Chronic Traumatic Encephalopathy (C.T.E)

Introduction

Chronic Traumatic Encephalopathy refers to a degenerative disorder of the brain that mainly affects the military veterans, athletes as well as other people that experience repetitive brain trauma. There is a formation of a protein in C.T.E by the name Tau which is responsible for the establishment of clumps which then extent all over the whole brain slowly to eventually kill the brain cells. The condition has been observed in individuals as young as seventeen years of age although the signs do not show till several years afterwards the beginning of impacts of the head in the body of the victim. The early symptoms of the condition always appear in the late 20s and 30s and beings a substantial influence on the conduct and mood of the patient. Various changes that occur to such people include aggression, impulse control problems, paranoia, and depression. As the disease undergoes progression, the patients experience challenges with memory and thinking which include the loss of consciousness, impaired judgment, confusion and eventually progressive dementia (Perkins, 2016). This paper discusses Chronic Traumatic Encephalopathy together with its effect into the brain which includes symptomatic concussions together with non-indicative sub concussive head hits, which never cause signs.

C.T.E is therefore common especially on athletes who have a repetitive history of trauma of the brain. In the modern society, C.T.E is commonly referred to as the concussion disease, in which it goes hand in hand with those retired professionals who have in their life experienced concussions in their profession and career (Bernick and Banks, 2013). The trauma of the brain, therefore, consists of all the two concussions which result in signs and sub-concussive head hits on an individual which does not cause any symptoms. There is no specific or certain amount of hits that an individual requires to get diagnosed with the condition since an individual might get uncovered to the repetitive injuries of the brain in their early lives nevertheless such signs may never come up till after some decades. No known single assessment that is applied in identifying individuals who have C.T.E. However, medical professionals and investigators are greatly in work to discover improved techniques of diagnosing as well as treating C.T.E.

From my research, it is worth to note that C.T.E results in the progressive shrinkage and loss of the brain’s nerve cells. For such a reason, the repetitive brain trauma that is caused by the brain injuries takes its toll on the life of the individual over time since most of the symptoms of the disease do not emerge until during the late stages of life. The damages, therefore, occur in areas that have a great influence on the person’s thinking ability, making prudent decisions, organizing information, planning and storing their commemorations. The disorder results in poor memory, despair, change in moods and behaviors of the individual. As the disease progresses, such victims eventually develop dementia as well as difficulties talking or walking (Perkins, 2016).

Through observation under a microscope, the brains with C.T.E depict very compact buildups of intertwined filaments of proteins inside the cells. These twists are however made up of a strange protein by the name ‘tau’ which is capable of building up in the brain to cause the abnormal nerve fibers as well as cell tangles. The abnormalities are as well different from the ones observed in an Alzheimer’s brain where there is a great loss of the brain tissue as it is observed. On the life of the individuals with C.T.E, there are psychological impacts on the personal life of the victim. Such symptoms always have debilitating and life-changing impacts for the individuals themselves as well as their families. Such are inclusive of memory loss, difficulty in controlling the erratic and impulsive behaviors, behavioral disturbances and impaired judgment as well as aggression and depression, gradual onset of dementia and challenges with balance (Bernick and Banks, 2013).

People with C.T.E wrongly assign the signs to the standard aging procedure in which they may be given an incorrect analysis since most of the condition’s symptoms are always similar to those of Parkinson’s or Alzheimer’s sickness. Although the onset of the disease is typically midlife, it could also take place during the early stages as proved by the post-mortem outcomes of an eighteen-years-old individual who had sustained several concussions while in performance in football in high school. Though no data is recognized on the harshness and the reoccurrence of shock and concussion in the initiation of C.T.E, there is enough evidence that prior occurrences lead to increased risks of Mptbi (Perkins, 2016). Currently, the clear diagnosis of C.T.E occurs the moment a medical practitioner or a doctor successfully examines the brain after the death of the victim. For the doctors to be able to gain important information about such people, tests such as CT examinations, PET photographs, and MRI examinations as well as blood examinations together with other neuropsychological tests help in ruling out other conditions.

