Chronic Traumatic Encephalopathy (CTE) Occurring in Football Players Essay

1. Introduction

Chronic Traumatic Encephalopathy (CTE) is a condition that involves brain degeneration due to repetitive traumatic brain injuries (TBIs). Moreover, CTE is caused by minor repeated traumatic brain injuries, including sub concussions, concussion, or repeated blows to the head (Iverson et al., 2015). This brain disease is progressive and fatal.Chronic Traumatic Encephalopathy (CTE) Occurring in Football Players Essay.  This condition is also attributed to the development of dementia (Inserra & DeVrieze, 2020). While Chronic Traumatic Encephalopathy (CTE) affects various athletes and players, this paper will focus on football players’ impact. The paper will also discuss the symptoms, diagnosis, preventive strategies, and management and treatment in football players.

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1. Body

Chronic Traumatic Encephalopathy (CTE) among football players is associated with various aspects

1. Symptoms
2. This condition is denoted by various clinical manifestations, including cognitive, neurologic, and mood and behavioural symptoms.
3. It is also characterized by pathologic characteristics. CTE is mainly depicted by cortical atrophy that occurs mostly in the medial and frontal-temporal lobes. Other pathologic features of this condition include numerous tau-positive neurofibrillary tangles and astrocytic tangles in the frontal, insular, and temporal cortices are portrayed on a cellular level.
4. Diagnosis criteria

Chronic Traumatic Encephalopathy (CTE) diagnosis is complicated and has no neuropsychological test or physical examination findings, which are specific for this condition.

1. First, this condition cannot be diagnosed through imaging, including magnetic resonance imaging (MRI) and computed tomography. These tests are typically used in cases where more severe brain injuries can be ruled out.
2. Secondly, pathologic diagnosis of CTE is complicated due to the absence of neuropil threads and neurofibrillary tangles in various areas in the cortex and their intermittent presence in other regions within the same lobe in an irregular pattern that involves sulci and gyri. Chronic Traumatic Encephalopathy (CTE) Occurring in Football Players Essay.

• Thirdly, histopathology cannot diagnose this condition due to the lack of correlation between clinical presentations and histopathology evidence

1. Preventive strategies

Prevention strategies can be used to reduce the prevalence of CTE among football players.

1. First, preventing CTE can be used to avoid concussion if it is assumed that repetitive concussions cause the condition. Nonetheless, this assumption is associated with various challenges such as the failure of causation to result from correlation and history of multiple concussions. Secondly, the prevention of this condition is compromised by the lack of protective equipment.
2. However, rule changes in football have made the game safer for the players.

• Also, return to play technique is an effective preventive approach that involves various activities.

1. Management and treatment strategies
2. Management plays a significant role in reducing the prevalence of CTE among football players. First, concussions are managed by removing the player from the match immediately until the symptoms have resolved.
3. The second management technique involves counselling the player and his or her family.

• CTE does not have a cure. However, behavioural and cognitive (memory and thinking) symptoms are treated temporarily using some medicines.

Chronic Traumatic Encephalopathy (CTE) Occurring in Football Players

Chronic Traumatic Encephalopathy (CTE) is a condition that involves brain degeneration due to repetitive traumatic brain injuries (TBIs). Moreover, CTE is caused by minor repeated traumatic brain injuries, including sub concussions, concussion, or repeated blows to the head (Iverson et al., 2015). This condition is common among football players and individuals who play other contact sports such as boxing (Maroon et al., 2015). Additionally, military veterans and other individuals with a history of repetitive traumatic brain injury are likely to develop CTE. This brain disease is progressive and fatal.  Chronic Traumatic Encephalopathy (CTE) Occurring in Football Players Essay.This condition is also attributed to the development of dementia (Inserra & DeVrieze, 2020). The risk of developing dementia in late life is two to four times high among individuals who experience TBI in their early or midlife. The risk is even higher among the individuals who experience several TBIs in their early life. While Chronic Traumatic Encephalopathy (CTE) affects various athletes and players, this paper will focus on football players’ impact. The paper will also discuss the symptoms, diagnosis, preventive strategies, and management and treatment in football players.

