Our heads are very precious and sensitive, aren't they? But sometimes, when we play sports, fall, or have other accidents, we can get minor injuries and bruises to our heads. You may have heard that when our heads are subjected to such impacts, not just once or twice, but continuously, for years, it can damage our brains. That's one of those serious, long-term conditions that we're going to talk about today, chronic traumatic encephalopathy, or CTE for short.
What is CTE (Chronic Traumatic Encephalopathy)?
Simply put, CTE is a brain disorder caused by repeated blows to the head and concussions. It can change the way different parts of your brain work and communicate with each other. It's like a perfectly functioning machine suddenly going haywire. Depending on the extent of the damage and the parts of the brain affected, it can be very serious.
Let's break down the meaning of the name CTE a bit:
- Chronic: This means that CTE is not something that develops and goes away in a short period of time, but is a long-term condition .
- Traumatic: This means that it is related to an injury or trauma .
- Encephalopathy: This is a term derived from two Greek words. The word means "disease of the brain."
So, putting all this together, we understand that CTE is a long-term brain disease caused by repeated head injuries.
Who is at higher risk of developing CTE?
CTE can develop in anyone who has sustained a concussion. But it doesn't happen overnight. For many people, it can take years, even decades, for symptoms to become apparent. Typically, people who develop CTE have sustained a concussion for years. This risk is especially high in professional athletes.
Think about it, people who play sports like boxing, MMA (mixed martial arts), rugby, and football. How many times do they get hit in the head? Also, some military personnel are at risk because they have to deal with things like explosions.
But here's the thing. Not everyone who plays sports at the school level develops it. The average age of those diagnosed with CTE is about 42-43 years old. That means it only shows up a little later.
If we look a little more clearly at who is most at risk:
- People who practice combat sports: Boxing, mixed martial arts (MMA), as well as traditional martial arts like taekwondo and judo are also at risk.
- People who play contact sports: especially sports like football (American), ice hockey, and rugby.
- People who engage in street activities: cyclists, rollerblading, skateboarding (the risk is higher if they are not wearing a helmet).
- Military personnel: Those exposed to explosions and similar traumatic brain injuries.
How common is this situation?
In fact, experts don't know exactly how common CTE is. One reason is that there's currently no way to be 100% sure that someone has the disease while they're still alive. Doctors can suspect, but they can't say for sure without examining the brain during an autopsy.
What's more, the symptoms of CTE are very similar to other brain diseases like Alzheimer's disease and frontotemporal dementia , so it can sometimes be difficult to distinguish between the two.
What are the symptoms of CTE?
Symptoms of CTE usually develop slowly, gradually increasing over time. It's hard to say exactly when they start or how quickly they progress.
Some of the most common symptoms are:
- Difficulty concentrating and thinking about one thing (we also call this ``mild cognitive impairment'').
- Frequent headaches .
- Short-term memory loss (cannot remember what was just done or said).
- Behavioral changes: Things like suddenly becoming angry, getting angry to the point of exploding.
In addition to this, other symptoms may appear:
- Depression (feeling sad, disinterested in anything).
- Difficulty planning and executing tasks properly (`(Executive dysfunction)`).
- Slurring of speech, slurred speech.
- Tremors in the limbs and uncontrolled muscle movements (also called ``Parkinsonism'', similar to Parkinson's symptoms).
- It's like losing balance while walking, staggering.
- Loss of coordination of limbs (`(Ataxia)`).
- Increased aggressive behavior.
- Thoughts of harming yourself, suicidal thoughts or attempts.
Important: If you or someone you know is having these thoughts, please seek help immediately. Call a doctor, a friend, or an emergency number.
What causes CTE?
There are two main factors that contribute to the development of CTE.
1. Repeated head injuries:
This is considered the main cause of CTE. The important thing is that not every injury requires a person to be `knocked out`. It takes small bumps and bruises, even if they are small, to accumulate over years to lead to this condition. Think of it like hitting a wall with a hammer over and over again. It may not happen all at once, but if you keep hitting the wall, it will damage it.
2. Accumulation of misfolded proteins in the brain:
Proteins are very important chemical molecules in our body. These proteins are needed for every single task. There is a special type of protein called 'tau' in our brain. This 'tau' protein acts as a support for brain cells.
For a protein to work properly, it needs to be in the right shape. Just like a key needs to fit into a lock. But, due to these repeated injuries to the head, these `(tau)` proteins change their shape and stop working properly. Then these disordered `(tau)` proteins start to accumulate in different places in the brain. Like garbage. That's how, if you see these `(tau)` proteins accumulating in a specific pattern, CTE is currently confirmed during an autopsy.
How exactly is CTE diagnosed?
This is a bit of a complicated issue. There is currently no way to confirm with 100% certainty that someone has CTE while they are still alive. The only way is to take brain tissue samples after death and examine them under a microscope.
However, doctors can look at someone's symptoms, history of head injuries, physical and neurological tests, and make a guess, "This person may have CTE." We call that a ``presumptive diagnosis.''
