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Progress in the Study of Chronic Traumatic Encephalopathy

Olivia Paraschos

Over 80% of all traumatic brain injury (TBI) related emergency visits are due to concussions of some sort. The sports that are most commonly thought of in relation to high concussion risks are contact sports such as football or rugby. However, horseback riding is actually the culprit behind the highest amount of TBIs in sports. 42.5% of all TBIs reported in hospitals were due to equestrian related incidents, whereas only 20.2% were related to contact sports. The issue though, is not what sport is the most dangerous but rather how many of these sports lend themselves to repeated injuries that could have long-term consequences. Many athletes, whether they be contact sport athletes or equestrian enthusiasts, do not let the potentially life-threatening injuries they may acquire prevent them from enjoying their sport of choice. While preventing them from participating in any of these sports is not a feasible option, there are other research based ways to lessen the impact of these repeated injuries on their lives. Oftentimes, the incidents in which the injuries are acquired are easily repeatable; as soon as the injury heals, many athletes quickly return to the activity that gave them the injury in the first place. The repeated impact also is worsened because there is often more white matter degeneration and persisting inflammation after the initial injury. This can then lead to something called Chronic Traumatic Encephalopathy (CTE) which occurs with repeated injury and harmful contact to the brain on numerous occasions.

The danger of CTE is that many people impacted by this degenerative disease just attribute it to other natural causes such as aging or ignore it altogether. The first time this disease was ever diagnosed was in 2002 by two doctors at the Brain Injury Research Institute: Bennet I. Omalu, M.D. and Julian Bailes, M.D. However, they were only able to do this post-mortem and up until now there has not been nearly enough progress in our ability to diagnose the presence of Chronic Traumatic Encephalopathy. There has recently been research into how better to identify CTE, and a study at UCLA has delved deeper into the current limitations for correctly diagnosing CTE.

The study performed at UCLA in 2015 has further explored Chronic Traumatic Encephalopathy. The researchers picked up on abnormal patterns of the proteins by chemically marking matter in positron emission tomography (PET) scans. The marker used, FDDNP, binds to “deposits of neurofibrillary tau ‘tangles’ and amyloid beta ‘plaques.’”4 The method of scanning in these tests was even able to distinguish between CTE and other illnesses - such as Alzheimer's - which it has often been confused with in the past. As of right now, there are not any preventative measures for this disease except for avoidance of all potentially harmful activity: such as athletic endeavors. However, this concept uncovered in the UCLA study could eventually be used to diagnose CTE earlier and could even help us move towards early prevention in the future.

There are many effects of CTE that are shared with other common degenerative brain diseases like Parkinson’s and Alzheimer’s. These effects include personality changes, memory loss, progressive dementia, and depression. The UCLA study determined a “fingerprint” characteristic of CTE found in many groups of abnormal proteins, but especially in the tau proteins of the brain. A main difference found in the accumulation of these proteins is that in patients that have often been concussed in the past, the tau protein buildup was common in both the amygdala and subcortical regions of the brain. This is significant because these areas of the brain are able to control many key factors of activity and thinking such as memory, emotions and other physical and mental functions. Another distinguishing factor between injuries that lead to CTE compared to other brain traumas is that there are both “rotational and translational accelerations and decelerations as well as impact decelerations.” This impacts the effect on the brain since there will be some injury inflicted to the membrane, and even an interference in the repair of axons disconnected from the impact, but no extreme bleeding or traditional focal brain damage that is found in more treatable traumas or diseases.

As for future progress towards the study and diagnosis of CTE, there seems to be a shift towards exploring MRI-based methods as opposed to PET scans due to their safer and less expensive properties. For right now, further exploration into this MRI route are being taken by Dr. David Merrill, an assistant clinical professor of psychiatry and biobehavioral sciences at UCLA and his team. However, there still is a long way to go in terms of fully diagnosing CTE, let alone coming up with more effective treatments and potentially a way to supplement the damage that is often caused by traumatic brain injuries.

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