Clinically, the diagnosis of C.T.E is always tough to make. There is no bleeding, as well as other abnormalities, are visible on the C.T.E appearance and CT scan which appears to act as if other diseases that attack the functioning of the brain of the patients who suffer from the condition (Sundman, Doraiswamy and Morey, 2015). It is only through autopsy and brain dissection that is used in confirming the disease. The best way of helping in possibly detecting C.T.E is once such people are still existing, which is done through talking and engaging a doctor to let them know and understand what is going on regarding the health of such people. The doctor is therefore supposed to know of all the symptoms such people have been having with the aid of family members in talking about the personality and behavior changes that have taken place after such people experience brain trauma. The doctor should also be guided through the medical history of the patient especially anything that pertains to the head injuries history.

Through communication with the health professionals, the victims are capable of coping with any signs and symptoms of C.T.E. Through that, the neurologists and doctors can best help their patients upon knowing their experiences and condition in health. It is, however, important to talk to the doctors since it is other aspects comprising heredities which have a significant part in the development and C.T.E advancement since not every individual with a repeated account of brain disturbance advances the illness although those additional elements are not understood fully yet. Over the years, C.T.E has been known to affect mostly boxers although currently the condition is associated with football concussions. The most recent story regarding C.T.E and football was the demise of the previous National Football League (NFL) linebacker Junior Seau together with his enshrinement into the Pro Football Hall of Fame (Takahata et al. 2016). This was after he played NFL in both the collegiate as well as the pro level for most of his life after which he committed suicide at the age of forty-three years by shooting himself in the chest to allow the researchers look for the evidence of C.T.E which is a degenerative brain sickness which leads to impulse control problems, advancing dementia together with depression in which they found it.

Although the player was eligible for NFL’s enshrinement into the hall of fame, the family was never allowed to talk on his behalf due to the hall’s policy. However, the player’s cause of death together with his symptoms of suicidal thoughts and depression resulted from C.T.E which was caused by the numerous concussions together with the hits he took as he played in the NFL. The fact that they never let his family speak was because it was the National Football League that caused his death. In acknowledging the football’s fundamental dangers, the sport’s existence was called into question (Wortzel, Brenner and Arciniegas, 2013). Unfortunately, there exists no recognized C.T.E cure although there are clinical researches that are being conducted by the C.T.E center with the aim of discovering the development and progress of the condition, the risk factors that are involved in the development of the disease and the possible ways of diagnosing the situation during the life of an individual. However, the symptoms of C.T.E such as depression such as anxiety, depression can be individually treated. In case an individual believes they have C.T.E, it is recommended that such people talk to their physician.

Not every individual suffering from the impact of repetitive hits in their head develop C.T.E although there are numerous threat features in action that result to some individuals being extra disposed to to the development of C.T.E than the others. These include the stage of primary contact with the impacts of the head as well as the length of the exposure. Those athletes who begin playing or being indulged in contact games at a tender age have a higher risk for C.T.E. Such is according to the several published studies which indicate that the exposure to the head impacts before the age of twelve years is linked with very worse results as compared to beginning after twelve years of age (Kiernan, 2015). Moreover, the length of contact to the impacts if the head is directly proportional to the development and risks of C.T.E as compared to those athletes who have a shorter career. Among the individuals diagnosed with C.T.E, the athletes with a longer career risk having a severe pathology than the ones with a relatively shorter career.

The possible genetic differences can also significantly contribute to the individuals being more prone to the development of C.T.E than others. However, there is a need for more research in helping the scientists possibly determine what such factors might be which would help in understanding the better ways of preventing and diagnosing the disease before it severely attacks an individual. Through brain tissue analysis, the disease can be diagnosed which is only possible after the death of such people (Kiernan, 2015). The diagnosis should, however, involve those medical practitioners and medics with brain illnesses specialty that cut the tissue of the brain by usage of distinctive compounds in making the Tau Clusters noticeable. There is, therefore, searching systematically of the brain areas for those Tau clusters that have a distinctive and precise pattern to C.T.E. However, the process of diagnosing the disease can take several months for it to be completed in which the study is not characteristically completed as a normal autopsy portion. Only a few doctors until recently who knew the way to carry a diagnosis of C.T.E.

