Chronic Traumatic Encephalopathy (CTE)

By Fr. Jerome LeDoux
Contributing Columnist

Now that you have read an almost unreadable title, pause a while and peer into the scary, melancholy, depressing world of people engaged in mortal combat with a foe that only now is becoming widely known, recognized and challenged.

The Concussion Legacy Foundation gives an exhaustive summary and analysis of CTE, a degenerative brain disease found in athletes, military veterans and others with a history of repetitive brain trauma. The culprit is a protein called Tau that forms clumps that slowly spread throughout the brain, killing brain cells.

It is quite curious that this description of CTE does not mention first the sport of boxing, especially prizefighting, that is the deadliest form of boxing. The original name of this degenerative brain disease was dementia pugilistica (boxer’s dementia), more commonly known as punch-drunk syndrome. As you surmised, this was the first sport diagnosed as causing CTE; hence, the name boxer’s dementia.

Dr. Harrison Martland first revealed CTE in 1928, describing a group of boxers as suffering from “punch-drunk syndrome.” Over the next 75 years, several researchers reported similar findings in boxers and other victims of brain trauma, with fewer than 50 cases confirmed. In 2005, Pathologist Bennet Omalu published the first evidence of CTE in former NFL Pittsburgh Steeler Mike Webster. Shortly after that revelation, the Concussion Legacy Foundation partnered with Boston University and the U.S. Department of Veterans Affairs to form the VA-BU-CLF Brain Bank, led by Dr. Ann McKee. The Brain Bank has revolutionized how we understand the disease, finding CTE in over 300 of the more than 500 brains donated.

Though some 17-year-olds have suffered CTE symptoms, they usually do not begin appearing until years after the onset of head impacts. Early symptoms more usually appear in one’s late 20s or 30s, affecting mood and behavior. Some common changes are impulse control problems, aggression, depression and paranoia.

As CTE progresses, the afflicted may experience thinking and memory problems, including memory loss, confusion, impaired judgment and eventually progressive dementia. Usually appearing in one’s 40s or 50s, problems of knowing tend to appear later than mood or behavioral problems. An afflicted person may suffer from one or both groups of said problems/symptoms. In some cases, symptoms worsen with time, even without additional head impacts. In other cases, symptoms may be stable for years before worsening.

The best available evidence shows that CTE is caused by repetitive hits to the head sustained over a period of years. This means many more times than occasional concussions. Most people diagnosed with CTE suffered hundreds or thousands of head impacts over the course of many years of playing contact sports or serving in the military. Yet, concussions are not the biggest factor. All the credible evidence shows that the biggest factor is numerous sub-concussive impacts or hits to the head short of full-blown concussions. This aspect of CTE is like a stealth bomber.

Which is even more alarming to the NFL and professional hockey and soccer teams, for it shows that, even if violence is toned down in the various leagues, there remains a real threat for the development of CTE in the players. Findings on head impacts: through tackle football (200+ cases confirmed at the VA-BU-CLF Brain Bank), the military (25+ cases), hockey (20+ cases), boxing (15+ cases, 50+ globally), rugby (5+ cases), soccer (5+ cases, 10+ globally), pro wrestling (5+ cases).

To the surprise of many, CTE is suffered by professional players also in soccer, rugby, hockey and wrestling. No matter what the sport is, head impacts and hard body collisions are the critical factors in causing CTE.

With such overwhelming evidence and narratives, some parents have become very apprehensive about having their sons play in the NFL in particular, in spite of the fatal attraction of ready money. Some collegiate football stars are opting out of pursuing a pro career, even eschewing lucrative offers by professional teams. Their thinking is that no monetary offer can be worth the gamble on being afflicted by CTE. Even some high school stars are opting out of playing collegiately. The coveted multi-million-dollar paydays cannot restore a player’s lost health of life and limb.

Since CTE can be verified only through post-mortem examination, doctors are left with treating symptoms like mood changes, headaches and memory problems.

Cognitive behavioral therapists can help with mood changes. There are treatment options for headaches, and there are memory training exercises and strategies.

This article originally published in the August 6, 2018 print edition of The Louisiana Weekly newspaper.