You may have heard about chronic traumatic encephalopathy (CTE), a brain disease linked to repeated hits to the head. CTE has been found in some former NFL players and others who had repeated head impacts.
If you or a family member played contact sports, you may wonder about the risk of CTE. The risk depends in part on how often and for how long a person experienced repeated head impacts. Even people with extensive exposure do not always develop CTE.
In this Q&A, Kristen Dams-O’Connor, PhD, Director of the Brain Injury Research Center of Mount Sinai, explains what researchers know about CTE, what may affect your risk, and what you can do if you are concerned.
Kristen Dams-O’Connor, PhD
How do I know if I’m at risk for CTE?
The biggest known risk factor for CTE is extensive exposure to repeated hits to the head over a long period of time. Researchers call these repetitive head impacts.
American football is the best-studied example. Repeated head impacts can also happen in other contact sports, including soccer, and possibly during military service or from domestic violence.
In football, the risk appears to increase based on how many years a person played, the level at which they played, and their position. For example, someone who played football briefly as a child or teenager would have a very different level of exposure than an NFL player who experienced repeated impacts for many years. If someone played in a position that exposed them to more impact, like a lineman, that may also carry greater risk.
Just because someone experiences repetitive head impacts does not mean they will get CTE. In fact, most people who have played football never develop CTE, and it isn’t clear yet why some do but others don’t.
Can one concussion cause CTE?
Current evidence does not suggest that one traumatic brain injury, whether it’s a mild concussion or more severe traumatic brain injury, puts you at significant risk for CTE. Researchers have found very few cases of CTE in people whose only known exposure was a single traumatic brain injury. The concern is greater when a person has repeated head impacts over time. These impacts do not have to cause diagnosed concussions, it is the extent and duration of repetitive head impacts that seems to matter most.
Can I be tested for CTE?
There is currently no test that can definitively diagnose CTE while a person is alive. CTE can only be diagnosed by examining brain tissue under a microscope after death.
Researchers are studying ways to diagnose CTE during life. These include blood tests that may detect signs of disease and specialized brain imaging. These tools are still being studied and cannot currently diagnose CTE in patients.
What symptoms should I be concerned about?
People who were found to have CTE after death have experienced symptoms such as:
- memory changes
- acting without thinking
- irritability
- trouble controlling emotions
- poor decision-making
- problems with planning, organizing, and completing tasks
Having these symptoms does not mean you have CTE. They are common after traumatic brain injuries and can also occur with dementia and many other conditions. At this time, researchers cannot tell from symptoms alone whether a person has the brain changes associated with CTE.
Substance use, including alcohol and drug use, can also contribute to symptoms during life, and may also contribute to the deaths of some people who are later diagnosed with CTE. But these concerns should not automatically be attributed to CTE, and many can be treated.
What can I do if I’m worried about CTE?
First, do not assume you have CTE. Problems such as memory difficulties, emotional changes, depression, or trouble controlling anger may have other causes, and some can be treated effectively. Also, fearing you have CTE may cause psychological problems. For example, research has found that some people who fear they have CTE experience depression and even suicidal thoughts and behaviors. Instead, focus on getting treatment for the symptoms you are experiencing rather than assuming CTE is causing them.
Behavioral and psychological treatments may help with some symptoms. For example, the Brain Injury Research Center of Mount Sinai offers neuropsychology and brain injury rehabilitation services that can help patients manage problems with thinking, memory, emotions, and behavior. Treatment may include psychotherapy, cognitive rehabilitation, and learning strategies for managing emotions. Medications may also be appropriate for certain symptoms.