What is CTE and Why Athletes Need to Know About It

CTE stands for chronic traumatic encephalopathy. It's a brain disease caused by repeated head injuries that may include concussions.

It mostly happens in athletes who play contact sports like football and ice hockey. Doctors first identified it under a different name in the 1920s in aging boxers. CTE results from cumulative damage and usually happens years later.

Although there’s no cure, you or your child can take steps to avoid getting CTE.

Even if your “bell has been rung” a few times, it doesn’t mean you’ll get the disease. But you should know what to watch out for.

Causes

When you’ve had repeated blows to the head, including concussions, they set off a slow series of events that may lead to brain problems.

Repeated brain injuries can lead to a buildup of tau, a protein that’s found in the brains of people with Alzheimer’s.

Tau is not all bad. It stabilizes brain cells. But when it builds up due to impact to the brain, it tangles and clumps together. This slowly kills cells called neurons. The clumped tau also spreads to other cells and makes it harder for the brain to work. This is CTE.

Since not everyone with a history of brain trauma gets CTE, some researchers think other things, like genetics, may play a role. But head impacts are the only proven cause.

Symptoms

You may have:

• Memory loss
• Confusion
• Impulsive or erratic behavior
• Bad judgment
• Aggression
• Depression
• Paranoia
• Dementia

These conditions usually begin years, sometimes decades, after your last brain injury or when you stopped playing.

Some symptoms are similar to those seen in people with Alzheimer's or Parkinson's disease, which makes it hard to diagnose. Let your doctor know about any head injuries you’ve had, no matter how long ago, and when your symptoms started.

Who’s at Risk?

When doctors discovered CTE in prizefighters in the 1920s, they called it “dementia pugilistica.” The condition became so well known that for years, fighters with slurred speech and behavior issues were called “punch drunk.”

But in recent years, CTE has been found in other athletes, most notably former football and hockey players. You may have read in the news about NFL players, like Junior Seau, who were diagnosed with the disease after their deaths. Although doctors can suspect CTE, they can’t confirm the diagnosis until they autopsy the brain.

Researchers also have found the condition in athletes who competed through only high school or college, in some cases decades before they died.

Others, including military veterans who’ve had a head injury, are also vulnerable to the disease. But people who play or have played contact sports face the highest risk.

Kids and their parents should also be alert. Children who play these sports may have higher odds of getting a serious brain injury than even pro athletes. Youth football players take hits to the head nearly equal to that of college players -- and a child’s brain is less insulated than an adult’s, leaving the brain cells more sensitive to the shock of concussions. Some soccer leagues have banned "heading" the ball.

How to Play It Safer

Kids and higher-level athletes should take some steps to lower their chances of getting a concussion:

• Wear appropriate equipment.
• Make sure all gear is worn properly.
• Check the playing field, and tell the coach about any uneven areas and holes.
• Don't use unnecessary aggression during the game.
• Learn and use the proper technique for your sport.

There’s work for the coach here, too. They should limit the number and length of contact practices. Many states now have laws on the books about that.

Researchers are developing tests to diagnose CTE earlier. There have already been breakthroughs in tau imaging, and scientists have learned a lot about the condition. Their work may lead to advances in the diagnosis and treatment of the disease.

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