The Background of Chronic Traumatic Encephalopathy

Chronic traumatic encephalopathy, also known as CTE is a disease that is common in

athletes who receive repetitive hits to the head. Finding how to test and detect these individuals

while they are still alive is progressing. Medical professionals are finding commonalities

between Alzheimer’s research and an effective treatment for CTE. Although it is not only in

athletes, it has been found in domestic abuse victims also. This disease has raised much concern,

it has begun many legal battles between families and national leagues.

For the doctor that is diagnosing CTE to a patient it is a difficult process. During the

autopsy a brain scan is executed to look for the irregular accumulation of the protein of tau. The

main cause of the disease is repeated blows to the head. James states that “the progressive

deterioration of brain function, which typically leads to severe mental and physical disabilities,

with the most severe symptoms often resulting in an early death” “Ringing the Bell for the Last

Time: How the NFL’s Settlement Agreement Overwhelmingly Disfavors NFL Players Living

with Chronic Traumatic Encephalopathy” (399). This shows how significant is to find more

information on CTE and how it can be cure, tested, or treated.

While it is not yet testable in alive patients, medical professionals are trying to find an

effective treatment. Dr. Martland has reported CTE almost a century ago and doctors are still

trying to find an effective treatment. It has been found that CTE shares key features with

Alzheimer’s disease (“Neuropsychiatry. Is Alzheimer Disease Research Key to Effective

Treatment of CTE in Athletes? 1”). Being that the symptoms of CTE do not start right away,

Miller describes it as a “window of opportunity to intervene therapeutically” (2). Individuals

with alzheimer’s disease use a medication that unfolds the misfolded tau proteins. Those same

symptomatic medications that are used is now a treatment option for CTE. Clinical trials have
suggested that the tau protein aggression inhibitors have the potential to reduce the damage to the

brain.

In the article “Progress is Seen in Detecting C.T.E in Living Patients”, Ken Belson goes

further into detail about the advancement of detecting CTE in the living. A PET scan is being

developed at UCLA. Belson mentions how researchers have been able to detect the disease, but

they have yet to determine why some people are predisposed to developing the disease. There is

only one problem that come along with the PET scan, the cost of it. “The current battery of tests,

including the PET scan cost about $10,000 per patient” (“Progress is Seen in Detecting C.T.E in

Living Patients”). This test is likely to settle lawsuits between the NFL and retired players.

Although it is not a vast improvement, a small step is better than nothing.

Jesse Mez et al, hypothesized a dose-response relationship between duration of football

played and CTE risk and severity. The method they used entailed 266 deceased American

football players (“Duration of American Football Play and Chronic Traumatic Encephalopathy”).

The authors evaluated the ability of years played to classify the CTE status using receiver

operation curve analysis. An ROC curve is used to assess the overall diagnostic performance and

to compare the performance of two or more diagnostic tests. The results of the hypothesis came

out to 223 of the total 266 met neuropathological criteria for CTE. To conclude the odds of CTE

nearly double every 2.6 years of football played.

CTE is one of the most known diseases in contact sports. These sports consist of boxing,

soccer, ice hockey, rugby, rodeo, and football. Many athletes have suffered from this disease

without knowing, being that it is only tested posthumously. The symptoms of CTE do not appear

until until after the years of head impact. Alosco et. al mentions how CTE cannot yet be detected

during life, but the National Institute of Neurological Disorder and Stroke were awarded a seven-
year grant. Within these seven years their project will consist of the development in vivo fluid

and neuroimaging biomarkers (Alosco, et a136”). The authors go deeper into the project, they

explain that it will consist of 240 male participants. These males are between the ages 45-74,

they were all either former professional football players, former collegiate football players, or

asymptomatic participants. This is a major step because at the end or possibly before CTE will be

one step closer to being discoverable in alive participants.

Chronic traumatic encephalopathy is usually brought up when talking about sports, but

that is not the only condition that can cause it. The article by Danielsen et al, goes in depth about

how CTE was found in a young victim of domestic abuse “Chronic Traumatic Encephalopathy

(CTE)-Type Neuropathology in a Young Victim of Domestic Abuse” (625). The twenty-nine year

old woman was the first case of CTE in an abuse victim. The woman had suffered years of

assault, and long term domestic violence. Her autopsy revealed multiple abrasions, contusions,

and lacerations to her face, nose, upper lip, chin, and ears. The article states that the report was

meant to raise awareness for the need to additional studies of the chronic effects in the head

trauma of victims..

In the article “Rationale and design of the “Neurodegeneration: Traumatic brain injury as

Origin of the Neuropathology (NEwTON)” study: a prospective cohort study of individuals at

risk for chronic traumatic encephalopathy”, van Amerongen et al. create the NEwTON research

project. It will include a unique cohort of male and female participants who are at risk for CTE.

The participants were grouped based on various sources of head trauma. The NEwTON study

will identify clinical and cognitive characteristics of individuals at risk for CTE, measure

clinical course of individuals at risk for CTE, identify potential diagnostic and prognostic

biomarkers in blood, and to recruit candidates for autopsy brain donations. This study includes
40 healthy unexposed control subjects and 40 at risk participants. The two groups went through

different procedures, the control group was included in the study to identify, validate, and

compare biomarkers (“Rationale and Design of the ‘NEurodegeneration: Traumatic Brain Injury

as Origin of the Neuropathology (NEwTON)’ Study: A Prospective Cohort Study of Individuals

at Risk for Chronic Traumatic Encephalopathy 3”). The participants that were exposed had to be

above the age of thirty, have a history of high exposure contact sports, at least one of the

following core clinical features of TES must be present and be different from pre-morbid

functioning, lastly, they must have clinical features that are present for a minimum of twelve

months. This project will find, identify, and phenotype patients with possible CTE. As of June 1 st,

2021, the Medical Ethics Committee gave approval to the NEwTON project to launch the study.

