Chronic Traumatic Encephalopathy as a Preventable Environmental Disease

Abstract

In this Perspective we explore the evolution of our understanding of chronic traumatic encephalopathy (CTE) and its relationship with repetitive head injury. As with many neurodegenerative conditions, there is an imperfect correspondence between neuropathology and clinical phenotype, but unlike other neurodegenerative diseases, CTE has a discrete and easily modifiable risk factor: exposure to repetitive head injury. Consequently, evaluation of the evidence regarding exposure to repetitive head injury and CTE risk should be undertaken using public or occupational health frameworks of medical knowledge. The current debate over the existence of CTE as a disease of concern is fuelled in part by immediate medico-legal considerations, and the involvement of high-profile athletes, with inevitable media interest. Moving beyond this debate has significant potential to address and reduce disease impact in the near future, and provide novel insights into mechanisms underlying abnormal protein accumulation in CTE and other neurodegenerative diseases.

Sport-related concussion research agenda beyond medical science: culture, ethics, science, policy

“…In contrast, evidence concerning the nature of pertinent chronic health conditions and the role brain injuries may have in their progression is weaker. [35][36][37][38] This uncertainty, and accordingly, the problem for individuals to weigh their options, is not merely due to lack of knowledge about causal connections between repeated concussions and chronic conditions. Rather, the problem stems from the population-specific character of extant evidence.…”

“…Risks resulting from playing sports can be individually weighed because the relevant facts, including probabilities of brain injury, are sufficiently established. In contrast, evidence concerning the nature of pertinent chronic health conditions and the role brain injuries may have in their progression is weaker 35–38. This uncertainty, and accordingly, the problem for individuals to weigh their options, is not merely due to lack of knowledge about causal connections between repeated concussions and chronic conditions.…”

Management of Neuropsychiatric Symptoms for Chronic Traumatic Encephalopathy

“…Therefore, it is important to minimize the risk of CTE by reducing repetitive head trauma and identifying risk factors. Events that increase the risk of head injury such as targeting in football or body checking in hockey should be minimized or eliminated from the game [33,34,[61][62][63]. Following a blow to the head, players should be evaluated by a physician or a certified athletic trainer to rule out the possibility of a concussion [33,34].…”

Evidence of reduced inhibition in older adults with a history of repetitive brain trauma. A transcranial magnetic stimulation study

“…While definitive evidence of neurodgenerative disease only exsists post-mortem [3,4], some attempt has been made to investigate pathophysiological changes in retired contact sport athletes using transcranial magnetic stimulation (TMS) [5][6][7][8][9]. However these studies have been limited to older retired players (<50 years and older) to the exclusion of younger retired players aged in their 30s and 40s.…”

“…Epidemiological studies report, in those with a history of repetitive neurotrauma from playing contact sports, an increased risk of neurological impairments and neurodegenerative disease [1, 2]. While definitive evidence of neurodgenerative disease only exsists post-mortem [3, 4], some attempt has been made to investigate pathophysiological changes in retired contact sport athletes using transcranial magnetic stimulation (TMS) [5-9]. However these studies have been limited to older retired players (<50 years and older) to the exclusion of younger retired players aged in their 30s and 40s.…”