CTE: What We Know and the Questions that Still Exist

A close-up look at a human brain while consider CTE and what we know about it

Chronic traumatic encephalopathy, commonly known as CTE, is becoming a more familiar medical term, due in part to the speculation it’s a direct result of concussion. UnityPoint Health Sports Medicine provider, Shawn Spooner, MD shares what the medical community knows about CTE and the questions that still need to be answered.

What is CTE?

CTE is a degenerative neurological disease most commonly associated with repetitive brain injury or trauma. With CTE, a protein called “tau” builds up in certain areas of the brain, which results in memory trouble, higher levels of depression and poor impulse control. Unfortunately, CTE diagnosis can only be made after an individual passes away.

Some sources indicate CTE and concussions go hand-in-hand, but Dr. Spooner says concussions aren’t the sole contributing factor for CTE.

"Many people associate CTE and football together, however, we simply do not know enough about CTE to definitively say how it develops or all of the factors involved,” Dr. Spooner says. “Currently, what should be understood is CTE is not a continuation of concussion. The natural course of the disease is not simply concussion, chronic neurocognitive impairment then CTE. There are likely many other factors, including genetic and environmental factors, that increase an individual’s risk for developing any condition, including concussions, chronic post-concussive disorders or even CTE.”

Unlike CTE, another neurological condition, chronic neurocognitive impairment (CNI), can be tested for symptoms and behaviors. Studies of American football players and soccer players indicate a possible relationship between the number of concussions or head injuries experienced with CNI, but Dr. Spooner says more large-scale research needs to be done to determine more concrete data on both CTE and CNI.

CTE Treatment

While CTE can’t be diagnosed until following death, Dr. Spooner says being aware of signs and symptoms that seem more prolonged than typical following a concussion is important.

“Those who exhibit disorders or symptoms, such as post-concussion syndrome or CNI, are treated best in a multidisciplinary approach. Physical therapy, occupational therapy, speech therapy and neuropsychology are common members of a treatment team. This type of multi-disciplinary team is best led by a specialist in concussion, such as fellowship-trained sports medicine physicians, certain neurologists or primary care providers, with training or background in concussion and post-concussion syndromes,” Dr. Spooner says.

Ways to prevent CTE may not be exactly clear at this time, Dr. Spooner encourages parents, athletes and others to stay aware and educate themselves through reliable sources.

“In general, preventative measures, as applied to athletics, would be the same for CTE/CNI as for concussion. I think it is good for all those who might have the potential to be most affected, such as athletes with higher risk of concussion, like football, and those who participate in sports with repetitive, non-concussive head impacts, such as boxing, to stay aware of the emerging research involving CTE. It is important for physicians, trainers, coaches, parents and those who work closely with athletes to keep up to date on emerging research, policy changes and/or consensus recommendations as we learn more,” Dr. Spooner says.

However, Dr. Spooner also cautions against turning to concussion prevention or treatment methods not recommended by your primary care provider.

“There are many sham products, treatments and supplements being marketed, claiming to prevent or treat concussion. Nearly all of these products, everything from special helmets, pads, mouth guards, to supplements and physical treatments have no scientific basis and are simply taking advantage of people’s fears of concussion and CTE to make a profit. If you are wondering about any of these products or treatments, please consult your provider.”

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