In general, our society has shown great diligence in pursuing prevention of many serious diseases such as diabetes mellitus, cardiovascular disease, cancer, and infectious diseases. We adhere to diet, exercise, early monitoring, vaccination schedules and use of lipid lowering drugs. There is one preventable condition, however, that we have been slow to recognize. That is Chronic Traumatic Encephalopathy (CTE). It is the delayed result of multiple traumatic brain injuries, commonly known as concussions. A prime example would be the Parkinson’s Disease suffered by the great heavyweight champion, Muhammed Ali.
Symptoms and Signs
- cognitive impairment
- short term memory loss
- emotional instability: depression, impulsive behavior, irritability, aggression suicidal and even homicidal tendencies,
- speech and motor impairment
- related conditions are Alzheimer’s disease, Amyotrophic Lateral Sclerosis, Parkinsonism, Fronto-temporal Degeneration
Diagnosis- clinical signs can point to it but the diagnosis is established only at autopsy. Findings are:
- brain atrophy- decrease in weight
- neuronal loss (decrease in number of cells)
- Tau deposits
Disease Process-CTE is thecumulative result of multiple traumatic brain injuries which may not necessarily involve a direct blow to the head. The brain sits in fluid in the skull. Any force which may cause the brain to abut against the skull, commonly acceleration-deceleration in nature, occurring in any number of contact sports, can cause injury to brain cells. The cell wall can be disrupted and leak out some of its content, which may explain the presence of Tau deposits. The axons, or fibers that interconnect brain cells can also be stretched, torn and injured as well.
- developing brain- the brain is not mature until age of 25, making children and young adults vulnerable
- female- women are more vulnerable
Activities that increase risk
- Boxers and football players-In a report in 2009 of 47 cases proven by autopsy to have CTE, 90% were in athletes, 85% boxers and 11% football players whose careers lasted 14-23 years
- Other high impact sports include ice hockey and soccer, also victims of domestic violence are at risk
- Avoid sports that involve repeated concussions: Boxing is at the top of the list since the object of the sport is to cause traumatic brain injury to the opponent. Football is a close second.
- Improve Concussion Monitoring
- When to quit the sport- it has been established that a total of 3 concussions increases the risk of long term neuro-cognitive deficit. This recommendation probably is not stringent enough. Any concussion should be regarded seriously. Studies have shown that there is some brain shrinkage among football players who have not even been diagnosed with concussion.
- When to return to the game- this is an area still being researched. Pre-concussion baseline tests of brain function should be done on all athletes. There is an online program called XLNT Brain (xlntbrain.comthat enables athletes, coaches, and parents to evaluate concussions.
Chronic Traumatic Encephalopathy is a relatively new discovery that should awaken us to some real risks involved in some of our most revered national pastimes. We need to weigh the risk as well as the benefits of sports such as boxing and football.