Chronic Traumatic Encephalopathy: A Q and A Fact Sheet...Mar 28, 2016 · CTE is in its early...

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

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

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.

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

Chronic Traumatic Encephalopathy: A Q and A Fact Sheet...Mar 28, 2016 · CTE is in its early...

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