression.
Research on CTE is still currently being conducted, and the condition is still not entirely understood. Those at high risk for the development of CTE are individuals who have prolonged exposure to head trauma, including wrestlers, boxers, high-contact sports players, military personnel, epileptics, and victims of domestic abuse. Despite the high risk amongst sports players, damage and further risk can be minimized through proper brain trauma care(Cleveland Clinic, n.d.). Currently, there are no treatment options for CTE, but with the recent establishment of criteria for CTE before death, there is hope for its application in future research and development of treatment.
References
Chronic Traumatic Encephalopathy (CTE). Alzheimer’s Association. (n.d.) https://www.alz.org/alzheimers-dementia/what-is-dementia/related_conditions/chronic-traumatic-encephalopathy-(cte)
Chronic Traumatic Encephalopathy. Cleveland Clinic. (n.d.) https://my.clevelandclinic.org/health/diseases/17686-chronic-traumatic-encephalopathy-cte
Chronic Traumatic Encephalopathy. Mayo Clinic. (n.d.) https://www.mayoclinic.org/diseases-conditions/chronic-traumatic-encephalopathy/diagnosis-treatment/drc-20370925
Fesharaki-Zadeh A. (2019). Chronic Traumatic Encephalopathy: A Brief Overview. Frontiers in neurology, 10, 713. New Criteria Published for Diagnosing the Clinical Syndrome of Chronic Traumatic Encephalopathy During Life. Boston University School of Medicine. (2021) https://www.bumc.bu.edu/busm/2021/03/16/new-criteria-published-for-diagnosing-the-clinical-syndrome-of-chronic-traumatic-encephalopathy-during-life/
Shpigel, Ben. What to Know about C.T.E. in Football. (2021). The New York Times https://www.nytimes.com/article/cte-definition-nfl.html.
What is CTE. Brain Injury Research Institute. (n.d.). http://www.protectthebrain.org/Brain-Injury-Research/What-is-CTE-.aspx
Youmans, & Winn, H. R. (2011). Youmans neurological surgery (6th ed.). Saunders/Elsevier.
Chronic Traumatic Encephalopathy. Cleveland Clinic. (n.d.) https://my.clevelandclinic.org/health/diseases/17686-chronic-traumatic-encephalopathy-cte
