CTE – Long term effects of concussions on the brain

There is a good chance you have heard of sports-related concussion and the effects of CTE (Chronic Traumatic Encephalopathy). The movie “Concussion” involves Dr Omalu, a forensic pathologist, who discovers severe neurotrauma in the brains of former NFL athletes and terms it CTE. This movie was based on true events centering Dr Omalu and his fight against the NFL to recognize concussion dangers. There has been a massive uptake in media interest following these events. Some of the stories included players displaying significant mental or cognitive health problems. Unfortunately, some of these players in the NFL, NRL and AFL have even taken their own life. This has obviously led to players, coaches and parents questioning the merits and risks of contact sports.

We often see players and parents wanting to know what is happening in their brain and how it can be prevented. This is a complex issue with many uncertainties surrounding it. Let’s explore what CTE is and the research surrounding it.

 

What is CTE?

 

CTE is thought to be a progressive, neurodegenerative disease which is associated with repeated concussive forces to the head. A protein called Tau builds up within the areas of the brain  and can lead to brain cell death. As the Tau protein progresses, the person may notice worsening symptoms such as memory loss or mood changes.  This can be very confronting for those suffering and their family members, as aggression and suicidal thoughts may result. It is thought that symptoms in CTE may manifest eight to twenty years after retirement from sport. 

As CTE progresses, there is a larger proliferation of Tau protein and the brain starts to lose its weight. The difficulty is that CTE can only be diagnosed once a person is deceased. The reason for this is there is so much overlap with other neurodegenerative conditions such as Alzheimer’s. This makes it impossible to attribute signs of mental illness to CTE until a post-mortem examination of the brain. The amount of Tau protein and brain weight can then be looked at in detail.

Is CTE related to concussion?

Since the early 2000’s, more and more professional athletes are donating their brains to brain banks. They may be worried that they exhibit symptoms of CTE and, more often than not, CTE was diagnosed in these players. However, as things currently stand, CTE has not been shown to relate to any history of concussion. All that means is that the current evidence is not strong enough to establish a link between concussions and CTE. The link may very well be there, but it has not been unearthed to show a causative relationship.

The nature of CTE makes it extremely difficult to research. The amount of research we currently have is limited and the strength of the studies looking at CTE is generally weak. With this type of evidence, we just cannot be sure that CTE is caused by concussions. As for now, it is important that we treat concussions conservatively as there may still be a link to CTE. 

Why are so many former athletes diagnosed with CTE?

Recently, when a former athlete’s mental health comes into question, the media can often jump straight to CTE. With CTE being a hot-button topic, they are more likely to get more interest surrounding the story. However, symptoms of mental health can be so variable and caused by different reasons which are not CTE. For example, retirement from professional sports or an increased drug use may lead to mental health symptoms…. Having a sneeze may be related to an allergy, or it could come from a cold. There are so many variables that overlap. Despite strong media interest, we just cannot say if mental health symptoms are due to CTE.

Now, there are a lot of brains of former athletes tested in brain banks which have come back with a diagnosis of CTE. It is important to know that there is a selection bias in what the brain banks receive. Athletes with mental health symptoms are much more likely to donate their brains to the banks rather than the general population. Therefore, the proportion of these donors who receive confirmation of CTE is likely to be disproportionately high. Having no control group of the general public or former athletes with no mental health symptoms makes comparison difficult. 

Unfortunately, many news stories we see are former athletes taking their own life. It is a tragedy when any person would feel the need to end their life. Autopsies of the brains of former NFL players, deceased from suicide, indicated CTE was present in some players. On paper, this makes it appear that CTE can be a culprit for suicide. However, researchers also found that the suicide rate in former athletes of contact sports is lower than the general population. Despite this, the general public do believe that there is an increased risk of suicide in former contact sport professional athletes. This misconception is likely due to the highly publicized cases of suicide and mental illness of former professional athletes. 

The good news?

The new attention into the field of concussion and CTE has prompted a rapid change into taking head injuries seriously. Identification and management of head injuries have been improved exponentially in the last fifteen years. As a result of this, the serious effects of PCS (post-concussive symptoms) such as years of headaches/dizziness in patients has reduced. Second Impact Syndrome has reduced as well, which means there has been less cases of permanent brain damage as players have been managed better. 

The Bottom Line

Sport in children and adults is one of the healthiest things that they can do. Exercise and social inclusion can have a profound affect on our overall sense of wellbeing. The link currently between concussion and CTE is unclear. The risk of head-injuries in sport is certainly there, however they can be addressed well with appropriate management. Historically the concussion itself hasn’t been the problem, but the concussion management has been the problem. Here are the key things to remember:

• Parents, coaches, and teammates are the first line of defense. Make sure to always pull an athlete off the field if you see any signs or symptoms of concussion. Refer them to healthcare practitioner with experience in the management of concussion.

 

• It is important to obtain comprehensive medical clearance before an athlete returns to sport following a concussion. This will allow an athlete to safely return to sport without any undue risk of further brain injury.

 

• Currently there is no compelling reason to hold an athlete back to return to contact sports following a concussion. There is no established link at this stage between concussion and CTE however there may be one in the future. Therefore, clearance is not a guarantee barring an athlete from future complications.

 

• A culture of sport promoting a ‘win at all costs’ mentality is averse to concussion recovery. Athletes are given undue duress in continuing to participate in sports with concussive symptoms. This will put their long-term brain health at risk due to complications from concussions. Parents and coaches should foster an atmosphere of openness and honesty when disclosing symptoms. 

 

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