What is CTE?

Learn about the impact of the disease on your brain and your legal options

Chronic Traumatic Encephalopathy (CTE) is a progressive degenerative brain disease commonly found in the brains of people who have suffered repetitive head traumas.

CTE was first recognized in 1928 when Dr. Harrison Martland diagnosed a group of boxers as having “punch drunk syndrome.”

More recently, CTE has been discovered in football players, including former New England Patriots football player Aaron Hernandez, who hanged himself with a bedsheet in a Massachusetts prison while serving a life sentence for the murder of Odin Lloyd after suffering from the most severe CTE ever found in a person his age.

The term encephalopathy derives from the Ancient Greek en (in) kephale (head) and patheia (suffering).

Experts are still learning about CTE, but, in short, it’s believed that repeated brain trauma causes degeneration of brain tissue along with the accumulation of an abnormal type of tau protein, a substance that interferes with the normal functioning of neurons.

CTE statistics

According to the Centers for Disease Control and Prevention (CDC), there are roughly 64,000 deaths related to traumatic brain injury in the United States every year.

Although the prevalence of CTE is still being studied, early indications are that the disease could be incredibly prevalent, particularly among football players.

A study published in the Journal of the American Medical Association found CTE in 99 percent of the 111 brains obtained from National Football League (NFL) players. The study also found CTE in 91 percent of college football players and 21 percent of high school football players.

These statistics are a bit misleading due to the fact that the brains studied were donated by the families of former players who had exhibited cognitive or mental health issues.

Nevertheless, the best estimates are that roughly 9 percent of athletes and 3 percent of nonathletes will develop CTE.

“People think that we’re blowing this out of proportion, that this is a very rare disease and we’re sensationalizing it,” said Ann McKee, the Boston University neuropathologist who is the leading expert in CTE. “My response is that where I sit, this is a very real disease. We have had no problem identifying it in hundreds of players.”

Symptoms of CTE

Researchers are still trying to understand all of the symptoms caused by CTE. Thus far, it’s believed that CTE likely causes cognitive, behavioral, mood, and motor changes.

CTE symptoms don’t appear right after a head injury. In fact, CTE symptoms typically develop years or even decades after repeated head trauma. Researchers believe that early-life symptoms of CTE include depression, anxiety, impulsivity, and aggression; whereas late-life symptoms include memory and thinking problems.

You should strongly consider contacting your doctor if you experience any of the following:

• Heady injury. It’s a good idea to contact your doctor if you or your child suffer a head injury, even if you don’t think emergency care is necessary. Your doctor will be able to evaluate the symptoms and tell you how to proceed.
• Memory problems. You should see your doctor if you are experiencing memory or other thinking (cognitive) problems.
• Personality or mood changes. You should see your doctor if you experience depression, anxiety, aggression, or impulsivity.

Research shows that people with CTE may be
at increased risk of suicide.

If you have thoughts of hurting yourself, call 911,
your local emergency number, or the National
Suicide Prevention Lifeline at 988. 

Causes of CTE

CTE is caused by repeated blows to the head or recurrent concussions. Those at greatest risk for CTE are athletes who play contact sports, including boxers, football players, hockey players, and soccer players. Military veterans are also at risk due to their increased chances of suffering repeated blows to the head.

At least two studies, one published in Neurology and one conducted by researchers at Boston University School of Medicine, have found that the risk of developing CTE is heightened for people who start playing football before the age of 12.

Michael Alosco, an assistant professor of neurology at Boston University School of Medicine, points out that the first 12 years of a person's life are critical for brain development, and that may help explain why people who start playing football before the age of 12 are more at risk of developing CTE. 

“Those are the ages where the gray matter of your brain is really growing, the vasculature of your brain is really growing, the connections between neurons are forming,” Michael says. “Neurodevelopment is really at its peak.”

Whether it’s due to research studies like the ones described above or popular films like Killer Inside: The Mind of Aaron Hernandez and Will Smith’s Concussion, people are starting to pay attention to the risks of playing contact sports. 

The number of high school students playing football is dropping across the country. In 2008, 1.11 million high school students played football. That number is now 1.006 million, the lowest number since 1999.

How is CTE diagnosed?

The only way to definitively diagnose CTE is after death by brain tissue analysis. In simple terms, doctors slice the decedent’s brain tissue and use chemicals to make the abnormal tau protein visible. Doctors then study the tau protein to see if it exists in the unique patterns specific to CTE.

The side-by-side images of a “normal” brain and a brain with CTE are dramatic. You can see some of these images here.

Although the results aren’t definitive, a study published in the journal Alzheimer’s Research & Therapy found that magnetic resonance imaging (MRI) may be able to detect CTE in the living. Researchers are also working to develop a method for diagnosing CTE using a positron emission tomography (PET) scan.

How is CTE treated?

Tragically, CTE is a progressive, degenerative brain disease for which there is no cure.

There are some therapies, such as monoclonal antibody therapy and low-intensity pulsed ultrasound, that seem promising, but much more research is needed to determine whether these therapies will someday be able to cure CTE.

Certain medications may be helpful in temporarily treating the cognitive and behavioral symptoms associated with CTE.

Here are some other things you can do to help minimize the impact of CTE symptoms:

• Exercise
• Get adequate sleep
• Build a support team (friends, family, colleagues, therapists, a church community or some other social group)
• Develop a routine
• Write things down
• Practice relaxation techniques (such as yoga or tai chi)

If you’re experiencing CTE symptoms, the best thing you can do is see a professional immediately.

Preventing CTE

The only way to prevent CTE is to avoid repetitive head injuries.

Of course, you can’t prevent all head injuries, but you can take steps to avoid them. For example:

• Avoid contact sports (particularly boxing and football)
• Wear proper equipment if you decide to play contact sports (such as specially designed headgear)
• Consider giving up a sport if you sustain a concussion (athletes with a history of concussions are at greater risks for concussions)
• Wear a bicycle helmet when biking
• Wear a motorcycle helmet when on a motorcycle

Lawsuits based on CTE and other traumatic brain injuries

A number of wrongful death lawsuits have been filed by the families of athletes who developed CTE. Thus far, these lawsuits have been largely unsuccessful.

In order to win a CTE lawsuit, you need to prove that the defendant (coach, school, sports organization, etc.) was at fault for your loved ones' injury.

Typically, this means establishing that the defendant was negligent. To establish negligence, you need to prove that:

1. The defendant owed the deceased a duty of care. In most cases, the defendant owes the plaintiff a duty to exercise “reasonable care.” In certain situations, the defendant owes the plaintiff a more specific duty of care.
2. The defendant breached the applicable duty of care. The defendant might breach the applicable duty of care by, for example, failing to remove a player from a game despite obvious signs that the player suffered a concussion.
3. The decedent was injured as a direct result of the breach. The defendant’s breach must be the cause of the decedent’s injuries.

Other legal causes of action that might be appropriate in a CTE lawsuit include:

• Product liability. A product liability claim might be appropriate if the decedent suffered a head injury because a product (such as a balance beam or football helmet) was defective or lacked proper warnings.
• Medical malpractice. A medical malpractice claim might be appropriate if a doctor failed to properly diagnose a condition or gave improper advice (for example, if a doctor failed to properly diagnose a concussion and allowed the football player to reenter a game).

The results of CTE or any other traumatic brain injury can be devastating. People who suffer serious head injuries often need 24-hour care. If you or a loved one suffered a traumatic brain injury, you should consider reaching out to a personal injury attorney to discuss your legal options.

Here are some resources to help you prepare for your initial consultation with an attorney: