Battle of the Brain Trauma

CTE stages better defined after studying donated brains of former athletes and veterans

(RxWiki News) Moods shift. Personalities change. Memories are difficult to form and recall. All are signs of the brain breaking down over time and researchers are getting a better understanding of how to diagnose the condition.

New research has broken down chronic traumatic encephalopathy (CTE) into four stages and better defines what happens in each stage, which could lead to earlier diagnosis and assisting patients sooner.

"Severe headaches won't go away? Get it checked out."

CTE wears and tears down the brain over time after repeated heavy blows to the head.

Early on in the problem, abnormal deposits of tangled proteins called tau start forming in the brain, which can eventually kill brain cells. It is typically found in Alzheimer's patients and can only be diagnosed after death.

The study, led by Ann McKee, MD, professor at Boston University School of Medicine, director of the Neuropathology Service for VA New England Healthcare System and co-director of the university's Center for the Study of Traumatic Encephalopathy, looked at 68 cases of CTE among deceased military veterans and athletes who were between 17- and 98-years-old.

Veteran Affairs CSTE Brain Bank donated the spinal cords and brains. Researchers found that among the brains, 64 of the cases were athletes. And18 of them were also veterans.

Researchers interviewed the families of the brain donors about the donor's history of head injuries, concussions, behavior and symptoms up to their death. The neurophysicist asking the questions did not know the results of the donor's neuropathological exam.

They also gathered demographic information, athletic history, medical history, military service and family history.

They found that 89 percent of the former athletes and veterans had mood, behavioral and cognitive impairments.

Thirty-four of the CTE cases were professional football players; nine were only college football athletes and six played high school football only. Hockey players, boxers, and wrestlers comprised the rest of the cases.

Among the veterans with brain damage were soldiers, sailors and marines from World War II, the Vietnam and Gulf Wars and as recent as Iraq and the current war in Afghanistan.

From the cases, researchers established specific criteria to diagnose CTE and divide the cases into four stages:

  • Stage 1: headaches and problems concentrating and paying attention
  • Stage 2: the above, plus short-term memory impairment, depression and explosivity
  • Stage 3: cognitive problems and trouble planning, multitasking, organizing and judging
  • Stage 4: full-blown dementia

A third of all the CTE cases were diagnosed with additional brain problems. Sixteen percent had Lewy body disease (which can lead to dementia) and 12 percent had motor neuron disease that affects their muscle movement.

In addition, 11 percent had Alzheimer's disease and 6 percent had frontotemporal lobar degeneration, which affects behavior, personality and language.

"While it remains unknown what level of exposure to brain trauma is required to trigger CTE, there is no available evidence that occasional, isolated or well-managed concussions give rise to CTE," said Robert Cantu, MD, co-director of CSTE and co-founder of the Sports Legacy Institute, which also co-authored the study.

Dr. McKee says that future research should look at how many people actually get CTE, whether the symptoms are different from similar conditions and how genetics and the environment affect the problem.

"The ability to diagnose CTE while someone is alive is an important next step to allow us to address some of these important issues, as well as develop and test treatment and prevention strategies for the disease," said Robert Stern professor of neurology and neurosurgery at BU and co-author of the report.

The study was published in the December issue of Brain, A Journal of Neurology. A number of institutions and departments involved with veterans, neurological disorders, and sports history and legacy funded the study. 

Review Date: 
December 12, 2012