Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with repeated head trauma characterized by progressive neurological and psychiatric symptoms. While CTE was first described in boxers nearly 100 years ago, recent high-profile cases in football players have increased media attention and debate. However, CTE can only be definitively diagnosed after death by examining the brain. While some athletes who sustain repeated head trauma go on to exhibit CTE symptoms, not all contact sport athletes are affected, and some individuals without head trauma histories also experience similar issues. Ongoing large studies aim to better define long-term brain changes after injury and establish CTE diagnostic criteria to help inform the ongoing discussion around sports concussions and policy.

1. SEPTEMBER 7,2016
Chronic Head Trauma in
Athletes: The Debate Continues

2. CHRONIC TRAUMATIC ENCEPHALOPATHY
 it is considered a neurodegenerative disease associated with
previous head trauma and characterized by progressive neurologic
and psychiatric symptoms.

3. -These changes in the brain can begin months, years,
or even decades after the last brain trauma or end of
active athletic involvement

4. -Symptoms of chronic traumatic encephalopathy (CTE)
were first described nearly 100 years ago among
boxers, yet it is only in the past decade that the interest
in CTE has accelerated. This is in large part due to high-
profile cases of CTE among former professional
football players, which stimulated intensive media
interest.

5. -Unfortunately, CTE can only be definitively identified
after postmortem examination of the brain.

6. -- Nearly all of the evidence to date linking sports
concussions to CTE and other types of dementia such as
Alzheimer's disease has come from case reports, fuelling
debate about the causes of the neuropathologic findings
and the clinical observations.
STUDY SYNOPSIS AND PERSPECTIVE

7.  - In general, case reports in the literature describe athletes who sustain
repeated head trauma playing football or other contact sports and later in
life experience mood disorders, headaches, cognitive and speech difficulties,
and suicidal thoughts and aggressive behaviour. At autopsy, some of these
athletes display pathologic findings that have been collectively labelled CTE,
the authors point out.

8.  - Yet, importantly, not all athletes who participate in contact sports
experience the findings ascribed to CTE. Also, there are individuals
who have headaches, mood disorders, cognitive difficulties, suicidal
ideation, and other clinical problems ascribed to CTE who have never
experienced repeated head trauma or had the pathologic post-
mortem findings of those currently diagnosed with CTE.

9. "Given the profound public health implications of
rapidly emerging CTE research, it is essential that the
evidence pertaining to sports concussions and CTE be
disseminated to the public, the scientific community,
and clinicians who care for concussed athletes in a
balanced and accurate manner," says Brian L. Edlow,
MD, from Massachusetts General Hospital, Boston, and
Holly E. Hinson, MD, from Oregon Health & Science
University, Portland.

10.  - As reported previously by Medscape Medical News, the
National Institutes of Health (NIH) and the National Football
League (NFL) recently funded 2 multicentre studies focused on
defining the scope of long-term changes that occur in the brain
years after a head injury or multiple concussions.

11. - Among the specific goals of this research are to
establish and validate criteria for the histopathologic
diagnosis of CTE, identify structural magnetic
resonance imaging biomarkers of CTE in human brain
specimens, and begin to identify in vivo magnetic
resonance imaging biomarkers.

12. Magnetic Resonance Imaging

13. In Vivo Magnetic Resonance Imaging

14. CTE researchers will play an important role
in framing the discussion: as more evidence
emerges from prospective studies,
stakeholders including athletes, parents,
and policymakers will need to consider the
risks of contact sports, and whether the
rules need to be changed.
Conclusion