What Is Chronic Traumatic Encephalopathy (CTE)?

Reviewed on 11/30/2022
Brain scan of person with Chronic traumatic encephalopathy (CTE)
Chronic traumatic encephalopathy (CTE) is a brain condition affecting the mood, memory, behavior, and cognitive function, which is caused by repetitive hits to the head sustained over many years. It is commonly seen in athletes in contact sports, military veterans, and others with a history of repetitive brain trauma.

Chronic traumatic encephalopathy (CTE) is a progressive and degenerative brain condition caused by repetitive hits to the head sustained over many years. 

  • CTE is not the same as a concussion, and many people who get concussions do not develop CTE, but a pattern of repeated minor head injuries appears to increase the risk.
  • Most people diagnosed with CTE have experienced hundreds or thousands of head impacts, and the condition is often seen in athletes in contact sports, military veterans, and others with a history of repetitive brain trauma
  • CTE was previously known as “punch drunk” syndrome and dementia pugilistica because the condition was first noted in boxers.

What Are Symptoms of Chronic Traumatic Encephalopathy (CTE)?

Symptoms of chronic traumatic encephalopathy (CTE) affect the functioning of the brain and eventually lead to dementia. The symptoms of CTE tend to start a few years after a person has stopped playing a sport or after the activity that causes repeated hits to the head.

Mood and behavior symptoms of CTE include: 

  • Aggression
  • Mood swings
  • Depression
  • Anxiety
  • Frustration
  • Agitation
  • Problems with impulse control
  • Paranoia

Cognitive symptoms of CTE include:

  • Short-term memory loss
    • Asking the same question several times
    • Difficulty remembering names 
  • Confusion
  • Disorientation
    • Getting lost
    • Wandering
    • Not knowing the time 
  • Thinking problems
    • Difficulty making decisions
    • Impaired judgment
  • Dementia

Sleep symptoms may also occur. 

As CTE progresses, symptoms may include:

  • Significant memory problems
  • Slurred speech (dysarthria)
  • Parkinsonism
    • Tremor
    • Slow movement
    • Muscle stiffness 
  • Difficulty eating or swallowing (dysphagia) (rare)

What Causes Chronic Traumatic Encephalopathy (CTE)?

The exact causes of chronic traumatic encephalopathy (CTE) are not completely understood, but the condition is believed to be caused by repeated blows to the head or recurrent episodes of concussion.

Those at greatest risk of developing CTE include: 

  • Athletes in contact sports who have a history of repetitive mild traumatic brain injury 
    • Boxing
    • Martial arts
    • Football
    • Soccer
    • Rugby
    • Hockey
  • Military veterans with a history of repeated head trauma, such as blast injuries 
  • People with a history of repeated head injuries 
    • Self-injury
    • Victims of repeated assault
    • Poorly controlled epilepsy that results in repeated head trauma

How Is Chronic Traumatic Encephalopathy (CTE) Diagnosed?

Currently, the only way a confirmed chronic traumatic encephalopathy (CTE) diagnosis can be made is after death through brain tissue analysis. 

While a person is alive, a diagnosis of CTE may be made based on a history of repeated head injuries such as through participation in contact sports, along with the presence of symptoms and clinical features. 

The changes to the brain due to CTE do not always show up on brain scans or they may look similar to other conditions. If a scan is performed, it is commonly a magnetic resonance imaging (MRI) scan or a computerized tomography (CT) scan.

What Is the Treatment for Chronic Traumatic Encephalopathy (CTE)?

Treatment for chronic traumatic encephalopathy (CTE) is similar to that used for other types of dementia and is based around supportive treatments. 

Lifestyle modifications that can help with symptoms of CTE include: 

  • Write things down 
  • Develop and maintain a routine
  • Control impulsive behaviors 
    • People with CTE may develop habits such as gambling, overspending, or using alcohol, drugs, or other addictive substances to cope 
    • Avoid these activities or seek professional help
  • Learn to manage anxiety and stress 
    • Practice relaxation techniques such as deep breathing or meditation 
    • Seek professional help if needed
  • Build a support system
    • Reach out for help when needed
  • Get adequate sleep
  • Exercise regularly
  • Maintain a healthy, well-balanced diet 

What Are the Stages of CTE?

There are 4 stages of chronic traumatic encephalopathy (CTE). 

Stage I: 

  • Characterized by headaches and loss of attention and concentration. People may also experience short-term memory problems, depression, aggression, and difficulty with executive functions (planning, attention, focus, multi-tasking). 

Stage II: 

  • Characterized by mood swings, depression, and short-term memory loss. A small number of patients experience executive functioning problems, language difficulties, impulsivity, and suicidal thoughts

Stage III: 

  • Characterized by memory loss, executive dysfunction, impulsive anger and aggression, problems with attention and concentration, mood swings, and problems understanding or interpreting what is seen. About 75% of people at this stage are considered cognitively impaired.

Stage IV: 

  • This is the final stage of CTE, which has progressed to full-blown dementia characterized by severe cognition problems and memory loss. Patients experience profound loss of concentration, paranoia, depression, executive dysfunction, language problems, aggression, problems with balance and walking, and difficulty understanding or interpreting what is seen. 

How Long Do People Live with CTE?

A 2009 analysis of 51 people who had chronic traumatic encephalopathy (CTE) found the average lifespan of those with the condition was 51 years.

In the later stages of dementia, patients can often die of infection. The inability to communicate can result in patients not getting care and treatment they need because they are unable to tell others they feel sick. 

Reviewed on 11/30/2022
Image source: iStock Images