Chronic traumatic encephalopathy (CTE): Causes-Symptoms-Diagnosis-Treatment


 What Is Chronic traumatic encephalopathy (CTE)?

(CTE) The cause for Chronic traumatic encephalopathy (CTE) was discovered by Dr Bennet Omalu during an autopsy of former Pittsburgh Steelers center Mike Webster in 2002. At that time CTE had never been reported on in the medical literature and very little research had been done about its causes or effects on people who suffer from it Dr Omalu's discovery of CTE opened up a world of possibilities as to how to help football players protect themselves from this debilitating brain disease and others who are at risk Just like other degenerative diseases such as Alzheimer's disease researchers have found.

What Is Chronic traumatic encephalopathy (CTE)?
traumatic encephalopathy (CTE)

The effects of concussions and other mild brain injuries associated with football have been well documented but something else might be lurking in the brains of former NFL players A new study from researchers at Boston University shows that former NFL players are at risk for developing chronic traumatic encephalopathy (CTE) due to repeated blows to the head Researchers studied the brains of 85 people who had played contact sports They found abnormalities in nearly all of them -- including athletes from high school down to semi professional levels The findings were published in July 2013 issue of "JAMA Neurology."

(CTE) Chronic traumatic encephalopathy (CTE) sometimes referred to as "dementia pugilistica," is a neurodegenerative disease found in some people who have experienced repeated brain trauma It has been most closely associated with boxing but CTE has also been diagnosed in contact sport athletes and military veterans.

Medical terms

  • Chronic traumatic encephalopathy is the term used to describe brain degeneration caused by repeated head traumas A diagnosis of chronic traumatic encephalopathy can only be made at autopsy where a section of the brain is studied

  • CTE is a rare disorder that is not yet well understood; CTE is not related to the immediate consequences of a late-life episode of head trauma; CTE has a complicated relationship with head traumas such as persistent post-concussive symptoms and second impact syndrome that occur earlier in life.

  • Scientists are still trying to understand how head traumas and other factors can contribute to brain changes in athletes

  • Cognitive dysfunction can be found in the brains of people who played sports like football and boxing as well as those exposed to explosive blasts Symptoms may include difficulties thinking (cognition) and emotions and physical symptoms like changes in mood or behavior These problems are thought to develop years or decades after head trauma occurs

  • CTE may not be diagnosed during life except in those rare individuals with high-risk exposures Researchers do not yet know the frequency of CTE in the population and do not understand the causes There is no cure for CTE Researchers are currently developing diagnostic biomarkers for CTE; however this process is lengthy and expensive but none has been fully validated yet.

Symptoms Chronic traumatic encephalopathy (CTE)

There are no specific symptoms that have been clearly linked to CTE Some of the possible signs and symptoms of CTE are not present in many other conditions In the few people with proved CTE signs and symptoms cognitive behavioral mood and motor changes have been reported

Cognitive impairment

  • Impairment of thinking ability

  • Memory loss

  • There will be problems with planning and carrying out tasks because of the executive functions

Behavioral changes

  • Impulsive behavior

  • Aggression

Mood disorders

  • Depression or apathy

  • Emotional instability

  • Substance misuse

  • Suicidal thoughts or behavior

Motor symptoms

  • Parkinsonism

  • Motor neuron disease

CTE symptoms do not develop right after a head injury Experts believe that they may develop over years or decades after repeated head trauma Experts currently believe that the first form of CTE only appears in young adults between the late 20s and early 30s In this form CTE causes brain degeneration and dementia with symptoms including memory loss and depression The second form of CTE is associated with more severe brain damage than the first which may cause dementia over decades rather than years Cerebrovascular disease is a form of CTE that occurs to people who are 60 years and older Symptoms often develop between the ages of 50 and 60 progress to dementia and cause problems in memory thinking and behavior

