Head Trauma Can Increase the Risk for CTE, a Condition Similar to Alzheimer's Disease

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On sports teams of the 1950s, helmets with face masks and other safety equipment were considered dispensable, if not downright "sissified." So Lou Creekmur, a lineman with the Detroit Lions from 1950 to 1959, experienced numerous face and head injuries—he broke his nose 13 times and sustained an estimated 16 or 17 concussions. Despite this, Creekmur never missed a single game during 10 consecutive seasons, part of a record that earned him a place in the National Football League (NFL) Pro Football Hall of Fame.

But Creekmur left the NFL with more than just an impressive record. In the years following his retirement, his thinking and behavior gradually declined. By age 77, he started to withdraw, going out less frequently and having abrupt mood swings that would sometimes take an aggressive, even violent, turn. His memory began to fade, as did his ability to speak clearly. His wife, Caroline, took him to several doctors, some of whom diagnosed Creekmur with Alzheimer's disease.

But Caroline had seen Alzheimer's in other family members, and her husband's behavior was different—he seemed to understand what was happening, though he was unable to do anything about it. Creekmur died in 2009 at age 82, and Caroline donated his brain to the Center for the Study of Traumatic Encephalopathy at Boston University.

Without even having to examine Creekmur's brain under a microscope, researchers could see that it showed an advanced case of chronic traumatic encephalopathy, or CTE.

Outward Signs of Chronic Traumatic Encephalopathy (CTE)

Once known as dementia pugilistica for the many boxers who developed the disease, CTE has received greater attention recently as more and more athletes—professionals as well as recreational players and weekend warriors—have been found to have it. In addition to boxers and football players, it's been discovered in other people who suffer repeated head trauma: mostly hockey, soccer, and rugby players, wrestlers, and equestrians but also domestic abuse victims, and even a circus clown who was subjected to repeated "dwarf-tossing" contests.

The outward symptoms of CTE will sound familiar to anyone who has experience with Alzheimer's disease: Memory problems, disorientation, and difficulty concentrating are the earliest signs. As it progresses, people begin to show poor judgment, erratic behavior, significant memory loss, and some degree of Parkinson's disease (impaired speech, difficulty with motor skills, slow movement, and a loss of balance). In its more advanced stages, tremors, full-blown Parkinsonism, a staggering gait, deafness, and dementia mark CTE.

CTE is also commonly associated with psychological problems like:

  • depression
  • agitation
  • aggression and violence
  • loss of inhibitions
  • sexual compulsiveness
  • euphoria
  • drug and alcohol abuse
  • suicide

The substance-abuse death of 42-year-old football coach Mike Borich, who was found to suffer from CTE after his brain was donated and examined, highlights these aspects of the disease. Prior to his death, Borich's life had become a swirl of alcohol and drug abuse, and violent mood swings were complicated by bouts of disorientation, depression, and forgetfulness.

The symptoms of CTE usually show up a few years after an individual has stopped playing a sport, and some researchers believe that the severity of the disease may correlate with the length of time spent in the activity. Sadly, a 2009 analysis of 51CTE sufferers revealed that the average lifespan of people with the disease is just 51 years.

CTE & Changes in the Brain

The brain pathology of CTE also shares some similarities with Alzheimer's, though there are marked differences as well. Ona microscopic level, a protein known as tau that's found in neurons starts to degrade, forming neurofibrillary tangles and neural threads throughout the brain.

These tangles and threads are features of Alzheimer's, too, but in CTE they tend to be clustered around the small blood vessels within the cortex, and the tangles are more dense than those typically found in the brains of people with Alzheimer's.

The brain atrophy associated with most forms of dementia is also seen in CTE, particularly in the frontal, temporal, and parietallobes, the parts of the brain involved in planning and organizing, hearing and speech, and reading and writing, respectively.

The beta-amyloid plaques common to Alzheimer's patients are occasionally found in people with CTE; however, researchers have found them in fewer than half of the CTE cases examined. This has led many experts to believe that the distinctive formation of tau deposits in neurofibrillary tangles and neural threads is the primary cellular feature of CTE.

The brains of both Creekmur and Borich showed extensive atrophy as well as CTE's trademark tangles and threads.

Changing the Rules to Prevent CTE

The fact that CTE is a preventable form of dementia has not escaped attention. In October of 2009, the U.S. House Judiciary Committee convened hearings on the issue of sports-related concussive head injuries and CTE; two months later, the NFL instituted a rule that no player with symptoms of a concussion could practice or play until cleared by a neurologist.

Over 20 states also have legislation in place or pending that would force grade-school athletes suspected of having a concussion to be screened by a doctor before returning to play. Though no one believes that injuries like concussions can be completely eliminated from contact sports, players can reduce the likelihood of a serious head injury by wearing proper equipment like helmets—even during practice.

In addition, many experts and coaches have implemented proactive steps like getting a concussion history from players, since theeffects of brain injury tend to be cumulative. Coaches are also being called upon to perform more extensive sideline evaluations after a head injury, including testing for balance, orientation, memory, and concentration. And athletes who may be injured should not be returned to play that day and ideally should not return until their concussion heals or symptoms such as headaches and brain fogginess go away.

Best Ways to Prevent Head Injury

  1. Wear a helmet when playing a contact sport or riding a bike.
  2. Wear a seat belt every time you drive or are in a motor vehicle.
  3. Use a step stool with a grab bar to reach objects in high places.
  4. Utilize handrails on all stairways in and outside your home.
  5. Remove household tripping hazards like small area rugs and loose electrical cords.
  6. Exercise regularly to improve balance, strength, and coordination.
  7. Have eye checkups yearly and whenever vision problems arise.

Publication Review By: Peter V. Rabins, M.D., M.P.H.

Published: 16 Mar 2011

Last Modified: 01 Dec 2014