What Is Chronic Traumatic Encephalopathy? BrainLine

Tau immunostained sections of medial temporal lobe from 3 individuals -- Top left: Whole brain section from a 65 year old control subject showing no tau protein deposition; Bottom left: Microscopic section from 65 year old control subject also shows no tau protein; Top middle: Whole brain section from NFL great John Grimsley showing abundant tau protein deposition in the amygdala and adjacent temporal cortex; Bottom middle: Microscopic section showing numerous tau positive neurofibrillary tangles and neurites in the amygdala; Top right: Whole brain section from a 73 year old world champion boxer with severe dementia showing very severe tau protein deposition in the amygdala and thalamus; Bottom right: Microscopic section from a 73 year old world champion boxer with severe dementia showing extremely dense tau positive neurofibrillary tangles and neurites in the amygdala. (Courtesy of Dr. Ann McKee.)

Multimedia

• 
  Second impact syndrome (SIS) can have in-an-instant, tragic consequences. Chronic traumatic encephalopathy (CTE), on the other hand, can have slow and heartbreaking consequences.
• The Science Behind Second Impact Syndrome and Chronic Traumatic Encephalopathy
• 
  "We knew it existed in boxing, but we didn't know it was living amongst us ... "

  See all videos interviews with Dr. Ann McKee.

• Repetitive Brain Trauma
• 
  A second concussion may have more dangerous consequences than a first concussion, especially in a young adult brain.

  See all videos interviews with Dr. Ann McKee.

• Why Is an Injured Player More at Risk for a Second Concussion?
• 
  Increased knowledge about the long-term effects from contact sports may catalyze rule changes.

  See all videos interviews with Dr. Ann McKee.

• Are Contact Sports Dangerous?
• 
  CTE is a neurodegeneration, a brain disease that's progressive and characterized by a build-up of a protein called tau. See all video interviews with Dr. Ann McKee.
• What Is Chronic Traumatic Encephalopathy?
• 
  If you see a teammate acting differently or strangely, tell your coach immediately. You might just save his life.

  See all videos interviews with Dr. Ann McKee.

• What Can You Do to Help an Injured Teammate?
• 
  MRIs and CT scans are incredible technology, but pathology still provides an indispensable map, especially when studying a diseased brain.

  See all videos interviews with Dr. Ann McKee.

• Pathology: Still the Most Useful Technique for Studying Diseased Brains
• 
  Tau protein shows up in the brain in other neurodegenerative diseases, but only in this unique, tangled pattern in CTE.

  See all videos interviews with Dr. Ann McKee.

• What Is Tau and Its Role in Chronic Traumatic Encephalopathy?
• 
  A jarred brain needs sufficient time to rest and recover. It's simple, but makes all the difference in the long term.

  See all videos interviews with Dr. Ann McKee.

• How Can We Improve the Way Sports Handle Brain Injuries?
• 
  “Brown Is Bad, Brown Is Cell Death.”  The “brown” is tau, a protein that accumulates in the brains of people, like professional football players and boxers, who have sustained repeat blows to the head. Learn about the research and education going on at the Center for the Study of Traumatic Encephalopathy, a collaboration between Boston University School of Medicine and the Sports Legacy Institute. See all videos interviews with Dr. Ann McKee.
• Game Changers

Chronic Traumatic Encephalopaty (CTE) is a result of repeated blows to the head. It is seen most often in boxers and athletes who play contact sports like football and ice hockey.

More specifically, CTE  "… triggers progressive degeneration of the brain tissue, including the build-up of an abnormal protein called tau. These changes in the brain can begin months, years, or even decades after the last concussion or end of active athletic involvement. The brain degeneration is associated with memory loss, confusion, impaired judgment, paranoia, impulse control problems, aggression, depression, and, eventually, progressive dementia.”¹

The syndrome was originally described in 1928 as dementia pugilistica (also “punch drunk”) — a condition first noticed in boxers who suffered repeated blows to the head. As they aged, they would manifest tremors, slowed movement, confusion, speech problems, and declining cognitive ability or dementia.

Bringing CTE to light

CTE remained under the radar until a Pittsburgh medical examiner named Bennet Omalu identified CTE in two former Pittsburgh Steelers. These two football players died in his jurisdiction in 2002 and 2005. He published his findings, drawing the attention of Chris Nowinski, co-founder of The Sports Legacy Institute (SLI), who worked with families to deliver more cases that Dr. Omalu and others diagnosed with CTE.

In 2008, the co-founders of SLI — Nowinski and Dr. Robert Cantu — partnered with Dr. Ann McKee and Dr. Robert Stern. They created The Center for the Study of Traumatic Encephalopathy (CSTE) at Boston University School of Medicine, the world’s first center dedicated to studying CTE.²

In 2009, research spearheaded by Dr. Ann McKee and her colleagues provided the first pathological evidence that repetitive head trauma experienced in collision sports isassociated with CTE.

“It doesn’t take an expert, a doctor, or a pathologist … anyone can see that they don’t want those brown, ugly spots on their brains,” says Dr. McKee, a neuropathologist and one of the world’s foremost neurodegenerative disease experts.

And in August 2010, new findings from Dr. McKee and her colleagues suggested that brain trauma in sports may cause a new disease that mimics amyotrophic lateral sclerosis. ALS, or Lou Gehrig’s disease, is a neurological condition that affects voluntary muscle movements.

Who’s being diagnosed with CTE?

Until recently, CTE was thought to occur primarily in retired athletes who were in their late 40s, 50s, and 60s. However, in September 2010, the brain autopsy of a University of Pennsylvania football player who killed himself in April revealed the same trauma-induced disease found in more than 20 deceased National Football League players. This college athlete’s suicide raised questions about the age at which athletes may start being at risk for CTE.

And, to date, the only way to diagnose CTE is after death. This makes prevention more important since signs and symptoms may not show up until years after the last concussion.

What is learned about the effects of CTE in athletes may be transferable to other arenas like the military, where service members fighting in the conflicts in Iraq and Afghanistan are sustaining one or multiple concussions.

References

^{1, 2} Sports Legacy Institute

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