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In-Depth: What is chronic traumatic encephalopathy (CTE)?

Ann McKee
Posted at 11:41 AM, Dec 16, 2021

TAMPA, Fla. — CTE, the mysterious brain disease that often strikes athletes, especially football players, made headlines this week with news that the late Tampa Bay Buccaneers wide receiver Vincent Jackson was battling the degenerative disease when he took his life.

Jackson’s diagnosis was the second this week of a former NFL player who died. Former NFL player Phillip Adams was also diagnosed with Stage 2 CTE. He also died of suicide in April after he murdered six people in South Carolina.

There are lots of questions around CTE, so ABC Action News is taking a deeper look at what CTE is, how it’s being diagnosed, and more on the topic.

What is CTE?
According to Boston University, the leading research center for the disease, CTE is Chronic Traumatic Encephalopathy. It’s a “progressive degenerative disease of the brain found in people with a history of repetitive brain trauma (often athletes), including symptomatic concussions as well as asymptomatic subconcussive hits to the head that do not cause symptoms.”

The disease has only recently been named CTE and was previously known to impact boxers dating back to the 1920s when it was called “punch drunk syndrome or dementia pugilistica.”

What does CTE do to the brain?
Boston University’s CTE Research Center said the repeated trauma to the brain ends up triggering a progressive degeneration of brain tissues that includes a buildup of an abnormal protein in the brain called tau.

The Concussion Legacy Foundation, which credits BU’s research, said the tau protein “misfolds and malfunctions” which “causes other proteins to misfold, and sets off a chain reaction” where the misfunctioning tau protein “spreads throughout the brain, killing brain cells.”

What are the symptoms of CTE?
The symptoms of CTE can often mirror other diseases, which makes tracking the disease difficult. The symptoms include memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, anxiety, suicidality, parkinsonism (symptoms of Parkinson’s disease), and eventually progressive dementia.

The United Kingdom’s National Health Service said the symptoms of CTE will vary but are similar “to those of other types of degenerative brain conditions, particularly Alzheimer’s Disease.” It listed symptoms including “short-term memory loss, changes in mood/frequent mood swings, increasing confusion and disorientation, and difficulty thinking.” The NHS also said late symptoms include slurred speech, significant memory problems, and parkinsonism.

Can you get CTE from one concussion?
Boston University said current research leads scientists to believe the disease is caused by “repetitive brain trauma.” That said, researchers don’t know the exact number of hits that are needed to trigger the disease. Boston University researchers said other factors “such as genetics” may play a role in the development of CTE in some people.

Plus, it’s important to remember that researchers believe sub-concussive hits or other hits to the head that don’t cause full-blown concussions can also be a factor in the development of CTE.

Does everyone who has multiple concussions get CTE?
Here is one of the issues researchers are facing when trying to find ways to fight CTE. Not everyone who suffers repeated concussions or sub-concussive hits will develop CTE.

Still, according to the Concussion Legacy Foundation, “CTE is most frequently found in contact sport athletes and military veterans. CTE has been found in individuals whose primary exposure to head impacts was through tackle football (500+ cases confirmed by BU), the military (50+ cases), hockey (30+ cases), boxing (20+ U.S. cases, 50+ globally), rugby (10+ cases), soccer (20+ cases globally), pro wrestling (5+ cases), and fewer than three cases each in basketball, baseball, domestic violence, and individuals with developmental disorders who engaged in head banging behaviors.”

CTE sounds like Alzheimer’s Disease; what are the differences?

While the disease are similar, there are major differences between both. Researchers said CTE symptoms typically begin earlier in life (40’s) than those of Alzheimer’s (60’s). According to Boston University researchers, the initial and central symptoms of Alzheimer’s “involve memory problems” while the initial symptoms of CTE often involve “problems with judgment, reasoning, problem-solving, impulse control, and aggression.” Scientists said the diseases also show differences in postmortem analysis of the infected brains.

Can CTE be diagnosed?
Unfortunately, the answer is no. There currently is no testing or way to use any brain imaging technology to diagnose CTE while a patient is alive. The only way to diagnose CTE is through post-mortem neurological analysis, often conducted by the VA-BU-CLF Brain Bank. Researchers hope to be able to develop techniques to diagnose CTE while a patient is alive and are conducting researcher to find a way to diagnose the disease.

Can CTE be cured or treated?
While there is no test for CTE, research is ongoing to find treatments and to give patients a better quality of life. There currently is no cure for CTE, but the Concussion Legacy Foundation said on their page for treatment questions, “there are many therapies available to treat the symptoms associated with CTE.”

Still, as Boston University wrote, “If you suspect you have CTE, it is also important to remember that you may not have the disease. Therefore, focusing on treating the symptoms is currently the best approach.”

Sources: Boston University CTE Center; Concussion Legacy Foundation; Indiana University School of Medicine; UK National Health Service