Chronic Traumatic Encephalopathy

Overview

Chronic traumatic encephalopathy (CTE) is a brain condition that has been found in some people who have had many blows to the head over a long period of time. 'Chronic' means long-lasting. 'Traumatic' means it is linked to injury. 'Encephalopathy' means disease of the brain. In CTE, a protein called tau (say: 'tow') builds up in clumps inside the brain. Over years, this can damage brain areas that control mood, thinking, and movement. One key point: at the moment, CTE can only be confirmed by looking at brain tissue under a microscope after a person has died. Doctors cannot yet diagnose it with certainty in a living person. Also, most people who have had head knocks never develop CTE.

Nobody knows exactly how common CTE is, because it can only be confirmed after death and brain tissue studies are limited to certain groups. It appears to be uncommon in the general population. It has been found most often in people who had many years of repeated head impacts, such as some athletes in contact sports and some military personnel exposed to blasts.

CTE has been found in people with a history of repeated head impacts. This includes athletes in contact and collision sports such as boxing, rugby, American football, ice hockey, and soccer (from heading the ball), military personnel exposed to explosions or repeated blows, people who have experienced repeated violence, and some people with conditions that cause repeated head-hitting. It is not a condition of old age alone, and it is not diagnosed in children.

Symptoms

Common symptoms

• Mood changes such as low mood, irritability, anxiety, or feeling easily overwhelmed
• Changes in behaviour such as impulsiveness, anger, or poor judgment
• Trouble with memory, concentration, or planning
• Feeling slowed down or 'not myself'
• Sleep problems
• Later on, problems with balance, slurred speech, or shaking (tremor)
• In the later stages, thinking difficulties that affect daily life

Symptoms in children

• CTE is not diagnosed in children. Symptoms in children are usually about concussion (short-term brain injury after a knock), not CTE.
• After a head knock, watch for headache, dizziness, nausea, being extra sleepy, trouble concentrating, being more emotional than usual, or sleep changes
• Children should not return to sport or rough play until cleared by a healthcare professional, and should return gradually (step by step)

Causes

Main causes

• Repeated blows to the head over months or years — including smaller hits that do not cause a concussion ('subconcussive' impacts)
• The brain responds to this repeated injury partly by building up clumps of a protein called tau, which is thought to damage brain cells over time
• The exact way this happens is still being studied; not everyone with head impacts develops CTE

Risk factors

• Playing contact or collision sports for many years, especially from a young age
• Military service with exposure to blasts or repeated blows
• Repeated head injury from violence or accidents
• A history of multiple concussions
• Conditions that cause repeated head-hitting or head-banging
• Genetic and lifestyle factors are being researched, but none is proven to cause CTE on its own

When to see a doctor

See a doctor urgently if:

• Any of the emergency head-injury signs listed above — call emergency services
• Thoughts of suicide or self-harm — get help straight away
• A sudden, severe headache, especially if it came on after a knock to the head
• Sudden confusion, weakness, or trouble speaking

Book a routine appointment if:

• Ongoing changes in memory, concentration, mood, or sleep
• A history of repeated head impacts and you are worried about your long-term brain health
• A family member or coach has noticed changes in you that concern them
• You feel anxious or low about your risk and want to talk it through

Diagnosis

There is no single test for CTE, and it cannot currently be confirmed while a person is alive. A doctor will ask about your symptoms, your history of head knocks and sport or military service, and will check for other conditions that can cause similar symptoms. Researchers have proposed 'research criteria' to describe the pattern of symptoms that might be linked to CTE, but these are for research and do not confirm the diagnosis. Confirmation is only possible by examining brain tissue after death.

Tests that may be done

• A full medical history and symptom review
• A physical and neurological examination (checking balance, reflexes, strength, and memory)
• Thinking and memory tests (sometimes called cognitive tests)
• Blood tests to look for other causes such as thyroid or vitamin problems
• Brain scans such as CT or MRI to look for other problems like stroke or injury
• Sleep assessment if sleep problems are a concern
• A mental health assessment, since depression and anxiety are common and treatable

What to expect at your appointment

Your doctor will work through other possible causes first, since many conditions can look similar. You may be referred to a neurologist (a brain and nerve doctor), a neuropsychologist (who tests thinking and memory), or a mental health specialist. This can take a few appointments. It is a good idea to bring a list of your symptoms, when they started, your sports or military history, and any questions you want to ask.

