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CTE FACT SHEET Copyright 2016: Sports Neuropsychology Society 1 Chronic Traumatic Encephalopathy: A Q and A Fact Sheet For over 90 years, the medical community has considered the idea that repeated injuries to the brain may cause long-term neurological and psychological impairment or damage. Recently, there has been public debate about the risk of participating in contact sports. This interest has been fueled by reports of high-profile professional athletes who experienced a progressive decline of their physical and thinking abilities, and changes in mood and behavior at earlier ages than normally expected. In some cases, these athletes committed suicide. Examination of their brains after death revealed abnormalities in many, but not all, of the players’ brains. These abnormal findings have been called Chronic Traumatic Encephalopathy or CTE. Some medical researchers (see references) have suggested that the CTE was a result of concussions or repeated hits to their heads during their playing careers. The media attention that followed raised public concern about the risks of developing CTE from playing contact sports. However, many of the media accounts contained inaccurate information, leaving the public misinformed and confused about CTE. Scientific research is being conducted to understand CTE better and how it may be related to brain trauma. This research is still in the early stages. Many questions remain unanswered. This Q & A Fact Sheet was created by the Sports Neuropsychology Society to provide answers, based on currently available scientific data, to some of the frequently asked questions and concerns about CTE. It is written for parents, coaches, athletes, policymakers and other health care stakeholders. What is CTE? CTE is a syndrome characterized by abnormal changes in brain cells (abnormal tau proteins), which may be accompanied by changes in thinking, mood, and behavior. The presence of abnormal tau proteins is not unique to CTE since it is also found in the brains of people with other neurological conditions. However, it is thought that the pattern of abnormal tau protein deposits is different in CTE and indicative of a unique condition. The syndrome is also thought to be progressive with worsening symptoms over time, but research on the long-term effects of CTE is in its early stages and is inconclusive at this time. What are the signs that someone has CTE? The diagnosis of CTE can only be made by autopsy after death. Identifying the possible signs of CTE in the living person is a challenge for science and medicine. Some signs or symptoms that

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Page 1: Chronic Traumatic Encephalopathy: A Q and A Fact Sheet...Mar 28, 2016  · CTE is in its early stages and is inconclusive at this time. What are the signs that someone has CTE? The

CTEFACTSHEET Copyright2016:SportsNeuropsychologySociety1

ChronicTraumaticEncephalopathy:AQandAFactSheet

Forover90years,themedicalcommunityhasconsideredtheideathatrepeatedinjuriestothebrainmaycauselong-termneurologicalandpsychologicalimpairmentordamage.Recently,therehasbeenpublicdebateabouttheriskofparticipatingincontactsports.Thisinteresthasbeenfueledbyreportsofhigh-profileprofessionalathleteswhoexperiencedaprogressivedeclineoftheirphysicalandthinkingabilities,andchangesinmoodandbehavioratearlieragesthannormallyexpected.Insomecases,theseathletescommittedsuicide.Examinationoftheirbrainsafterdeathrevealedabnormalitiesinmany,butnotall,oftheplayers’brains.TheseabnormalfindingshavebeencalledChronicTraumaticEncephalopathyorCTE.Somemedicalresearchers(seereferences)havesuggestedthattheCTEwasaresultofconcussionsorrepeatedhitstotheirheadsduringtheirplayingcareers.ThemediaattentionthatfollowedraisedpublicconcernabouttherisksofdevelopingCTEfromplayingcontactsports.However,manyofthemediaaccountscontainedinaccurateinformation,leavingthepublicmisinformedandconfusedaboutCTE. ScientificresearchisbeingconductedtounderstandCTEbetterandhowitmayberelatedtobraintrauma.Thisresearchisstillintheearlystages.Manyquestionsremainunanswered.ThisQ&AFactSheetwascreatedbytheSportsNeuropsychologySocietytoprovideanswers,basedoncurrentlyavailablescientificdata,tosomeofthefrequentlyaskedquestionsandconcernsaboutCTE.Itiswrittenforparents,coaches,athletes,policymakersandotherhealthcarestakeholders. WhatisCTE?CTEisasyndromecharacterizedbyabnormalchangesinbraincells(abnormaltauproteins),whichmaybeaccompaniedbychangesinthinking,mood,andbehavior.ThepresenceofabnormaltauproteinsisnotuniquetoCTEsinceitisalsofoundinthebrainsofpeoplewithotherneurologicalconditions.However,itisthoughtthatthepatternofabnormaltauproteindepositsisdifferentinCTEandindicativeofauniquecondition.Thesyndromeisalsothoughttobeprogressivewithworseningsymptomsovertime,butresearchonthelong-termeffectsofCTEisinitsearlystagesandisinconclusiveatthistime.WhatarethesignsthatsomeonehasCTE?ThediagnosisofCTEcanonlybemadebyautopsyafterdeath.IdentifyingthepossiblesignsofCTEinthelivingpersonisachallengeforscienceandmedicine.Somesignsorsymptomsthat