The full list of symptoms that can be found at autopsies of people with CTE is still not known It is unclear what kind of symptoms CTE may cause in life Little is known about how CTE progresses

When to see a doctor

CTE is thought to develop over many years after repeated brain injuries that may be mild or severe However if you experience any of the following symptoms see your doctor:

  • Suicidal thoughts.Research shows that people with CTE may be at increased risk of suicide If you think about hurting yourself call 911 

  • Head injury.If you have had a head injury even if you did not need emergency care see your doctor If your child has received a head injury that concerns you call the doctor immediately Depending on the signs and symptoms of your child's head injury your doctor may recommend seeking immediate medical care

  • Memory problems.If you have any concerns about your memory or thinking (cognitive) or behavior see your doctor

  • Personality or mood changes.If you experience depression anxiety aggression or impulsive behavior you should see your doctor

Causes Chronic traumatic encephalopathy (CTE)

Repetitive head trauma is related to CTE in football and ice hockey players as well as military personnel serving in war zones However other sports and factors such as physical abuse also can lead to repetitive head injuries

However not all athletes and not everyone who experiences repeated concussions include military personnel go on to develop CTE Some studies have shown no increased incidence of CTE in people exposed to repeated head injuries

Scientists in CTE have found the tau protein around blood vessels which is different than accumulation of the protein observed in Alzheimer’s disease and other forms of dementia Tau buildup in CTE is thought to cause areas of the brain to waste away Injuries to the sections of nerve cells that conduct electrical impulses affect communication between cells

People with CTE may also show signs of other neurodegenerative diseases including Alzheimer's disease ALS (also known as Lou Gehrig's disease) Parkinson's disease or frontotemporal lobar degeneration Alzheimer's Disease (AD)

Risk factors Chronic traumatic encephalopathy (CTE)

Repeated exposure to traumatic brain injury is thought to increase the risk of CTE But we are still learning about the risk factors

Prevention Chronic traumatic encephalopathy (CTE)

There is no treatment for CTE However CTE may be prevented by reducing the number of mild traumatic brain injuries and limiting head injury Individuals who have suffered one concussion are more likely to suffer another head injury Current recommendations are to prevent CTE by limiting mild traumatic brain injuries and preventing head injuries There may be additional injury after a concussion

What is the life expectancy of a person with CTE?

How your brain functions both in terms of memory and judgment starts to deteriorate once you’re old enough to drink Memory loss cognitive impairment and reduced impulse control are the most common consequences of aging A recent study showed that a person with chronic traumatic encephalopathy (CTE) has an average age of death of 55 – years younger than someone without CTE.

Football players are exposed to repeated episodes of head trauma which have the potential to cause Chronic Traumatic Encephalopathy (CTE) CTE is a degenerative brain disease that can cause significant behavioral and cognitive changes The signs and symptoms associated with CTE usually become evident soon after retirement from contact sports.

Can you live a normal life with CTE?

Yes while the effects of CTE will vary from person to person depending on the extent of their brain injury and how long it is allowed to progress people with CTE can function normally in daily life It is important for people with changes related to head trauma including those diagnosed with mild cognitive impairment (MCI) or dementia due to head trauma to seek treatment for their injuries as quickly as possible Early detection allows for better outcomes such as improving memory and mental processing so that a patient can remain alert and active.

Typically considered a neurodegenerative disease CTE is typically associated with repeated blows to the head or concussions Research has also linked the condition with post-traumatic stress disorder which can cause even more damage in those who have suffered from intermittent brain trauma Although research is ongoing doctors believe that there may be two forms of CTE: One that develops over time and another linked to head trauma from such injuries as war Whatever the case it's clear that additional research is needed so doctors can get a better understanding of how to diagnose and treat this devastating condition.

