Understanding Chronic Traumatic Encephalopathy (CTE)
What is CTE?
Chronic Traumatic Encephalopathy (CTE) is a progressive neurodegenerative disease linked to repeated traumatic brain injuries, including both concussions and non-concussive impacts. Currently, CTE cannot be diagnosed definitively while a person is alive, making this a crucial area for ongoing research. The neuropathology of CTE is marked by misfolded tau proteins found in specific patterns within the brain, which helps differentiate CTE from other diseases that also exhibit tau pathology.
Who is Most at Risk?
Individuals with a history of repeated traumatic brain injuries are at the highest risk for developing CTE. This does not refer to just a few concussions; many diagnosed with CTE have experienced thousands, if not tens of thousands, of impacts throughout their careers or lives. Athletes involved in contact and collision sports, military personnel, and others exposed to repeated brain injuries constitute the most vulnerable populations.
How Can We Prevent CTE?
The positive aspect of CTE is that it is entirely preventable, as it results from environmental exposure—specifically, repeated brain trauma. To reduce the risk of CTE, it is essential to significantly limit exposure to repeated head impacts, particularly in sports. This involves minimizing contact during practice and modifying game rules to decrease overall exposure. For youth under the age of 14, it is advised to eliminate unnecessary repetitive head impacts by removing tackling, heading, and checking from contact sports like football, rugby, soccer, hockey, and lacrosse.
Are There Diagnostic Tests in Development?
Several research initiatives are currently investigating potential diagnostic tests for CTE to facilitate clinical diagnoses during a person’s lifetime. Progress is being made in exploring biomarkers, including imaging and blood biomarkers.
Current Research Priorities
Research efforts are focused on establishing and validating clinical diagnostic criteria and objective measures for CTE, which will enable in-life diagnoses. Following this, research can progress toward treatments and disease-modifying therapeutics.
Age and Developmental Effects
The existing literature has not definitively addressed whether adolescents or older individuals experience different impacts from traumatic brain injuries or repeated concussions. However, research consistently indicates that the risk of developing CTE increases with the duration of exposure to impacts. Advocating for reduced contact in youth sports is crucial, as most athletes do not continue past high school, and early exposure significantly raises the risk of developing CTE later.
Impact on Other Brain Disorders
Traumatic brain injuries are recognized as risk factors for various brain disorders and diseases. They have been associated with the onset or exacerbation of mental health conditions and an increased likelihood of neurodegenerative diseases such as Alzheimer’s, Parkinson’s, and ALS.
Advice for Coaches and Parents
It is essential for coaches and parents to consider whether exposing young athletes to the risk of a life-altering neurodegenerative disease is necessary. As a former NCAA athlete, I understand the passion for sports, but it is possible to create meaningful memories without subjecting children to repetitive head impacts. The values learned from sports—teamwork, discipline, and perseverance—are not reliant on contact. Emerging evidence suggests that repeated brain trauma may impair performance by decreasing reaction times, indicating that minimizing head impacts is beneficial for athletic performance.
Exciting Developments in CTE Research
I am encouraged by the rapid advancements in CTE research globally. Researchers from Australia, the UK, Canada, New Zealand, Brazil, and other countries are contributing valuable insights, indicating that CTE is a worldwide issue. In 2023, we witnessed the publication of diagnoses for the first two female athletes with CTE and the first public case linking CTE to domestic violence. Increased awareness, especially concerning CTE in women, is essential to drive research efforts and ultimately lead to diagnosis and treatment options.
A Final Message to Readers
It is possible to appreciate sports while advocating for safer practices. CTE is a devastating yet entirely preventable neurodegenerative disease. It is our collective responsibility to reduce the number of cases by implementing reforms that minimize cumulative head impacts. We must weigh the risks of inaction against the potential benefits of taking proactive measures. If CTE is indeed caused by repeated traumatic brain injuries, implementing safety reforms will prevent future cases. If we are mistaken, children can still enjoy sports without the added risk of head impacts. The potential consequences of doing nothing are far greater than the risks of taking action.