chronic traumatic encephalopathy

What is Chronic Traumatic Encephalopathy (CTE)?

Chronic traumatic encephalopathy (CTE) is a brain disorder likely caused by repeated head injuries, also known as concussions or traumatic brain injuries (TBIs). This condition affects how areas of the brain function, communicate, and work with each other.

Symptoms of CTE:

• Behavioral problems
• Mood problems
• Problems with thinking
• Dementia
• Trouble with memory, other thinking skills, behavior, personality, speech, or balance

CTE can have severe effects depending on the extent of the damage and the affected brain areas. The condition slowly damages parts of the brain over time.

Causes of CTE:

Repeated head injuries or blows to the head are thought to be linked to CTE. This includes athletes involved in striking-based combat sports, such as boxing, professional football players, and others with a history of repetitive brain trauma.

History of CTE:

CTE was first identified in boxers in the 1920s, known as "punch-drunk syndrome." Over the following decades, researchers reported similar findings in other victims of brain trauma.

• [1] Chronic traumatic encephalopathy (CTE) is a brain disorder likely caused by repeated head injuries. It causes the death of nerve cells in the brain, known as degeneration. CTE gets worse over time.
• [3] The disease often gets worse over time and can result in dementia.[2]
• [4] Chronic traumatic encephalopathy (CTE) is a brain condition thought to be linked to repeated head injuries and blows to the head.
• [14] Chronic traumatic encephalopathy was first identified in boxers in the 1920s. At the time, it was called "punch-drunk syndrome."

Understanding Chronic Traumatic Encephalopathy (CTE)

Chronic traumatic encephalopathy (CTE) is a rare disorder that affects the brain, often as a result of repeated head injuries. The symptoms of CTE can be subtle at first but gradually worsen over time.

Common Symptoms:

• Trouble concentrating or focusing (mild cognitive impairment)
• Headaches
• Short-term memory problems
• Changes in behavior, including sudden outbursts or explosions of anger

These symptoms can be mistaken for normal aging, making it challenging to diagnose CTE. However, as the condition progresses, more severe symptoms may develop.

Advanced Symptoms:

• Memory loss and confusion
• Impaired judgment and impulse control problems
• Aggression, depression, anxiety, and suicidal thinking
• Personality changes and erratic behavior

Cognitive Decline:

• Executive function problems, including difficulty with planning, decision-making, and problem-solving
• Progressive disorders of thinking and memory, affecting daily life and activities

It's essential to note that CTE symptoms can vary from person to person, and not everyone will experience all of these symptoms. If you or someone you know is experiencing any of these symptoms, it's crucial to consult a medical professional for proper evaluation and diagnosis.

References:

• [1] Symptoms of CTE include memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, anxiety, suicidality, parkinsonism, and ... (Source: #3)
• [2] Common symptoms of CTE can include trouble concentrating or focusing (mild cognitive impairment), headaches, short-term memory problems, and changes in behavior. (Source: #2)
• [3] The encephalopathy symptoms can include behavioral problems, mood problems, and problems with thinking. (Source: #3)
• [4] Most documented cases have occurred in athletes involved in striking-based combat sports, such as boxing, which is a risk factor for CTE. (Source: #3)

Current Diagnostic Tests for Chronic Traumatic Encephalopathy (CTE)

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease that can only be definitively diagnosed after death through brain tissue analysis [8]. However, researchers are working to identify methods and biomarkers that would allow health professionals to diagnose CTE while a person is alive.

Currently, there is no conclusive way to diagnose CTE using imaging tests such as MRI, CT, PET, or SPECT scans [4]. These tests can be used to investigate and diagnose neurodegenerative pathologies, but they are not definitive diagnostic tools for CTE [6].

Researchers have been exploring the use of neuropsychological tests, brain imaging, and other biomarkers to diagnose CTE. However, these methods are still in the experimental stage and require further research to confirm their effectiveness.

Potential Diagnostic Tests

• Neuropsychological tests: These tests can assess cognitive function and may be used as a screening tool for CTE [1].
• Brain imaging: Researchers are exploring the use of specialized MRI scans to diagnose CTE, but these methods are not yet definitive [5].
• Biomarkers: Fluid biomarkers in the blood or cerebrospinal fluid may potentially be used to diagnose CTE, but more research is needed to confirm their effectiveness [5].

Limitations

The only way to definitively diagnose CTE is through postmortem neuropathologic examination of the brain tissue revealing characteristic tau protein deposits and other pathologies [3]. This method is not feasible for diagnosing CTE while a person is alive.

References:

[1] Nov 18, 2023 — The hope is to eventually use neuropsychological tests, brain imaging such as specialized MRI s, and other biomarkers to diagnose CTE. [2] There's no conclusive way to diagnose CTE while a person is alive. The only way to do that is to examine samples of a person's brain under a microscope, which ... [3] by K Pierre · 2021 · Cited by 35 — Like most neurodegenerative diseases, CTE can only be diagnosed by postmortem neuropathologic examination of the brain tissue revealing ... [4] Right now there is no known way to use MRI, CT, PET, SPECT, or other brain imaging methods to definitively diagnose CTE. In addition, there are no known blood ... [5] by K Pierre · 2022 · Cited by 13 — In this review article, we provide a brief introduction to CTE, current diagnostic workup and the promising research on imaging and fluid biomarker diagnostic ... [6] Jan 15, 2024 — Magnetic resonance imaging and Computed tomography scans are the most used tests for investigating and diagnosing neurodegenerative pathologies ... [7] Treatments for chronic traumatic encephalopathy (CTE) · physiotherapy if you have difficulties with movement · occupational therapy for help with things like ... [8] Currently, CTE can only be diagnosed after death through brain tissue analysis. Doctors with a specialty in brain diseases slice brain tissue and use special ...

