Chronic Traumatic Encephalopathy
Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disease that develops over years following repeated head trauma and minor impacts. It is characterized by abnormal accumulation of tau protein in the brain. It is seen particularly in people involved in contact sports and in those exposed to repeated head trauma; at present a definitive diagnosis is made only by post-mortem examination.
Përditësimi i fundit: 2026-06-07
Definition
Chronic traumatic encephalopathy is a progressive neurodegenerative disease that develops over many years following repeated head trauma, concussions and, in particular, minor impacts that do not cause loss of consciousness (subconcussions). It has been described mainly in people involved in contact sports (American football, boxing, rugby, combat sports) and in military personnel exposed to blast injuries. Symptoms usually begin years after the trauma.
Mechanism and Risk Factors
Repeated trauma leads to cumulative stretching injury of the nerve-fiber extensions (axons). In this process tau protein, which has a role in axon stability, accumulates abnormally and forms 'neurofibrillary tangles' in nerve cells. The distribution of tau accumulation is characteristic of CTE and progresses by spreading over time. The main risk factors are the number and severity of injuries, the length of the sporting career, beginning trauma at an early age and certain genetic predispositions. One or two concussions do not cause this disease; the risk rises with hundreds to thousands of repeated impacts.
Symptoms
Symptoms are generally grouped into behavioral/mood and cognitive categories. Behavioral symptoms include depression, impulsivity, outbursts of anger, personality changes and anxiety. Cognitive symptoms are memory impairment, difficulty with planning and organization, attention problems and, in advanced stages, dementia. In advanced stages, movement disorders (parkinsonism-like slowness, tremor, balance disturbance) may be added. Early warning signs include prolonged post-concussion complaints and personality changes.
Diagnosis
At present a definitive diagnosis can be made only by post-mortem examination of the brain (by demonstrating tau protein accumulation). A diagnosis made during life is of a 'suspected/possible CTE' nature and is assessed using clinical criteria based on a history of repeated trauma and the progressive course of cognitive/behavioral symptoms. Brain MRI is not specific but may show supportive findings such as shrinkage (atrophy) of the frontal and temporal lobes and a cavity in the septum pellucidum. Tau-targeted PET imaging is at the research stage. Neuropsychological tests are used to assess the cognitive profile and track its course; similar conditions (Alzheimer's disease, frontotemporal dementia) are considered in the differential diagnosis.
Treatment and Prevention
There is no treatment that halts or reverses chronic traumatic encephalopathy; the approach is directed at symptoms. The most effective strategy is primary prevention: reducing repeated head trauma, reviewing the rules and protective measures in contact sports, and carefully applying appropriate recovery/return-to-play protocols after a concussion. Medication and psychotherapy may be used for psychiatric symptoms such as depression and impulsivity, and cognitive rehabilitation for cognitive symptoms. Lifestyle measures such as regular exercise, a balanced diet, mental activity and good sleep support brain health. Close monitoring is important because of the risk of suicide.
Course
Chronic traumatic encephalopathy is a progressive disease and its course varies with the stage; deterioration may be slow in the early stages and faster in the advanced stages. In the early period, when behavioral symptoms are prominent, care should be taken regarding the risk of suicide. Support, education and psychosocial assistance for the patient and family are important parts of the process. The course of the disease varies from person to person and research in this area is ongoing; individual outcomes cannot be guaranteed.
Burimet
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:1111-1118.
- McKee AC, Stein TD, Nowinski CJ, et al. The spectrum of disease in chronic traumatic encephalopathy. Brain. 2013;136(Pt 1):43-64.
- Katz DI, Bernick C, Dodick DW, et al. National Institute of Neurological Disorders and Stroke consensus diagnostic criteria for traumatic encephalopathy syndrome. Neurology. 2021;96(18):848-863.
- Mez J, Daneshvar DH, Kiernan PT, et al. Clinicopathological evaluation of chronic traumatic encephalopathy in players of American football. JAMA. 2017;318(4):360-370.
Ky artikull ka karakter të përgjithshëm informues dhe nuk zëvendëson vizitën mjekësore. Vendimet për diagnozën dhe trajtimin janë individuale.