First, chronic Traumatic Encephalopathy (CTE) is characterized by two broad categories of symptoms. This condition is denoted by various clinical manifestations, including cognitive, neurologic, and mood and behavioral symptoms. Cognitive changes portrayed by individuals with this condition include deficits in attention, memory, and executive functioning (Concannon et al., 2014). These cognitive changes eventually lead to dementia in case patients survive for a long duration. Neurologic changes are manifest as dysarthric speech or parkinsonian symptoms. Chronic traumatic encephalomyelopathy, which is a variant CTE that is characterized by more severe neurological symptoms, develops in some people (Stern et al., 2018). This condition is clinically portrayed as motor neuron disease. However, it is different from amyotrophic lateral sclerosis despite having various clinical similarities. Some common behavioral symptoms include impulsiveness, substance abuse, disinhibition, aggression, and violence. Additionally, excessive consumption of alcohol and drug abuse are also common among individuals with CTE. These behaviors are attributed to some clinical symptoms of CTE (Davis et al., 2015). Nonetheless, some individual claim that these behaviors are among the key effects of CTE due to loss of judgement and inhibition. Depression, apathy, irritability, and suicidality are among the major mood changes manifested by individuals with CTE. Chronic Traumatic Encephalopathy (CTE) Occurring in Football Players Essay. Particularly, suicidality is a very common symptom among modern athletes with CTE (Iverson, 2014). These symptoms last for less than ten days in some athletes. However, prolonged symptoms are experienced in 10% to 15% of individuals (Concannon et al., 2014). Secondly, this condition is characterized by pathologic characteristics. CTE is mainly depicted by cortical atrophy that mainly occurs in the medial and frontal-temporal lobes. Other symptoms include enlarged lateral and third ventricles, cavum septum pellucidum, hippocampal atrophy, dilated perivascular spaces, and the pallor of the substantia nigra. Additionally, pathologic characteristics, including numerous tau-positive neurofibrillary tangles and astrocytic tangles in the frontal, insular, and temporal cortices, are portrayed on a cellular level (Meehan et al., 2015).

Furthermore, the diagnosis of Chronic Traumatic Encephalopathy (CTE) is complicated and has no neuropsychological test or physical examination findings specific to this condition. In other words, CTE cannot be diagnosed premortem due to the limitations of tests used to diagnose conditions affecting the brain. First, imaging, including magnetic resonance imaging (MRI) and computed tomography, cannot be used to diagnose this condition. These tests are typically used in cases where more severe brain injuries can be ruled out. Although MR spectroscopy, functional MRI, and diffusion tensor imaging have been used in studies, they are not recommended for the evaluation of concussions or diagnosis of CTE. Secondly, pathologic diagnosis of CTE is complicated due to the absence of neuropil threads and neurofibrillary tangles in various areas in the cortex and their intermittent presence in other regions within the same lobe in an irregular pattern that involves sulci and gyri. Additionally, some CTE cases, especially those involving individuals exposed to boxing, are attributed to β-amyloid (Concannon et al., 2014). However, this finding is inconsistent, making it hard to rely on this aspect during diagnosis. Chronic Traumatic Encephalopathy (CTE) Occurring in Football Players Essay. Thirdly, histopathology cannot be used to diagnose this condition due to its unreliability. Various histopathological changes differentiate CTE from other degenerative diseases, particularly frontotemporal dementia and Alzheimer dementia. The medial structures of the limbic system and the cerebral cortex are mainly affected in CTE. Histopathologic changes associated with CTE are medial temporal lobe, atrophy of the cerebral cortex, diencephalon, pallor of the substantia nigra, mammillary bodies and brainstem, ventricular enlargement, phosphorylated tau neurofibrillary tangles, and fenestrated cavum septum pellucidum. Tau pathology is distributed in cortical laminae II and III in CTE while it is spread in layer V among individuals with Alzheimer dementia (Concannon et al., 2014). Additionally, CTE depicts tau pathology in deep in the perivascular and sulci, and its uniformity is less compared to Alzheimer dementia. Advancing CTE stages are portrayed by the four stages of deposition of hyperphosphorylated tau, which are pathologically identified. Nonetheless, this staging is ineffective due to the lack of correlation between the advancing stages of autopsy and clinical presentation. Additionally, some individuals with histopathologic evidence of CTE are asymptomatic at the time of death.