Diagnosis Chronic traumatic encephalopathy (CTE)

There is currently no way to diagnose CTE (chronic traumatic encephalopathy) It can only be suspected when someone has a history of repeated head trauma and signs of degeneration in the brain such as changes in thinking and memory A diagnosis requires evidence of deposits of tau protein also called “tau tangles,” as well as other proteins that have been discovered in the brains of people who died with CTE A brain that can only be seen upon inspection after death (autopsy)

Some researchers are actively searching for a test to detect CTE in living patients who participate in sports Others continue to study the brains of deceased individuals such as former football players whose brains may have been damaged by CTE

The hope is that a range of neuropsychological tests and brain imaging such as specialized MRI tests and biomarkers will aid in diagnosis

PET scans

A positron emission tomography (PET) scan uses a low-level radioactive tracer that is injected into a vein Then a scanner tracks the tracer's flow through the brain Researchers are actively working to develop PET markers to detect tau abnormalities associated with neurodegenerative disease in Alzheimer's and other dementias People who are living

Researchers are also working to develop tracers that target tau protein in the brain and other proteins on PET scans Studies of retired athletes who experienced concussions are underway using these types of scans to look for tau buildup in their brains Researchers are also using PET scans with tracers to look for tau buildup in the brains of retired football players who have suffered head injuries as well as Parkinson’s patients Alzheimer’s patients and those suffering from depression or anxiety disorders This study is in a research phase and not available for clinical testing

Other tests

There is little research on plasma or cerebral spinal fluid to diagnose the long-term disease processes of CTE Some biomarkers that are used in Alzheimer’s disease research may be useful for CTE because the conditions are similar These biomarkers would need to identify brain tissue and determine if the condition is progressive or permanent disease from CTE is separate from the original brain trauma

Treatment Chronic traumatic encephalopathy (CTE)

CTE a progressive degenerative brain disease for which there is no treatment requires research in medical treatments that can stop the progression of CTE In addition to avoiding head injuries it is also important to stay informed about the latest recommendations for detecting and managing traumatic brain injury

Preparing for your appointment

You may start by seeing your family doctor who will probably refer you to a neurologist psychiatrist neuropsychologist or other specialist for further evaluation

Before your appointment make sure you have everything you need such as a list of questions for the doctor You may also want to bring any paperwork that is relevant to your condition and information about any medications you are taking

What you can do

  • Be aware of any pre-appointment restrictionsWhen you make this appointment ask if there is anything you need to do in advance Ask if you need to fast for blood tests

  • Write down any symptoms, Your doctor may ask questions about your mental function such as thinking clearly and remembering things In addition to answering these questions you can mention any concerns related to your mental status If you think that something is wrong with your mind remember the first time that you thought this way You should also tell your doctor if problems are getting worse over time ready to explain why and be prepared to discuss specific examples

  • Write down key personal information,The stress and recent changes can include any major stresses or recent life changes

  • Make a list of all medications,vitamins or supplements that you're taking.

  • Make a list of any other medical conditions you have including diseases that you currently have such as diabetes or heart disease and past diseases including strokes

  • Take a family friend or caregiver alongSometimes it can be difficult to recall all the information provided during an appointment Someone who accompanies you may remember something that you missed or forgot

Preparing a list of questions will help make the most of your time with the doctor Prioritize questions from most important to least important Some basic questions to ask the doctor include:

  • What is likely causing symptoms?

  • Are there other possible causes for your symptoms?

  • What kinds of tests are needed?

  • Is my condition likely temporary or chronic? How will it likely progress over time?

  • What's the best course of action?

  • What are other approaches to the primary approach being suggested?

  • How can I manage my other medical issues with your treatments?

  • Are there any trials of experimental treatments I should consider?

  • Are there any restrictions?

  • If medications are being prescribed there may be a potential interaction with other medications I am taking

  • Do you have any brochures or other printed materials that I can take home with me? What websites do you recommend?

  • You should call your insurance provider to find out if you will be covered for a specialist visit If not you may need to pay some of the cost yourself or have your insurer pay the costs

If you have a concussion ask your doctor these questions:

  • What is the risk of future concussions?