Page 2: Chronic Traumatic Encephalopathy: A Q and A Fact Sheet...Mar 28, 2016  · CTE is in its early stages and is inconclusive at this time. What are the signs that someone has CTE? The

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havebeenassociatedwithCTEincludeforgetfulness,depression,irritability,andotherpersonalitychanges.Yet,thesesamesignsandsymptomsofcognitiveandbehavioralchangesalsooccurinotherneurologicandpsychologicalconditions,andinindividualswhetherornottheyhaveahistoryofconcussionorrepeatedbraintrauma. BecausetherearemanyothertreatableconditionsthathavesymptomssimilartoCTE(butarenotCTE),itisimportantthatanycurrentorformerathletewithchangesinmood,behavior,andthinkingseekacomprehensivemedicalandneuropsychologicalevaluation.Properevaluationanddiagnosiscanleadtoidentifyingmedicalconditionsthatarehighlytreatable,thusimprovingtheathlete’squalityoflife. HowisCTEdiagnosed?Currently,CTEcanonlybediagnosedafteraperson’sdeathbybrainautopsy.Aneuropathologistconductsspeciallaboratoryproceduresthatdetectthepresenceanddistributionofanabnormaltauproteininthebrain.SincethereisnomarkerforCTEinalivingpersonatthistimeandtheproposedsignsandsymptomsofCTEarecommoninothermedicalconditions,itisnotappropriatetodiagnoseCTEinalivingpersonbasedonbehavioralchangesalone. WhatcausesCTE?AlthoughneuropathologistshavemadeadvancesindefiningandidentifyingCTE,researchersdonotyetknowtheexactcausesofCTE.ManyscientistsandinternationalconsensusgroupshavestatedthatwhiletheremaybearelationshipbetweenheadtraumaandCTE,noclear-cut,definitivecauseandeffectrelationshiphasbeenestablished.ItappearsthatmultiplebiologicalmechanismsandenvironmentalorlifestylefactorscouldalsoproducethebrainabnormalitiesfoundinCTE.ScientistsarecurrentlyinvestigatinghowavarietyoffactorsandmechanismsmayresultinCTE. AretherespecificriskfactorsthatmaypredisposeanathletetoCTE?Multiplegenetic,biological,psychological,social,andenvironmentalriskfactorsforCTEareunderinvestigationbuthavenotbeenconclusivelyidentified.AhistoryofrepeatedbraintraumaisoftenfoundinathleteswithCTE,butnotallathleteswitharepeatedbraintraumahistorydevelopCTE.Additionally,CTEhasbeenfoundinnon-athleteswithnoknownordiagnosed historyofbraininjury. ArechildrenwhoplaycontactsportsatriskforCTElaterinlife?HasCTEbeenfoundinchildrenandadolescents?Atthistime,thereisnoresearchthatlinksyouthcontactsportparticipationwithariskforCTE.Todate,therehavebeennoreportsofCTEinyoungchildren.Althoughtherehavebeensomereportsofabnormaltauproteininthebrainsofafewdeceasedadolescents,ithasnotbeenestablishedthattheabnormalproteinwasrelatedtothecauseofdeathorthecauseofanycognitiveorbehavioralchangestheseadolescentsmayhaveexperiencedinlife. Parentsandcoachesshouldensure,however,thatsafecoachingandplayingmethods(suchasreducedcontactexposure,safemethodsofcontact,properskilldevelopment,enforcementof