More so, prevention strategies can be used to reduce the prevalence of CTE among football players. Nonetheless, identifying prevention strategies for this condition is challenging due to the impossibility of diagnosing this condition premortem. First, preventing CTE can be used to avoid concussion if it is assumed that repetitive concussions cause the condition. Nonetheless, this assumption is associated with various challenges. Causation does not result from correlation and history of multiple concussions, causing CTE not to be proven by retrospective cases. Similar correlative challenges are experienced in identifying cumulative head trauma due to repetitive sub-concussive blows instead of concussions to be the underlying cause of this condition. Also, it is challenging to rule out the complex interaction of nonmodifiable and modifiable risk factors. Besides, the disease might be caused by drug and alcohol abuse or primary mood disorder. Secondly, the prevention of this condition is compromised by the lack of protective equipment. Currently, no equipment has been designed to prevent a concussion.  American football has been designed to prevent skull fractures and has been effective in accomplishing this.Chronic Traumatic Encephalopathy (CTE) Occurring in Football Players Essay.  However, no helmet has been effective in preventing concussions despite improvement in technology. The impact force can be reduced significantly by improving helmet technologies. Nonetheless, this has not reduced the incidence of concussions (Concannon et al., 2014). Additionally, no helmets for reducing sub-concussive blows have been designed. Therefore, designing a helmet for lowering sub-concussive blows can prevent head injuries among football players significantly. However, rule changes in football have made the game safer for the players. For instance, the kickoff line has been moved up, and upper limb-to-head contact has been eliminated in American football. Additionally, officials and coaches are responsible for enforcing rules and ensuring that players adhere to them during matches. They should also act as a good model in terms of behaviour for their athletes. On the other hand, players should abide by fair play rules and avoid some overly dangerous and aggressive tactics to harm others during a match. Thus, rules for regulating plyers’ technique and behaviour and restricting contact practices can prevent head injuries among football players. Also, return to play technique is a practical preventive approach that involves various activities. A football player is a removal from play upon onset of some symptom of a head injury. The player is provided with medical care to prevent long-term consequences. A graded process is adhered to in return to play. One needs to be asymptomatic before returning to play. A player also needs to be assessed by a trained health care professional to ensure that he is fit to return to the game. Results of a neuropsychological test also indicate when a person is appropriate to return to play. Practitioners should also advise football players about the significance of mental and physical rest and avoiding alcohol among other drugs. A medical practitioner should evaluate a player whose symptoms persist for more than ten days (Concannon et al., 2014). They should be managed in a multidisciplinary setting by clinicians experienced in sports-related concussions. This management process will prevent minor head injuries from developing into CTE.

Finally, management plays a significant role in reducing the prevalence of CTE among football players. First, concussions are managed by removing the player from the match immediately until the symptoms have resolved. The risk for prolonged symptom duration is increased by continued activity (Mez et al., 2017). Additionally, the occurrence of the catastrophic incident in particular second impact syndrome that might result in severe disability or death is prevented by the removal of a person from the play. Chronic Traumatic Encephalopathy (CTE) Occurring in Football Players Essay. Secondly, the condition is managed by counselling the patients and their families about the risks of CTE. Awareness of concussions that has been raised through media reports has benefited individuals with this brain disease. Specifically, the reports have reduced fear that is attributed to chronic traumatic encephalopathy. However, foot players should be informed that the prevalence and incidence of CTE in athletes are unknown. This information will reduce the fear of developing head injuries during the matches. Other athletes are also likely to develop concussions in their respective plays. Most importantly, football players should not that correlation is not equal to causality. Additionally, football players should be informed about potential risk factors, which lead to the development of CTE. Some of the key risk factors, include factors include repetitive concussions, repeated sub-concussive blows, use and abuse of drug and alcohol, genetic factors, and psychiatric and medical comorbidities (Tharmaratnam et al., 2018). The development of CTE is also attributed to chronic inflammation that results from medical comorbidities, which are highly prevalent among the general population, including hypertension and diabetes. Nonetheless, CTE is elucidated by a particular amount and frequency of trauma. While CTE is controlled through proper management and counselling, this condition does not have a cure. However, behavioural and cognitive (memory and thinking) symptoms are treated temporarily using some medicines.

