Risk Factors for Chronic Traumatic Encephalopathy: A Proposed Framework

Abstract

Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disease that has been neuropathologically diagnosed in contact and collision sport athletes, military veterans, and others with a history of exposure to repetitive head impacts (RHI). Identifying methods to diagnose and prevent CTE during life is a high priority. Timely diagnosis and implementation of treatment and preventative strategies for neurodegenerative diseases, including CTE, partially hinge upon early and accurate risk characterization. Here, we propose a framework of risk factors that influence the neuropathological development of CTE. We provide an up-to-date review of the literature examining cumulative exposure to RHI as the environmental trigger for CTE. Because not all individuals exposed to RHI develop CTE, the direct and/or indirect influence of nonhead trauma exposure characteristics (e.g., age, sex, race, genetics) on the pathological development of CTE is reviewed. We conclude with recommendations for future directions, as well as opinions for preventative strategies that could mitigate risk.

Management of Neuropsychiatric Symptoms for Chronic Traumatic Encephalopathy

“…Lucke-Wold B MedPress Publications LLC play regulations could allow sports medicine doctors and other physicians involved with the care of patients prone to repeated head injury to reduce the development of CTE later in life [33][34][35]. As innovative imaging modalities and biomarkers are discovered, early in vivo diagnostic strategies should be explored combining clinical manifestations, neurological and psychiatric examination, and diagnostic tools.…”

“…Therefore, it is important to minimize the risk of CTE by reducing repetitive head trauma and identifying risk factors. Events that increase the risk of head injury such as targeting in football or body checking in hockey should be minimized or eliminated from the game [33,34,[61][62][63]. Following a blow to the head, players should be evaluated by a physician or a certified athletic trainer to rule out the possibility of a concussion [33,34].…”

“…Events that increase the risk of head injury such as targeting in football or body checking in hockey should be minimized or eliminated from the game [33,34,[61][62][63]. Following a blow to the head, players should be evaluated by a physician or a certified athletic trainer to rule out the possibility of a concussion [33,34]. If a concussion is sustained, or cannot be ruled out, players should be removed from practice or the game for at least for the day to prevent future injuries.…”

“…If a concussion is sustained, or cannot be ruled out, players should be removed from practice or the game for at least for the day to prevent future injuries. Players should be monitored to determine when it is safe for them to return to play and should not do so until concussion symptoms resolve [33,34]. Players and coaches should be counseled on the importance of following these guidelines [33,34].…”

Developing methods to detect and diagnose chronic traumatic encephalopathy during life: rationale, design, and methodology for the DIAGNOSE CTE Research Project

“…However, not all individuals who are exposed to repetitive head impacts will develop CTE or other long-term neurological disorders. Risk modifiers may include severity and nature of repetitive head impact exposure (e.g., frequency [ 27 , 35 ], type of contact sport played [ 36 – 38 ], younger age of first exposure [ 39 – 44 ]), lower cognitive reserve [ 45 ], cerebrovascular health [ 24 , 46 ], and/or genetic make-up [ 47 – 49 ].…”