Page 3: Chronic Traumatic Encephalopathy: A Q and A Fact Sheet...Mar 28, 2016  · CTE is in its early stages and is inconclusive at this time. What are the signs that someone has CTE? The

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goodsportsmanship,properlyfittingprotectivegear)areinstitutedinallyouthsportsatalllevelsofplay.Alsoofgreatimportanceisprovidingeffectivetraininginconcussionrecognitionandmanagementskillstoallthoseindividualsinvolvedinyouthsports,forallagegroups,inbothschoolandnon-schoolleagues.CanCTEbepreventedand/ortreated?Atthisstageofscienceandknowledge,wedonotunderstandallthefactorsthatproduceCTE,norcanwedeterminewhowillgetit.WithoutsuchknowledgeoraclearunderstandingofCTE,itisimpossibletocreateasuccessfulCTEpreventionortreatmentprogram.Givenwhatwedoknow,itappearsappropriatetotakereasonablemeasurestoreduceexposureoftheheadtotraumaticforces,torestrictcontactpractices,andtoteachpropercontacttechniques.Additionally,propermanagementofaconcussionreducestheriskofprolongedsigns/symptomsandtheriskforsubsequentlong-termdifficulties. Whatshouldanathletedoiftherearechangesinthinking,behavior,emotions,orpersonality?Ifanathleteisconcernedaboutsuchchanges,orworriedaboutCTE,seekcomprehensivemedical,neuropsychological,andpsychiatricevaluationsthatcanhelpidentifyifthereareanytreatableproblemsthatarecausingthechanges.Besurethatthelicensedhealthcareprovidersyouchoosetoprovidetheseevaluationsarespecialistsinconcussionandheadtrauma. Tofindaneuropsychologistinyourgeographicareawhospecializesinsportsbraintraumaandconcussion,gotowww.sportsneuropsychologysociety.com. SourceTheaboveinformationisbasedonthecurrentresearchevidencethatwasavailableatthetimeofthepublicationofthisdocument(March28,2016)andrepresentstheconsensusofexpertopinionofthePolicyandPlanningCommitteemembersandExecutiveBoardoftheSportsNeuropsychologySociety. DisclaimerInformationpresentedinthisdocumentisnotintendedasmedicalconsultation,guidance,prescriptionoradvice.Thereadershouldconsultalicensedhealthcareprovideraboutanyhealthconcerns. ReferencesDavis,G.,Castellani,R.,McCrory,P.(2015)NeurodegenerationinSport.Neurosurgery,76(6)643-655.

Iverson,G.,Gardner,A.,McCrory,P.,Zafonte,R.,Castellani,R.(2015).Acriticalreviewofchronictraumaticencephalopathy.Neuroscienceandbiobehavioralreviews,56,276-293.

McKee,A.,Stein,T.,Kiernan,P.,Alvarez,V.(2015).Theneuropathologyofchronictraumaticencephalopathy.Brainpathology25,350-364.

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DepartmentofDefenseBlastInjuryResearchProgramCoordinatingOffice.(2015).Doesrepetitiveblast-relatedtraumacontributetothedevelopmentofchronictraumaticencephalopathy(CTE)?http://blastinjuryresearch.amedd.army.mil/sos/

Solomon,G.,Zuckerman,S.(2015).ChronicTraumaticencephalopathyinprofessionalsports:retrospectivesandprospectiveviews.Braininjury29(2),164-170.

Bienick,K.,Ross,O.,Cormier,K.,Walton,R.,Sotot-Ortolaza,A.,Johnston,A.,DeSaro,P.,Boylan,K.,Graff-Radford,N.,Wszolck,Z.,Rademakers,R.,Boeve,B.,McKee,A.,Dickson,D.(2015).Chronictraumaticencephalopathypathologyinneurodegenerativedisordersbrainbank.ActaNeuropathol130,877-889.

NIHNationalInstituteofNeurologicalDisordersandStroke.(2015).ReportfromtheFirstNIHConsensusConferencetoDefinetheNeuropathologicalCriteriafortheDiagnosisofChronicTraumaticEncephalopathy.http://www.ninds.nih.gov/research/tbi/ReportFirstNIHConsensusConference.htm


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