Developments in CTE Detection and Diagnoses
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July 16, 2018
By Desi Rotenberg, MS, LAT, ATC
Chronic Traumatic Encephalopathy (CTE) continues to be a topic that is widely discussed, both amongst medical professionals, and amongst athletic governing bodies. While there have been few advances in the detection of the disease, researchers are making progress in the recognition of symptoms prior to death. It is always important to note that CTE cannot be diagnosed while a patient is still living, and the extent of the damage within the brain can only be determined post-mortem.
Researchers are now piecing together the signs and symptoms that may be an early indication of CTE in individuals who have suffered multiple head traumas. The first indication is the presence of “Tau” proteins, which can be detected using Positron Emission Tomography.1 While the detection of these proteins does not directly correlate with a positive diagnosis of CTE, there is an indication that an increase in the Tau protein may be the brain’s natural homeostatic response to physical trauma.1 Diffusion Tensor Imaging and Magnetic Resonance Imaging are also used to identify “non-specific” pathologies that may accompany CTE, although as mentioned above, a positive test does not equate to a definitive diagnosis of CTE.
The second precursor that may be an early indication of CTE prior to death, are the cognitive and behavioral effects that may be present. In a 2017 study to determine the effects of cumulative head trauma, Montenigro, et. al. determined that “multiple, cumulative head trauma exposure can be a predictor for depression, apathy, executive dysfunction, and cognitive impairment later in life.”2 Furthermore, this longitudinal study was done using former high school and collegiate football players, and identified specific factors that have the potential to lead to a CTE diagnosis while a patient is still living.
Researchers have also begun to classify various subtypes of CTE that may be useful for future research, as possible detection and diagnoses become available. In a 2014 study published by Montenigro et al., a distinction is made between CTE and TES (traumatic encephalopathy syndrome). Researchers suggest that “chronic” must be removed from the name as it designates the condition as “ongoing.” However, based on the literature review that accompanied this study, CTE is a “progressive disorder that leads to the breakdown of neurological tissue following continuous impact to the brain.”4 Based on how little we know about the onset and presentation of the condition, researchers are suggesting that we continue to challenge the notion that CTE can only be diagnosed after death, in an attempt to encourage further diagnostic imaging exploration.
According to the Neurology Times, there is an ongoing, 7-year longitudinal study that examines former National Football League players, both with and without cognitive and behavioral symptoms, and aims to assess their current states with a wide variety of diagnostic testing. The goal of this study is to determine the behavioral and cognitive impacts that a professional football career has on the quality of life of former players, and then determine if CTE precursors are present at various points in the individual’s life span.1 Such precursors include mental health status, sleep quality, outlook on life, in addition to executive and cognitive functioning.3
It is clear that while we are still far from a formal modality to diagnose CTE in a living patient, researchers are honing in on a better understanding of the condition as a whole. This will further our recognition of the underlying symptomology that may be detectable and discernable in patients who experience continuous traumatic impacts to the head and may one day open the door for diagnosis of the condition prior to death. As we continue to progress our knowledge of CTE, its epidemiology, and its symptomology, we may be on verge of finding a way to offer treatment to those who are still living with the condition.
1. Alosco, M. L., & Stern, R. A. In Vivo Biomarkers for Chronic Traumatic Encephalopathy.
2. Montenigro, P. H., Alosco, M. L., Martin, B. M., Daneshvar, D. H., Mez, J., Chaisson, C. E., ... & McClean, M. D. (2017). Cumulative head impact exposure predicts later-life depression, apathy, executive dysfunction, and cognitive impairment in former high school and college football players. Journal of neurotrauma, 34(2), 328-340.
3. Mez, J., Daneshvar, D. H., Kiernan, P. T., Abdolmohammadi, B., Alvarez, V. E., Huber, B. R., ... & Cormier, K. A. (2017). Clinicopathological evaluation of chronic traumatic encephalopathy in players of American football. Jama, 318(4), 360-370.
4. Montenigro, P. H., Baugh, C. M., Daneshvar, D. H., Mez, J., Budson, A. E., Au, R., ... & Stern, R. A. (2014). Clinical subtypes of chronic traumatic encephalopathy: literature review and proposed research diagnostic criteria for traumatic encephalopathy syndrome. Alzheimer's research & therapy, 6(5), 68.
About the Author
Desi Rotenberg, originally from Denver, Colorado, graduated with his bachelor's degree in 2012 from the University of Northern Colorado. He has been a BOC Certified Athletic Trainer since 2012 and earned his master's degree in Exercise Physiology from the University of Central Florida in 2014. He currently is a high school teacher, teaching anatomy/physiology and leadership development. Along with being a teacher, he wears many hats, such as basketball coach, curriculum developer and mentor. He has been a contributor to the BOC Blog since the summer of 2015.