The results will appear sometime in 2023.

Ken Belson and Benjamin Mueller mention the study that was published by the scientific

journal Nature Communications “Collective Force of Head Hits, Not Just the Number of Them,

Increases Odds of C.T.E”. The journal explained that the players’ chance of developing the

disease is related to the number of head impacts absorbed and the cumulative impact of those

hits. They found that the number of concussions diagnosed did not correlate to brain disease.

Within the article it states, “Researchers have for years poised that more hits to the head a player

receives – even subconscious ones, which are usually not tracked – the more likely he is to

develop cognitive and neurological problems later in life”. Along with that statement it shows

how severe it is to catch CTE as soon as possible. The authors interviewed Dr. Nauman, a

biomedical engineering professor. He says that there are obvious changes that need to be made to

football to make it safer, he recommends the elimination of hitting in practices, and the

development of helmets that absorb more impact.

 The disease also has a legal aspect to it. The lawsuits have been settled for enormous

sums. Within the article Concussions and Coverage: Insurance for Claims Alleged Long-Term

Brain Injuries, Including CTE it states, “some researchers have described C.T.E as a progressive

degenerative disease of the brain found in people with a history of repetitive brain trauma…”

(Reiter and Tanglen 1). The National Football League reached a settlement of $1 billion, due to a

concussion related diagnosis, (which ultimately ended up being C.T.E). The negligence of the

national leagues did not have the upper hand in majority of the lawsuits. One of the most popular

lawsuits was with former New England Patriot Aaron Hernandez. Aaron hung himself with a bed

sheet in a Massachusetts prison (Paolini, 609”). Hernandez donated his brain to a CTE center, in

which they found out he was suffering from a severe case of the disease. The ex-football player

was diagnosed with CTE at the age of twenty-seven. To compare, his damage was like a player

who was well in their sixties. After the family and lawyer were informed of this tragic news,

Hernandez’s estate filed a federal lawsuit against the National Football League and the New

England Patriots on behalf of his four-year-old daughter (610). Hernandez’s lawyers state that

they were aware of the neurologic harm and would like to be compensated $20 million in

damages. In this case the court tossed the lawsuit, which was because Hernandez was in the

category of a retired player.

To conclude CTE is such a dynamic disease. It is extremely complex. From how one gets

it, which is caused my excessive head trauma, to it if can be treated. As the years go on and the

studies are further progressed, CTE will be a commonly-known disease. There are many projects

that are pushing to have the disease more noticed and trying to spread awareness. A few I have

mentioned before are the NEwTON project and the National Institute of Neurological Disorder

and Stroke. They want to spread awareness because sports are not the only place CTE can be
developed, years of abuse is another way to contract the disease. Health concerns are not the only

factor when it comes to CTE. Legal matters have been a common occurrence after the family

finds out their loved one was suffering from a disease cause by a billion-dollar National League.
 Works Cited

Alosco, Michael L., et al. “Developing Methods to Detect and Diagnose Chronic

Traumatic Encephalopathy during Life: Rationale, Design, and Methodology for the

DIAGNOSE CTE Research Project.” Alzheimer’s Research & Therapy, vol. 13, no. 1, Aug.

2021, p. 136. EBSCOhost, https://doi-org.ezproxy.ccac.edu/10.1186/s13195-021-00872-x.

Belson, Ken and Benjamin Mueller. “Collective Force of Head Hits, Not Just the Number

of Them, Increases Odds of C.T.E.” The New York Times. 20 June 2023,

https://www.nytimes.com/2023/06/20/sports/football/cte-study-concussions-brain-tackle.html

Belson, Ken. “Progress Is Seen in Detecting C.T.E in Living Patients.” The New York

Times. 6 Apr. 2015, https://www.nytimes.com/2015/04/07/sports/progress-is-seen-in-detecting-

cte-in-living-patients.html

Danielsen, Travis, et al. “Chronic Traumatic Encephalopathy (CTE)-Type

Neuropathology in a Young Victim of Domestic Abuse.” Journal of Neuropathology and

Experimental Neurology, vol. 80, no. 6, June 2021, pp. 624–27. EBSCOhost,

https://academic.oup.com/jnen/article/80/6/624/6168456

James, Sarah. “Ringing the Bell for the Last Time: How the NFL’s Settlement Agreement

Overwhelmingly Disfavors NFL Players Living with Chronic Traumatic Encephalopathy

(CTE).” Journal of Health & Biomedical Law, vol. 11, no. 3, Jan. 2016, pp. 391–438.

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Encephalopathy.” Wiley Online Library. Annals of Neurology. 07 Oct 2019,

https://pubmed.ncbi.nlm.nih.gov/31589352/

Miller, Sonya. “Neuropsychiatry. Is Alzheimer Disease Research Key to Effective

Treatment of CTE in Athletes?” Psychiatric Times, vol. 40, no. 1, Jan. 2023, pp. 24–25.

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Paolini, Mikayla. “NFL Takes a Page from the Big Tobacco Playbook: Assumption of

Risk in the CTE Crisis.” Emory Law Journal, vol. 68, no. 3, Jan. 2019, pp. 607–42. EBSCOhost,

https://scholarlycommons.law.emory.edu/cgi/viewcontent.cgi?article=1031&context=elj

Reiter, Thomas and Lucas Tanglen. “Concussions and Coverage: Insurance for Claims

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Traumatic Brain Injury as Origin of the Neuropathology (NEwTON)’ Study: A Prospective

Cohort Study of Individuals at Risk for Chronic Traumatic Encephalopathy.” Alzheimer’s

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