What is Chronic Traumatic Encephalopathy or CTE?
Chronic Traumatic Encephalopathy (CTE) is a neurodegenerative disease that has been linked to repeated head injuries. Repeated head injuries may take the form of concussion (mild traumatic brain injury) and/or hits to the head that do not result in concussion symptoms, called subconcussive hits. Individuals with CTE can experience a range of changes in their mood, behaviour, and thinking skills that can interfere with their normal or working life.
- CTE can affect an individual’s thinking, mood, and behaviour.
- CTE can be caused by repeated head injuries. Repeated head injuries often occur from participation in contact sports but can also occur in non-sporting situations (e.g., military service, domestic violence, workplace accidents).
- If you have concerns, it’s a good idea to seek help early.
Signs and symptoms of Chronic Traumatic Encephalopathy or CTE
CTE can result in a wide range of signs and symptoms. Signs and symptoms of CTE appear gradually, often many years (10+) after the repeated head injuries have occurred.
- Memory loss
- Concentration/attention difficulties
- Brain fog with headache or head pressure
- Difficulties learning new things
- Impaired judgement
- Loss of sense of direction
- Driving difficulties
- Changes in sleeping patterns
- Loss of awareness of having difficulties.
- Emotional lability (mood swings)
- Depression or suicidal thinking
- Loss of empathy.
- Episodes of rage, including road rage
- Loss of motivation
- Reduced social activity
- Slowness, or Parkinson’s disease-like changes.
There is currently no single test for diagnosing CTE. However, a doctor and medical team qualified in assessing brain injury can identify the likelihood of having CTE. This team may include neurologists, geriatricians, sports physicians, and rehabilitation specialists.
If you have concerns about CTE, it is a good idea to seek help early. A memory check with your GP is a simple way to start. A check-up with your doctor may also help to identify other conditions resulting from head injury – such as persistent post-concussion symptoms and post-concussion headache.
From there, a referral to a specialist may be arranged for further investigation. This may include cognitive screening, neuropsychological assessment, and/or brain scans (e.g., magnetic resonance imaging: MRI).
It’s important to recognise that the changes in thinking, mood, and behaviour described above may also be caused by other factors, such as alcohol, smoking, or poor sleep quality. You may want to discuss these when you first see your doctor. Specialists will also seek to identify conditions that can mimic CTE or negatively impact a person’s cognition, such as obstructive sleep apnoea, alcohol use disorder, depression, post-traumatic stress disorder (PTSD), attention deficit hyperactivity disorder (ADHD), stroke, and migraine. Detecting and managing other medical conditions can form an important part of the overall care for someone with CTE.
Who is at risk of CTE
CTE has been identified in individuals who have participated in boxing, football, competitive cycling, as well as equestrian and other sports involving contact or collisions. Outside of sports, CTE may occur as a result of repeated head injuries from violent assault (e.g., family and domestic violence), frequent falls leading to head impacts, explosions or blast trauma.
Head knocks that are seemingly minor (sub-concussive hits) as well as those with symptoms (concussions, or mild traumatic brain injury) are thought to increase the risk of developing CTE. However, a single or low number of head knocks is unlikely to be a problem.
Treatment and management options for CTE
Having a general practitioner who can coordinate care is part of good CTE management. A specialist may choose to monitor a patient’s progress over time to assess the stability of their symptoms and provide reassurance.
Avoid things that may worsen thinking, including alcohol and smoking. If sleep is affected, consider getting a laboratory sleep assessment and treating conditions such as obstructive sleep apnoea. It is important that family members also receive information and support so that they can assist in the best possible way.
Although there is no cure, prevention and care for those at risk of CTE is vital for good quality of life.
CTE can be prevented by avoiding and minimising the risk of (repetitive) head injury. Good concussion management is an important aspect of preventative care. Speak to your sporting club or workplace administration to discuss ways to minimise head injury.
If you participate in a sport where there is a risk of head injury, make sure to:
- Follow guidelines, protocols, and expert opinion.
- Contact your club to discuss ways to minimise head injury.
Helping someone with CTE
You may have concerns about someone you know who is showing changes in their thinking, mood, and behaviour. This person may or may not have CTE, but gently encouraging a memory check with their doctor is a great place to start.
As a family member or friend of someone living with CTE, it’s important to show compassion for yourself and look after your own wellbeing. For more information on ways that you can look after yourself, check out our webpage on “Coping with the new normal” here.
How you communicate and interact with someone living with CTE can improve the person’s responses. It can be helpful to speak to a psychologist or occupational therapist trained in head injury about role-play exercises and other strategies that can help facilitate smoother interactions with individuals affected by CTE.
CTE in sports – what are the risks?
Click below to read article by Professor Melinda Fitzgerald, CEO of Connectivity on CTE in sports – what are the risks?
Resources and further reading
Macquarie University Health – Concussion Connect – www.mqhealth.org.au/services/wellness-services/concussion-connect
Australian CTE Biobank – www.ctebiobank.org
Concussion Big5 – www.concussionbig5.au
Lifeline Australia – 13 11 14
Suicide Call Back Service – 1300 659 467
This webpage features information that has been adapted with permission from Neurologist and Director or Australian CTE Biobank, Dr Rowena Mobbs.
This website does not offer medical advice for individuals. Always be guided by your medical practitioner.