Chronic Traumatic Encephalopathy Deirdre Laird

CTE Initially discovered in 2002 by Bennet Omalu, M.D. alongside Julian Bailes, M.D. (former team physician for the Steelers) during the autopsy of Mike Webster, a deceased NFL Hall of Famer who was a center for the Pittsburgh Steelers

“Concussion” https://www.youtube.com/watch?v=JlbgVdDES1A

Not just football….. Boxers (1970’s dementia pugilistica), hockey, soccer, wrestling, soldiers, physical abuse, etc Repeated minor head injuries cause the following neurodegenerative changes: Cerebral atrophy Shrinkage of the mammillary bodies Diffuse axonal injury Tau immunoreactive inclusions (neurofibrillary and glial tangles)

Epidemiology & Pathophysiology Dense neurofibrillary tangles mainly composed of tau proteins are irregularly distributed in superficial cortical laminae mainly in the frontal, temporal, and insular cortices (unlike the distribution of neurofibrillary tangles in Alzheimer’s disease, which are less dense and distributed more evenly in deeper layers of cortical laminae) Formation of tangles: TRAUMA  aggravation/injury of AXONS  alteration in axon PERMEABILITY ionic shifts cause influx of CALCIUM  release of CASPASES/CALPAINS that trigger TAU phosphorylation, misfolding, truncation, and breakdown of cytoskeleton with dissolution of microtubules and neurofilaments  HOT MESS Gavett, B. E., Stern, R. A., & McKee, A. C. (2011). Chronic traumatic encephalopathy: a potential late effect of sport-related concussive and subconcussive head trauma. Clinics in Sports Medicine, 30(1). doi: 10.1016/j.csm.2010.09.007

One problem…. These tangles are sneaky Currently, CTE can only be diagnosed POST-MORTEM because these neurofibrillary tangles don’t show up on any fancy scans.

Soooooooo how do you diagnose someone with CTE if there’s no physical evidence of it?

Disordered memory and executive functioning Associated symptoms: Disordered memory and executive functioning Behavioral and personality disturbances- apathy, depression, irritability, impulsiveness, suicidality Parkinsonism Motor neuron disease Symptoms may occur years after head trauma(s), and many individuals with CTE have either committed suicide or died from accidents/drug overdoses at an early age (the earliest recorded case was of a high school senior, who had played football all of his life)

Longitudinal study of 93 former high school and collegiate football players that examined association between CHII’s and long-term clinical outcomes (March 2016) Cumulative head impact index (CHII): metric to quantify cumulative repeated head impact exposures; calculated for each participant based on number of seasons, position, level of play, etc Evaluated the predictive properties of CHII relative to other exposure metrics (duration of play, age of first exposure, concussion history) Montenigro, P., Alosco, M., Martin, B., & Daneshvar, D. (2016). Cumulative head impact exposure predicts later-life depression, apathy, executive dysfunction, and cognitive impairment in former high school and college football players. Journal of Neurotrauma. Retrieved ay 15, 2016. PMID: 27029716 The results?

STRONG relationship between CHII and symptoms of CTE….. Cognitive impairment Self-reported executive dysfunction Depression Apathy Behavioral dysregulation Ultimately, a person’s CHII had greater predictive validity than any other exposure metric that was evaluated

This is scary!!!

Brain Injury Research Institute www.protectthebrain.org Boston University CTE Center http://www.bu.edu/cte/

Why this should matter to future nurses such as your super fine selves

Questions?