Treatment

There is currently no cure for CTE and no treatment that reverses it. Care focuses on managing symptoms, keeping you safe, and supporting your quality of life. A team approach works best — for example a neurologist, a mental health professional, a physiotherapist, and an occupational therapist. Avoiding further head injury is an important part of care.

Self-care at home

• Avoid further head impacts — talk to your doctor or coach before returning to contact sport
• Keep a regular sleep routine and aim for enough sleep
• Use lists, a diary, or phone reminders to help with memory
• Stay physically active in safe ways, such as walking or swimming
• Limit or avoid alcohol and recreational drugs, which can worsen mood and memory
• Bring a family member or friend to appointments to help remember advice
• Tell someone you trust if your mood drops or you have thoughts of self-harm

Medical treatments

There is no specific medicine for CTE itself. Doctors may offer treatments to ease particular symptoms — for example, talking therapies such as cognitive behavioural therapy (CBT) for low mood or anxiety, medicines to help mood, sleep, or attention where appropriate, physiotherapy for balance or movement problems, and cognitive rehabilitation (practical help with memory and thinking strategies). A mental health professional can help if you feel anxious about your risk. Any medicines would be chosen and monitored by your doctor based on your individual situation.

When is surgery considered?

Surgery is not a treatment for CTE. Surgery may sometimes be needed for other problems after a head injury, such as bleeding inside the head, but that is a separate emergency situation.

Living with this condition

Many people with worries about CTE live full lives. If symptoms are affecting you, simple routines can help — planning your day, keeping keys and medicines in the same place, and writing things down. It can also help to pace yourself and rest when you need to. Talk to your employer, school, or family about any adjustments that would help.

Lifestyle tips

• Choose safer forms of exercise and follow the rules of your sport if you keep playing
• Protect your head — wear a helmet where recommended, use seatbelts, and avoid fighting
• Build a steady daily routine with regular meals and sleep times
• Stay connected with friends and family; isolation makes mood problems worse
• Be open with your doctor about memory or mood changes as they happen

Diet and exercise

There is no special diet for CTE. A balanced diet with plenty of vegetables, fruit, whole grains, and healthy fats is good for brain and heart health. Regular moderate exercise, such as brisk walking, helps mood, sleep, and thinking. If you have balance problems, ask a physiotherapist which activities are safe for you.

Mental health and emotional wellbeing

Worrying about CTE can be very stressful, and low mood, anxiety, and irritability are common. These are real symptoms and you deserve support, not blame. Talking therapies, support groups, and in some cases medicines can help a lot. If you ever have thoughts of ending your life or harming yourself, please reach out for help immediately — call your local emergency number or a crisis helpline in your country. You do not have to cope alone.

Prevention

You cannot fully prevent CTE, and not everyone exposed to head impacts will develop it. But you can reduce the number and force of head impacts: follow sport safety rules and technique coaching, limit heading the ball in youth soccer, use helmets where recommended (helmets reduce skull fractures and cuts but do not prevent all brain injury), wear a seatbelt, avoid fighting, and use protective equipment in the military where available. If you have had a concussion, rest and return to play gradually and only when cleared by a healthcare professional.

Vaccines

There is no vaccine for CTE.

Screening programmes

There is no screening test for CTE. If you are worried because of a history of head impacts, talk to your doctor — they can check for other treatable causes and give you advice on protecting your brain.

Complications

If left untreated

• Thinking and memory problems that get worse over time and affect work or daily life
• Ongoing mood problems such as depression or anxiety
• Behaviour changes that affect relationships
• Movement problems such as poor balance or slurred speech in later stages
• A higher risk of thoughts of self-harm, which needs urgent support
• Risk of further head injury if contact sport continues without advice

Long-term outlook

The outlook varies a lot from person to person, and there is still much to learn. Many people with a history of head impacts never develop CTE, and many symptoms people do have can be treated and improved. Research into CTE is growing quickly, which brings real hope for better tests and treatments in the future. In the meantime, looking after your general health, avoiding further head injury, and getting support for mood and thinking problems can make a meaningful difference.

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