Behavioral Health Symptoms Associated With Chronic Traumatic Encephalopathy: A Critical Review of the Literature and Recommendations for Treatment and Research

Abstract

Chronic traumatic encephalopathy (CTE) is a neurodegenerative syndrome that has been linked to serious psychiatric symptoms, including depression, aggression, and suicidal behavior. This review critically examines the extant research on the behavioral manifestations of CTE and concludes that the paucity of longitudinal prospective studies on CTE, combined with a lack of research-accepted diagnostic criteria for identifying individuals who are considered at risk for CTE, makes it difficult to reliably establish a causal relationship between CTE and the onset of behavioral health problems. Selection and reporting bias and inconsistency in data collection methods are other concerns. To advance the field, there is a critical need for more empirical research on the behavioral manifestations of CTE. Recommendations and intervention models are also discussed.

184 Interrelationships Among Neuroimaging Biomarkers, Neuropsychological Test Data, and Symptom Reporting in a Cohort of Retired National Football League Players

“…However, this widely accepted paradigm warrants further study due to limitations inherent to studying RBT, including small sample sizes and the potential for selection bias. 2,61 The purpose of this investigation was to assess the relationships among 3 neuroimaging findings (cavum septum pellucidum, FA global mean, and microhemorrhages) and neuropsychological test performance and symptom endorsement in a relatively large sample of retired National Football League (NFL) athletes. For this initial investigation, based on the prior literature examining retired NFL players, 23,33,66,74 we accepted the hypothesis that the relationships between these neuroimaging parameters and neuropsychological test and symptom scores would be significantly associated, as evidenced by multiple statistically significant correlations.…”

Rutin Acid Ameliorates Neural Apoptosis Induced by Traumatic Brain Injury via Mitochondrial Pathways in Mice

“…There are presently no effective strategies for mitigating brain damage caused by trauma, while the molecular basis for TBI-induced neurodegeneration remains obscure [12,13,14]. Secondary brain injury after trauma may result from oxidative stress, metabolic dysfunction, excitotoxicity, inflammatory response or vascular abnormalities [2,15,16].…”

The Biological Basis of Chronic Traumatic Encephalopathy following Blast Injury: A Literature Review

“…72,73 To address existing questions about links between CTE neuropathology and clinical/behavioral changes, established diagnostic criteria for longitudinal studies are needed. 74 In addition, methodological gaps, common in the existing body of case reports, must be addressed. Data reporting is inconsistent across case studies, and a high rate (43%) of duplication (i.e., re-reporting cases across multiple publications) has been described.…”

“…Data reporting is inconsistent across case studies, and a high rate (43%) of duplication (i.e., re-reporting cases across multiple publications) has been described. 51 Conclusions derived from case studies, which are often referred to researchers by families with concerns about neurobehavioral problems, 74 are limited by the significant likelihood of selection (ascertainment) biases. 51,75 In addition, pre-mortem symptom data, which are often derived from interviews with family members, is not objective and is subject to recall biases.…”

“…95 Because of the neuropathological similarities with AD and TBI, potential pharmacological and behavioral interventions for these conditions could also be applied to CTE. 74,191 Discussion CTE represents a major public health issue, given the number of athletes and service members who are exposed to concussive and/or subconcussive events. The current state of the science has generated an initial consensus on the neuropathology of CTE.…”