When doctors suspect CTE, they usually order a series of tests to rule out other conditions. While these tests cannot directly diagnose CTE, they can help rule out other causes. These tests include:
- CT scans
- MRI scans
- PET scans
- Tests that involve taking fluid from the spinal cord (this is called a ``Lumbar puncture'' or ``Spinal tap'')
Is there a treatment for this? Can it be cured?
Unfortunately, there is currently no cure for CTE. This is permanent brain damage.
However, some of the symptoms that arise can be treated. For example, there are treatments for memory problems, behavioral changes, and depression. What those treatments are and how they are given will depend on many things, including your symptoms and your health history. Therefore, your doctor is the best person to give you advice about this.
In addition, there are some lifestyle habits that are beneficial for general brain health, and it is also important to follow them.
How can the risk be reduced? Can it be prevented?
The best thing we can do to completely avoid CTE is to minimize the number of blows and concussions we receive to the head. There are a few simple things we can do to do this:
- Play safely: When playing high-impact sports like football and rugby , make sure to wear proper safety gear (like a helmet). It's also important to avoid dangerous collisions and play without putting yourself or others at risk.
- Don't play with an injury: Even if you didn't lose consciousness after a head injury, it's dangerous to play with the thought, "I'm fine, I'm fine." A concussion doesn't necessarily mean you lose consciousness. If you get a concussion and then get hit in the head again, it can be very dangerous.
- Wear a helmet when riding two wheels: Be sure to wear a helmet when riding a bicycle, rollerblading, or skateboarding. It can greatly reduce the risk of head injuries and concussions.
- Wear a seat belt: Car accidents are the leading cause of concussions among non-athletes. Wearing a seat belt can help reduce the risk of head injury in an accident.
What can someone with CTE expect?
As we've said before, CTE is a degenerative brain disease. That means the symptoms get worse over time. This can take years, even decades. Experts currently have no way of predicting exactly how long it will take for brain function to decline.
How long will this situation last?
CTE is a permanent, lifelong condition.
What is the outlook for this situation?
According to current research and understanding, CTE itself is not directly fatal. However, it can cause other health problems that can negatively impact your health and quality of life. For example, you may be unable to perform tasks such as eating, bathing, and dressing yourself. Such people often have to stay in long-term care facilities, where there is a medical staff.
As the disease progresses, difficulty swallowing (dysphagia) may occur, increasing the risk of pneumonia and respiratory failure.
How do you take care of yourself?
In the early stages of the disease, you can take care of yourself under the guidance of a doctor. Your doctor will advise you on lifestyle changes to manage your symptoms. However, as the disease progresses, it may become difficult to do things on your own. Unfortunately, once your symptoms reach a certain level, you may find it impossible to live on your own.
What would you do if you wanted things to happen the way you wanted?
If you are diagnosed with CTE (or a similar degenerative brain disease) in the early stages, it is important to talk to your doctor, family, and people you trust who can make important decisions for you. This conversation can help them know what you are interested in if you are unable to make decisions for yourself.
These kinds of conversations can be a little awkward and awkward. But it's better to have them sooner rather than later. That way, your loved ones can know in advance what your wishes are. They won't be left guessing.
In addition to that conversation, it's also a good idea to have your wishes and decisions in writing. This can include legal documents, things like what to do if you can't take care of yourself or make decisions about your health. Many people use a lawyer to help them create these kinds of documents.
When should I see a doctor?
If you notice any changes in your thinking, memory, attention, or mood, or behavior, be sure to see a doctor.
When should you go to an emergency room?
If you are having thoughts of harming yourself (including suicidal thoughts) or harming others, seek help immediately. Also, if you suspect that someone you know is in such a danger, let them know as soon as possible.
To get help in a situation like this, you can:
- Suicide prevention hotlines in Sri Lanka (e.g. Sumitrayo 1333, CCCline 1926).
- Mental health services in your area.
- 1990 (Suvaseriya) or 119 (Police Emergency Number). You can call these numbers to request help for someone in an emergency.
What is the difference between post-concussion syndrome (PCS) and CTE?
Although some people think that "Post-concussion syndrome (PCS)" and "Chronic Traumatic Encephalopathy (CTE)" are the same thing, these are two different conditions.
- PCS `(Post-concussion syndrome)`: This is a condition that occurs after a head injury `(concussion)`. It can last for a few weeks, a few months, but it goes away as the brain heals. There is also a long-term PCS condition, but in that case, the `(tau)` protein we talked about does not accumulate abnormally in the brain.
- CTE (Chronic Traumatic Encephalopathy): This is a permanent, progressive brain disease that is characterized by abnormal accumulation of the protein tau.
Finally, remember this.
CTE is a serious condition that can be caused by repeated blows to the head. It can take years to develop, and it is a disease that causes permanent damage to the brain and worsens over time. There is currently no cure.
However, there are things we can do to prevent this. The most important thing is to protect ourselves from severe, repeated blows to the head. It is especially important to use protective equipment and follow safety procedures when playing sports or engaging in dangerous activities.
Research into this disease is still ongoing. In the future, more may be discovered about how this condition occurs, and perhaps even new treatments. Therefore, let's all take care to protect our heads.
` CTE, brain diseases, head injuries, concussions, tau protein, sports injuries, neurological diseases
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