Overall, Chronic Traumatic Encephalopathy (CTE) is common among football players. Chronic Traumatic Encephalopathy (CTE) is characterized by two broad categories of symptoms. First, this condition is denoted by various clinical manifestations, including cognitive, neurologic, and mood and behavioural symptoms. Secondly, this condition is characterized by pathologic characteristics. CTE is mainly depicted by cortical atrophy that occurs mostly in the medial and frontal-temporal lobes. Other pathologic features of this condition include numerous tau-positive neurofibrillary tangles and astrocytic tangles in the frontal, insular, and temporal cortices are portrayed on a cellular level. Chronic Traumatic Encephalopathy (CTE) diagnosis is complicated and has no neuropsychological test or physical examination findings, which are specific for this condition. First, this condition cannot be diagnosed through imaging, including magnetic resonance imaging (MRI) and computed tomography. These tests are typically used in cases where more severe brain injuries can be ruled out. Secondly, pathologic diagnosis of CTE is complicated due to the absence of neuropil threads and neurofibrillary tangles in various areas in the cortex and their intermittent presence in other regions within the same lobe in an irregular pattern that involves sulci and gyri. Chronic Traumatic Encephalopathy (CTE) Occurring in Football Players Essay. Thirdly, histopathology cannot diagnose this condition due to the lack of correlation between clinical presentations and histopathology evidence. Prevention strategies can be used to reduce the prevalence of CTE among football players. First, preventing CTE can be used to avoid concussion if it is assumed that repetitive concussions cause the condition. Nonetheless, this assumption is associated with various challenges such as the failure of causation to result from correlation and history of multiple concussions. Secondly, the prevention of this condition is compromised by the lack of protective equipment. However, rule changes in football have made the game safer for the players. Also, return to play technique is an effective preventive approach that involves various activities. Finally, management plays a significant role in reducing the prevalence of CTE among football players. First, concussions are managed by removing the player from the match immediately until the symptoms have resolved. The second management technique involves counselling the player and his or her family. CTE does not have a cure. However, behavioural and cognitive (memory and thinking) symptoms are treated temporarily using some medicines.

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References

Concannon, L. G., Kaufman, M. S., & Herring, S. A. (2014). Counselling athletes on the risk of chronic traumatic encephalopathy. Sports Health, 6(5), 396-401.

Davis, G. A., Castellani, R. J., & McCrory, P. (2015). Neurodegeneration and sport. Neurosurgery, 76(6), 643-656.

Inserra, C. J., & DeVrieze, B. W. (2020). Chronic Traumatic Encephalopathy. StatPearls [Internet].

Iverson, G. L. (2014). Chronic traumatic encephalopathy and the risk of suicide in former athletes. British journal of sports medicine, 48(2), 162-164.

Iverson, G. L., Gardner, A. J., McCrory, P., Zafonte, R., & Castellani, R. J. (2015). A critical review of chronic traumatic encephalopathy. Neuroscience & Biobehavioral Reviews, 56, 276-293.

Maroon, J. C., Winkelman, R., Bost, J., Amos, A., Mathyssek, C., & Miele, V. (2015). Chronic traumatic encephalopathy in contact sports: a systematic review of all reported pathological cases. PloS one, 10(2), e0117338.

Meehan, W., Mannix, R., Zafonte, R., & Pascual-Leone, A. (2015). Chronic traumatic encephalopathy and athletes. Neurology, 85(17), 1504-1511.

Mez, J., Daneshvar, D. H., Kiernan, P. T., Abdolmohammadi, B., Alvarez, V. E., Huber, B. R., … & McKee, A. C. (2017). Clinicopathological evaluation of chronic traumatic encephalopathy in players of American football. Jama, 318(4), 360-370. Chronic Traumatic Encephalopathy (CTE) Occurring in Football Players Essay.

Stern, R. A., Daneshvar, D. H., Baugh, C. M., Seichepine, D. R., Montenegro, P. H., Riley, D. O., … & McKee, A. C. (2018). Clinical presentation of chronic traumatic encephalopathy. Neurology, 81(13), 1122-1129.

Tharmaratnam, T., Iskandar, M. A., Tabobondung, T. C., Tobbia, I., Gopee-Ramanan, P., & Tabobondung, T. A. (2018). Chronic traumatic encephalopathy in professional American football players: where are we now? Frontiers in neurology, 9, 445. Chronic Traumatic Encephalopathy (CTE) Occurring in Football Players Essay.