Chronic traumatic encephalopathy

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at February 4, 2016
StartDiseasesChronic traumatic encephalopathy

Chronic traumatic encephalopathy or CTE refers to a degenerative disease that occurs in the brain when athletes receive multiple concussions or other traumatic brain injuries. Also known as dementia pugilistica, the affliction gradually progresses over the course of years or decades and presents a variety of symptoms.


Definition & Facts

Chronic traumatic encephalopathy develops in athletes who suffer head trauma while playing contact sports or while fighting in military combat during wartime. According to a postmortem study performed in 2009, researchers confirmed 51 cases of CTE. Athletes accounted for 90 percent of the cases, including those involved in boxing, football, wrestling, and soccer.

Forensic neuropathologist, Dr. Bennet Omalu first connected the disorder with football players in 2002 when performing an autopsy on Pittsburgh Steelers center Mike Webster. Prior to this discovery, CTE was primarily recognized in boxers and called “punch-drunk syndrome.”

Prior to Omalu's discovery, athletes were commonly wrongly diagnosed as having Alzheimer's disease or Parkinson's disease. Although professional wrestler Chris Benoit's murder-suicide were initially attributed to brain damage caused by steroid use, physicians now know that he suffered from CTE which likely played a role. The condition was also a factor in football player Junior Seau's suicide.

Symptoms & Complaints

Some of the more common symptoms associated with the disorder include memory loss, impaired judgment, a lack of impulse control and declining physical balance along with diminishing gross motor skills. Patients also typically experience attention deficits and have difficulty developing organized thoughts. Most sufferers begin displaying many different behavioral changes, which include aggression, confusion, depression and suicidal ideation in addition to the onset of dementia.


Brain injury occurs when a blow to the head causes the delicate tissue to forcefully impact the interior sides of the skull. The action leads to bruising, bleeding and swelling of the brain. When an athlete suffers repeated head injuries, portions of the brain atrophy or shrink while others remain enlarged. Certain areas of the brain also display an accumulation of a substance known as tau proteins, which under normal conditions, serve to stabilize cell structure. However, when created in abundance in either Alzheimer's or CTE patients, they form large tangles that constrict neurons and cause cell death.

The cellular destruction combined with the abnormal tissue shrinking or swelling interfere with the communication process between neurons in various regions of the brain. These interruptions cause the array of symptoms. Over time, the condition worsens and can lead to debilitating or dangerous effects.

Diagnosis & Tests

Since the time that Dr. Omalu and his associate Dr. Bailes first observed the abnormal brain tissue, postmortem examinations have been the only means of positively identifying the disorder. However, research conducted by UCLA in 2015 has shown that it may be possible to detect CTE in living athletes, using a PET scan.

Former athletes now exhibiting symptoms may be advised by their physicians or by psychologists to undergo imaging research studies to determine the presence of chronic traumatic encephalopathy and receive appropriate care.

Treatment & Therapy

When traumatic brain injury patients exhibit physical symptoms, they often receive long-term physical therapy. While working with a therapists, individuals commonly gain or maintain muscle tone and mobility capabilities. Occupational therapists work with patients to improve cognitive abilities and motor function, which enables individuals to become more efficient in performing activities of daily living.

Speech therapists not only help to enhance verbal skills but also have the training to effectively recognize changes in thought processes. Recreational therapy serves to reintegrate brain trauma patients into the community. Some CTE patients may require medications designed to control psychological symptoms like depression.

On the home front, loved ones may encourage a family member with CTE to regularly exercise, which elevates mood while improving cardiovascular health and muscle strength. Exercise additionally helps promote restful sleep and boosts gastrointestinal function. Depending on the patient's physical capabilities, therapists often recommend specific types of exercises that offer the most benefit.

Activities or games requiring problem solving or strategy skills may help slow the progression of dementia. Breaking down common tasks into smaller steps encourages CTE sufferers to concentrate while reducing the chances of becoming frustrated.

Family members might also consider receiving counseling to learn when to diffuse situations or offer reassurance when a loved one displays agitation, depression or is suffering with dementia. Eliminating clutter and minimizing offensive noise helps dementia patients by reducing confusion and frustration.

As psychological symptoms often exacerbate in the evening, loved ones may need to guide the afflicted family member to a calmer location. Routine nighttime rituals also have a calming effect. Night lights strategically placed in hallways, stairways and other areas of the home during the night help prevent disorientation if the individual should awaken.

Prevention & Prophylaxis

Physicians believe that preventing the possibility of developing chronic traumatic encephalopathy involves implementing methods to reduce the number of brain injuries that individuals receive along with preventing further injury after developing a concussion.

Whether playing amateur or professional sports, athletes should wear approved helmets during practice and during games. The preventative measure is also recommended for cyclists, motorcyclists or anyone engaged in an activity where a fall or other type of impact may cause a blow to the head.

Coaches and sports trainers must ensure that athletes receive the appropriate medical attention after an athlete suffers a head injury. In many instances, physicians strongly advise that patients receiving any type of traumatic brain injury refrain from the activity until sufficient healing occurs.