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Long-term Effects of Concussion: Fact and Fiction
Rudy Castellani
University of Maryland School of Medicine

The speaker has no conflicts of interest

Chronic traumatic encephalopathy:
Definition
• Chronic Traumatic
Encephalopathy (CTE) is a
progressive degenerative
disease of the brain found
in athletes (and others)
with a history of repetitive
brain trauma…
• This trauma triggers
progressive degeneration
of the brain tissue,
including the build-up of
an abnormal protein called
tau…
http://www.bu.edu/cte/about/what-is-cte/

Neurofibrillary tangle
(phosphorylated tau)
Alzheimer’s disease and tau protein
+

Tau protein
Immunohistochemical stain
for phosphorylated tau (AT8)

Corsellis et al, 1973
CTE as a “tauopathy”

McKee et al, Omalu et al, Corsellis et al
Gardner et al
Quality of evidence

P-tau at autopsy
• Observable as early as
the first decade of life
• Life itself is a progressive
tauopathy
P-tau in asymptomatic people

Tau (AT8) immunostain (5 µm), retired NFL players
NFL offensive lineman, with a normal brain
for age, and no neuropsychiatric
disturbances
NFL offensive lineman with CTE
(Neurosurgery 57:128-134, 2005)
P-tau in asymptomatic people

50 year-old man
P-tau in asymptomatic people

Montine et al. Acta Neuropathol 2012; 123:1-11
Aside: Is autopsy a “gold standard”?

Neuropathology-psychiatry correlations?
http://www.bu.edu/cte/our-research/case-studies/lou-creekmur/

Completed suicide
Neuropathology-psychiatry correlations?

Baron et al. Am J Cardiol 2012;109:889 – 896
Neuropathology-psychiatry correlations?

Suicide rate by profession
• Physician – 1.87x
• Dentist – 1.67x
• Veterinarian – 1.54x
• Finance worker – 151x
• Chiropractor – 1.50x
• Heavy construction operators – 1.46x
• Urban planners – 1.43x
• Hand molders – 1.39x
• Realtors – 1.38x
• Assemblers of electrical equipment – 1.36x
• Lawyers – 1.33x
• Lathe operators – 1.33x
• Farm managers – 1.32x
• Operators of heat treating equipments – 1.32x
• Electricians – 1.31x
• Precision woodworkers – 1.30x
• Pharmacists – 1.29x
• Natural scientists – 1.28x
• NFL athletes – 0.41x

The speaker is a denier of the
following…
• CTE is a well-defined entity
• Control groups have been adequately studied
• Neuropathology predicts psychiatric signs
• Neuropathologists have expertise in
concussion

Questions to be explored
• Control groups
• Empirical, prospective
studies on concussion*
• Potential unintended
consequences
– Negative impact on
athletic participation?
– Negative impact on
retired athletes?
– Negative impact on the
mentally ill?

SPORT CONCUSSION
SUMMIT
September 24, 2015#uminjuryctr

Chronic traumatic encephalopathy (CTE) is a degenerative brain disease caused by repetitive head trauma. CTE is characterized by tau protein deposits in the brain that can cause behavioral, mood, and cognitive issues. Boston University has been researching CTE since 1996 and studying cases in boxers, football players, hockey players, and others exposed to repetitive brain trauma. Future areas of study include improved detection methods, risk factors, and potential treatments.

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