Repeated head injury and CTE (Chronic Traumatic Encephalopathy) | Symptoms to look for

January 30th is National CTE Awareness Day. CTE (Chronic Traumatic Encephalopathy) is a progressive disease of the brain which occurs in individuals with a history of repeated brain trauma, like concussion. Although it isn’t always necessarily associated with sports, we do see CTE in athletes who have played sports where head injury can occur, such as football or hockey – or winter sports like skiing and skating. And as media focus will be on the upcoming Super Bowl (February 13) and the Winter Olympics (February 4 – 20), we think it’s important to help spread awareness about the disease, its symptoms, and warning signs.

Background: concussions are not mild injuries

We’ve talked in the past about what happens to the brain in a concussion. Essentially, when a head injury occurs as a result of a bump, blow, jolt, or a collision with an object (the ground, the ice, a tree, another person’s head, etc.), the brain moves rapidly back and forth inside the skull causing tissue damage. In addition, when one part of the brain moves faster or slower than another part during impact, stretching or straining between the brain’s regions occurs, resulting in further damage. 

Medical professionals may describe concussions as a ‘mild’ traumatic brain injury (mTBI) because they are usually not life-threatening, but their effects on day-to-day life can be serious, and include short- and long-term:

• Cognitive issues – visual disruptions, problems with memory and attention 
• Emotional issues – depression, irritability, mood, and personality changes
• Physical issues – headache, dizziness and balance issues, difficulty with sleep, seizures, excess fatigue 

What is CTE?

The CDC estimates that between 1 and 3 million sports concussions happen each year to children and adults, in both professional and recreational sports. And for some individuals, even despite the use of helmets, over time they suffer repeated blows to the head. (And as we mentioned above, CTE is not always associated with sports; it can also be associated with the military or other situations where repeated head trauma has occurred.)

Recent research has uncovered a troubling link between repeated head hits and dementia-like symptoms, which scientists have termed Chronic Traumatic Encephalopathy. What they have found is that in the brains of people with CTE, a naturally occurring protein, known as tau, builds up over time. The clumps of tau strangle brain cells, diminishing their ability to function. CTE often affects part of the frontal cortex, an area of the brain critical to thinking and executive function, including working memory, planning, and abstract reasoning.

What are the symptoms of CTE?

​​Research on CTE causes, symptoms, and risk factors is still ongoing, but medical professionals do agree, according to the Alzheimer’s Association, that CTE has been associated with dementia-like symptoms, including:

• Memory and thinking problems
• Confusion
• Personality changes
• Erratic behavior including aggression, depression, suicidal thinking
• Problems paying attention and organizing thoughts
• Difficulty with balance and motor skills

And unfortunately, people may not experience these potential signs of CTE until years or even decades after head injuries occur, so they don’t know how much their repeated injuries may be causing long-term damage.

Who is at risk for CTE?

It’s impossible to quantify how many people might have CTE because the potential pool is large: it could include anyone who has ever played a contact sport and/or suffered multiple head injuries. What we do know is that CTE has been confirmed posthumously in boxers, wrestlers, football players, hockey players, skiers, and skaters, as well as in military veterans who have a history of repeated brain trauma. And CTE is not limited to professional athletes; it has also been found in athletes who did not play sports after high school or college.

Can CTE be prevented?

The short answer is no. To date, no helmet or protective gear has been found which can prevent the brain trauma that can cause CTE over time. What we can do is to continue to raise awareness about CTE, to keep up on brain injury research in the scientific community, to carefully consider the risks when thinking about playing contact sports, to wear all the protective gear that is required if participating in contact sports, and to take any head injury seriously – which means getting checked by a medical professional even if there seem to be no symptoms present at the time of the injury.

Further Reading

• Boston University CTE Center: Frequently Asked Questions about CTE
• NPR, Everyday people fear they have CTE. A dubious market has sprung up to treat them, Dec. 2021.
• Alzheimer’s Association, Chronic Traumatic Encephalopathy
• New York Times, What is CTE: What to Know About C.T.E. in Football, Dec. 2021