Current Status of Drug Treatment for Chronic Traumatic Encephalopathy (CTE)

Chronic traumatic encephalopathy (CTE) is a progressive brain disorder caused by repeated head trauma, often seen in athletes and individuals with a history of concussions. While there is no cure or treatment that can reverse CTE, various medications have been explored to manage its symptoms.

Medications for Managing Symptoms

Several classes of medications have shown some success in treating disease symptoms or improving cognitive function in individuals with CTE:

• Selective serotonin reuptake inhibitors (SSRIs): These antidepressant medications, such as sertraline and escitalopram, may be used to manage depression and anxiety associated with CTE [4].
• Movement disorder medications: Sinemet (carbidopa/levodopa), Mysoline (primidone), and Tegretol (carbamazepine) have been found to be effective in managing movement disorders and tremors related to CTE [3].

Monoclonal Antibody Therapy

Research has also focused on monoclonal antibody therapy as a promising strategy for combating CTE. Tau accumulation is a prominent feature of the disease, and targeting this protein with antibodies may help slow its progression [5].

Limitations and Future Directions

While these medications can provide temporary relief from symptoms, it's essential to note that there are no medications yet that reverse CTE. Researchers continue to explore new treatments and therapies to better understand and manage this complex condition.

References:

[1] No treatment for CTE is currently available, but researchers are conducting studies to better understand the development, progression, and potential treatments for the disease [9]. [2] There are no medications yet that reverse CTE, but certain medicines may be used to temporarily treat cognitive (memory and thinking) and behavioral symptoms [7]. [3] Medications such as Sinemet (carbidopa/levodopa), Mysoline (primidone), and Tegretol (carbamazepine) have shown some success in managing movement disorders and tremors related to CTE [3]. [4] Selective serotonin reuptake inhibitors (SSRIs), such as sertraline and escitalopram, may be used to manage depression and anxiety associated with CTE [4]. [5] Monoclonal antibody therapy is one of the most promising strategies for combating CTE, targeting tau accumulation [5]. [6] Treatment of established CTE is currently limited to supportive measures with a variety of symptomatic medications currently used for Alzheimer's disease (AD) and other neurodegenerative disorders [6].

Differential Diagnosis of Chronic Traumatic Encephalopathy (CTE)

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with multiple head traumas, and its diagnosis can be challenging due to overlapping symptoms with other conditions. Here are some key points to consider in the differential diagnosis of CTE:

• Alzheimer's Disease: CTE is often mistaken for Alzheimer's disease, which is a progressive neurological disorder that causes memory loss and cognitive decline [2]. However, while both conditions share similar symptoms, they have distinct underlying pathologies.
• Frontotemporal Lobar Degeneration (FTLD): FTLD is another neurodegenerative disorder that can present with similar symptoms to CTE, including changes in personality, language difficulties, and memory loss [3].
• Lewy Body Disease: Lewy body disease is a progressive neurological disorder characterized by the presence of abnormal protein clumps called Lewy bodies in the brain. Its symptoms can overlap with those of CTE, making differential diagnosis challenging.
• Cerebral Amyloid Angiopathy (CAA): CAA is a condition where amyloid proteins accumulate in blood vessels of the brain, leading to cognitive decline and memory loss. While it shares some similarities with CTE, its underlying pathology is distinct.
• Parkinsonism: Parkinson's disease can present with similar motor symptoms to CTE, such as tremors, rigidity, and bradykinesia [5].
• Multiple System Atrophy (MSA): MSA is a rare neurodegenerative disorder that affects movement, balance, and autonomic functions. Its symptoms can overlap with those of CTE, making differential diagnosis essential.
• Vitamin B12 Deficiency: Vitamin B12 deficiency can cause neurological symptoms similar to CTE, including cognitive decline, memory loss, and mood changes [1].

Key Diagnostic Criteria

While experts may not be able to confirm CTE before death, they can still make a presumptive diagnosis based on symptoms and physical and neurological examinations. The following criteria are essential for diagnosing TES (a related condition):

• History of multiple impacts to the head (or body resulting in impulsive force) [7]
• Presence of cognitive decline, memory loss, or other neurological symptoms
• Absence of other underlying conditions that could explain the symptoms

Early Symptoms

Early symptoms of CTE may include mild memory loss, headaches, irritable mood, slurred speech, or unsteadiness when walking. People with CTE may have trouble concentrating and performing daily tasks [8].

References:

[1] by L Caixeta · 2018 · Cited by 7 [2] by S Munakomi · 2023 · Cited by 3 [3] by L Caixeta · 2018 · Cited by 7 [5] by NK Da Silva Soyombo · 2022 · Cited by 1 [7] by PH Montenigro · 2014 · Cited by 381 [8] May 18, 2024