To play it safer and avoid the disease, higher level athletes and kids have to take some steps in ensuring there are lower chances of getting a concussion. Such includes wearing the appropriate equipment during different tasks, providing such gears are worn properly, checking and analyzing the playing field besides telling the instructors and coaches of any uneven holes and area, ensuring that there is no unnecessary use of aggression during game times and knowing to use and apply the proper techniques for the specific sport (Baugh et al. 2012). The coaches should limit the number as well as the length of the contact practices during sports with the proper knowledge to ensure the laws are followed to the latter. However, there is a foreseeable bright future as the researchers are currently working on the development of tests in diagnosing C.T.E with several breakthroughs being achieved in C.T.E specifically in tau imaging as scientists have learned much from the condition. Hopefully, the scientists’ work may result in advances in the diagnosis and treatment of the disease.

There have been several arguments regarding whether C.T.E has the possibility of making people violent. Such is because the disease affects areas of the brain which are involved with the emotions and behavior regulation. Depression and aggression are therefore common in addition to dementia and memory loss which were among the symptoms obtained from the brains that were donated to research with some of these athletes dying by suicide. However, such symptoms may as well be linked with other illnesses as well as substance abuse since there has been a very limited data on the possibility of the C.T.E brain damage to be the causative agent of those behaviors (Hurley, 2017).

Early C.T.E causes deterioration in concentration, attention and severe headaches. On the other hand late C.T.E results to the lack of insights, memory loss, poor judgment, aggression outbursts and suicidal thoughts (Hurley, 2017). The problem with the disease is that its diagnosis can only be confirmed through postmortem. During a concussion, it happens that there is the occurrence of an external impact such as an explosion or a rotational punch which causes the endothelial mechanical stress, neural mechanical stress, the impairment of the blood-brain barrier and the damages to axons and the microtubule breakage further resulting to the possibility of damage to neurons together with the traumatic brain injuries.

The chronic injuries in the brain are capable of causing aneurofibrillary tangle (NFT) formation. This happens when before the injury, the tau binds to besides stabilizing the microtubules. After the injury, there is consequential damage to microtubules and axons as well as the activation of kinases. Afterward, the increased tau phosphorylation also regarded as p-tau dissociates from the microtubules to form the neurofibrillary tangles (NFTs) (Baugh et al. 2012).

Conclusion

It is worth to note that C.T.E is a hazardous condition which causes severe adverse effects and eventually death to the victims. Its effects include brain trauma which becomes very difficult to manage as the analysis of the disease could lonely be established through autopsy after the death of the victim. There is, therefore, a great need for the researchers, scientists together with other medical professionals to work towards finding better ways of curbing the disease which poses a significant threat specifically to athletes, boxers and military individuals who are involved with pronounced contacts resulting to impacts and eventually C.T.E. Through research, the doctors and other scientists are capable of finding solutions to the problem hence reducing the number of deaths of individuals suffering from the disease.

Reference

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Bernick, C., & Banks, S. (2013). What boxing tells us about repetitive head trauma and the brain. Alzheimer’s research & therapy, 5(3), 23.

Hurley, D. (2017). Brain Bank Study of Football Players Finds Pervasive CTE, but True Prevalence Remains Unknown. Neurology Today, 17(17), 1. doi: 10.1097/01.nt.0000524836.75151.34

Kiernan, P. T., Montenigro, P. H., Solomon, T. M.,& McKee, A. C. (2015, February). Chronic traumatic encephalopathy: a neurodegenerative consequence of repetitive traumatic brain injury. In Seminars in neurology (Vol. 35, No. 01, pp. 020-028). Thieme Medical Publishers.

Perkins, A. (2016). Repetitive brain injury and CTE. Nursing Made Incredibly Easy!, 14(3), 32-40. doi: 10.1097/01.nme.0000481438.82416.14

Sundman, M., Doraiswamy, P. M., & Morey, R. (2015). Neuroimaging assessment of early and late neurobiological sequelae of traumatic brain injury: implications for CTE. Frontiers in neuroscience, 9, 334.

Takahata, K., Kato, M., Mimura, M., Shimada, H., Higuchi, M., & Suhara, T. (2016). Late-onset neurocognitive deficits following traumatic brain injury: chronic traumatic encephalopathy (CTE) and psychotic disorder following TBI (PDF TBI). Higher Brain Function Research, 35(3), 276-282. doi: 10.2496/hbfr.35.276

Wortzel, H. S., Brenner, L. A., & Arciniegas, D. B. (2013). Traumatic brain injury and chronic traumatic encephalopathy: a forensic neuropsychiatric perspective. Behavioral sciences & the law, 31(6), 721-738.

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