CTE

Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disease linked to repetitive head impacts, including concussions and subconcussive blows. It has been studied most extensively in contact sport athletes, boxers, and some military personnel, but can occur in others with repeated head trauma. A definitive diagnosis currently requires neuropathological examination after death.

Pathologically, CTE is characterized by abnormal accumulation of hyperphosphorylated tau protein in neurofibrillary tangles, often around small blood vessels in the depths of cortical sulci, with accompanying neuronal loss and gliosis. Other patterns of proteinopathy may be present. The exact relationship between these changes and clinical symptoms is an area of ongoing research.

Clinically, CTE presents years after exposure to head trauma with a spectrum of symptoms. Early features frequently include mood and behavioral changes (such as depression, irritability, impulsivity) and cognitive difficulties, particularly in memory and executive function. In later stages, motor symptoms similar to parkinsonism or ataxia may appear. The onset and trajectory are variable, and coexisting conditions can complicate the presentation.

Diagnosis during life remains unproven and is not widely available. No validated in vivo test exists, though research uses imaging techniques such as tau PET and various biomarkers to identify potential cases. Management focuses on symptom relief and support, including treatment of mood and cognitive symptoms and addressing sleep or sleep-related disturbances. Prevention centers on reducing exposure to repetitive head impacts and adhering to concussion prevention and return-to-play guidelines in sports.

Historically, CTE was first described in the early 2000s and has since become a focal point of research into repetitive head trauma, safety protocols, and brain health.