  • When will it be safe to resume competitive sports activities?

  • When will it be safe to resume vigorous exercise?

  • Is it safe to return to school or work?

  • Is it safe to drive a car or operate power equipment?

When you don’t understand something ask questions That way your practitioner can explain the treatment all the way through

What to expect from your doctor

The doctor may ask you a series of questions

Questions related to symptoms:

  • What are the symptoms you are experiencing? Are you having any trouble with word-use memory, focus personality or directions?

  • When did symptoms begin?

  • Symptoms are worsening or they sometimes improve and sometimes worsen

  • How severe are symptoms?

  • Have you stopped doing certain activities such as managing finances or shopping because of difficulty thinking through them?

  • How do you feel about the various ways to treat your symptoms?

  • Have you noticed any differences in your reaction to people or events?

  • How much energy do you have right now?

  • Have you noticed any trembling or bother walking?

Questions related to health history:

  • Have you gotten your hearing and vision checked recently?

  • If there is a family history of dementia it's important to be tested

  • What medications are you currently taking? Are any of your medications for migraines depression arthritis or high blood pressure?

  • Do you drink alcohol? How much?

  • What other health conditions are you being treated for?

If you have had a concussion your doctor may ask questions about the injury and events surrounding it

  • Have you had any previous head injuries?

  • Do you play contact sports?

  • How did you get this injury?

  • What did you experience immediately after the injury?

  • Do you remember what happened before and after the injury?

  • Did you lose consciousness after being injured?

  • Did you have seizures?

Questions related to physical signs and symptoms Questions such as "What is the difference between a fever and a cold?" or "What is an earache?" or "Why do I have chest pain?" etc

  • Have you experienced nausea or vomiting since the injury?

  • Have you been hurting your head? How soon after the injury did your headaches start?

  • Have you noticed any difficulty with physical coordination since the injury?

  • Have you noticed any sensitivity or problems with your vision and hearing?

  • Do you notice changes in your sense of smell or taste?

  • How is your appetite?

  • Do you still feel lethargic or easily fatigued?

  • Are you having trouble sleeping or waking up?

  • Do you have any dizziness or vertigo?

Questions related to cognitive or emotional signs and symptoms:

  • How are your memories and concentration since the injury?

  • Have you noticed any changes in your mood such as irritability or anxiety?

  • Have you ever thought about hurting yourself or others?

  • Have you noticed or have others commented that your personality has changed?

  • What do you think is wrong? What other symptoms are you concerned about?

General summary

  1. Traumatic brain injury is a major risk for many athletes both amateur and professional In addition to causing death and disability even mild concussions can contribute to long-term mental health problems such as dementia pugilistica (or chronic traumatic encephalopathy) or post-concussion syndrome According to the Brain Injury Association of America an estimated 1.5 million Americans suffer traumatic brain injuries in sports and recreational activities each year; 300,000 of those are treated in emergency rooms.
  2. According to Dr Bennet Omalu, a forensic pathologist who studied the brains of deceased NFL players and linked concussions sustained on the football field with chronic traumatic encephalopathy (CTE) "the disease is caused by repetitive blows to the head that produce cumulative damage in some areas of the brain." CTE can only be definitively diagnosed post-mortem but most symptoms are readily apparent during life While many people with CTE experience personality changes including irritability and depression others demonstrate visual or verbal memory impairment--both skills required for playing football at a high level--or impaired judgment leading to reckless behavior such as excessive risk.
  3. CTE is a degenerative brain disease most often found in athletes military veterans and others who have experienced repeated head trauma CTE symptoms are caused by an abnormal buildup of a protein called tau within the brain The damage from tau leads to problems with memory behavior movement and thinking — similar to how Alzheimer’s disease progresses There's no test for CTE during life but doctors may suspect it based on symptoms you or your loved one experience The diagnosis is confirmed only after death.

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