Overview
Chronic traumatic encephalopathy (CTE) is a brain disorder likely caused by repeated head injuries. It leads to the death of nerve cells in the brain, causing degeneration. CTE worsens over time, and the only definitive diagnosis can be made after death during an autopsy of the brain. It is primarily associated with repeated head injuries, often occurring in contact sports or military combat. The development of CTE has been linked to second impact syndrome, where a second head injury happens before the symptoms of the first head injury have fully resolved.
Understanding the disease
Symptoms
The symptoms of chronic traumatic encephalopathy (CTE) can develop over time and are related to repeated head injuries. Some of the symptoms include:
- Parkinsonism: This involves symptoms such as shaking, slow movement, and difficulty with speech.
- Motor neuron disease: This condition affects cells that control walking, speaking, swallowing, and breathing.
- Mental health and behavioral issues: In the early form of CTE, symptoms may include depression, anxiety, impulsive behavior, and aggression.
- Memory and thinking problems: These symptoms are more likely to appear in the second form of CTE, typically around age 60, and may progress to dementia. It's important to note that CTE symptoms may not appear immediately after a head injury and can take years or even decades to develop. The full list of signs to look for in people with CTE at autopsy is still unknown, and there is limited understanding of how CTE progresses.
Risk Factors
Repeated exposure to traumatic brain injury is thought to increase the risk of developing chronic traumatic encephalopathy (CTE). This usually occurs from repetitive head trauma, which is common in contact sports or military combat. The development of CTE has been associated with second impact syndrome, in which a second head injury happens before previous head injury symptoms have fully resolved. Other risk factors may include Creutzfeldt-Jakob disease, which is a rare brain disorder caused by deposits of infectious proteins called prions. However, the exact risk factors for CTE are still being studied and researchers are examining how the number and severity of head injuries may contribute to the development of the condition.
Development
Chronic traumatic encephalopathy (CTE) develops as a result of repeated head injuries, often occurring in contact sports or military combat. It causes the death of nerve cells in the brain, leading to degeneration. CTE gets worse over time, and its development has been associated with second impact syndrome, which occurs when a second head injury happens before previous head injury symptoms have fully resolved. Various risk factors are thought to increase the risk of CTE, such as repeated exposure to traumatic brain injury. Symptoms of CTE may include trouble with thinking and emotions, physical problems, and other behaviors, and they can develop years to decades after head trauma occurs. CTE cannot be definitively diagnosed during life except in people with high-risk exposures, and researchers are currently developing diagnostic biomarkers for CTE.
Assessment and Diagnosis
Triage
If chronic traumatic encephalopathy (CTE) is suspected, you should see a healthcare provider in situations involving suicidal thoughts or head injuries. Suicidal thoughts are a significant concern for people with CTE, and you should call 911 or your local emergency number, or contact a suicide hotline. If you or your child have experienced a head injury, even if it wasn't severe enough to require emergency care, it is important to consult a healthcare provider. They will assess the situation and recommend appropriate medical care based on the symptoms displayed.
Management and Treatment
Complications
CTE can lead to various potential complications, including cognitive, emotional, and physical problems. Some possible complications of chronic traumatic encephalopathy include:
- Trouble with thinking and emotions: CTE can cause problems with memory, judgment, reasoning, and processing speed. It may also result in emotional instability, mood changes, and impulse control issues.
- Physical problems: Individuals with CTE may experience slowness of movement, tremors, stiffness, and other motor impairments. These symptoms can impact daily functioning and quality of life.
- Behavioral issues: CTE has been associated with increased risk of aggression, violence, and impulsive behavior. It may also contribute to substance abuse and addictive behaviors.
- Dementia: As the disease progresses, CTE can lead to the development of dementia, including memory loss, disorientation, and confusion. It's important to note that CTE is still being researched, and the full extent of its complications and progression is not yet well understood.
Treatment
Currently, there is no cure or specific treatment for chronic traumatic encephalopathy (CTE). The best approach is to prevent head injuries and stay informed about how to detect and manage traumatic brain injuries. Supportive care is provided to those who are hospitalized with severe encephalitis, which may include breathing assistance, intravenous fluids, anti-inflammatory medicines, anti-convulsant medicines, and follow-up therapy such as brain rehabilitation, physical therapy, occupational therapy, and speech therapy. Certain forms of cognitive therapy, psychotherapy, and medication may also be helpful for managing depression and anxiety related to brain injuries.
Preparing for medical consultation
To prepare for an appointment for chronic traumatic encephalopathy (CTE), you should:
- Be aware of any pre-appointment restrictions or instructions.
- Make a list of your symptoms, noting any triggers or improvements.
- Take a list of all medications, vitamins, or supplements you are currently taking.
- Prepare a list of questions to ask your healthcare provider about possible causes, treatments, and prognosis.
- Consider bringing a family member or friend to the appointment for support and to help remember information discussed. It is important to be well prepared for your appointment, as CTE is a progressive brain disorder for which there is currently no cure. Your healthcare provider will likely refer you to a neurologist or other specialist for further evaluation. Remember to stay informed about how to detect and manage traumatic brain injury, as preventing head injury is the current approach to managing CTE.