The neuropathology of chronic traumatic encephalopathy: a review and comparison with other neurodegenerative disorders
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In the past decade, numerous studies have examined the correlation between repetitive head trauma in athletes who participated in contact sports and the development of various personality, behavioral, and cognitive changes. Autopsy data from these athletes have uncovered unique patterns of neuropathology that are believed to be associated with the observed clinical symptoms, and together characterize a condition known as chronic traumatic encephalopathy (CTE). Historically, the condition was known as “dementia pugilistica” commonly found in boxers; however, recent studies have identified cases of CTE in retired football players, hockey players, soccer players, war veterans, and other non-athletes. CTE is a progressive disease and clinical signs often appear many years after the trauma. These symptoms frequently include depression, aggression, suicidality, short-term memory loss, and executive functioning impairments. Postmortem examinations of individuals with CTE reveal distinct gross and microscopic pathology, including atrophy of the frontal and temporal cortices, sulcal accumulation of hyperphosphorylated tau, -amyloid deposition, and TAR DNA-binding protein 43 abnormalities. Although current hypotheses suggest that repetitive head trauma causes the development of CTE, the lack of prospective studies hinders our ability to definitively determine its etiology. Likewise, the inability to diagnose CTE in vivo has constrained our attempts to systematically examine the disease’s progressive nature. The goal of this paper is to review the past and current literature on CTE in boxers and football players. We also discuss current hypotheses concerning CTE’s clinical presentation and neuropathology, and situate CTE within the context of other neurodegenerative diseases. Finally, we address the current limitations of CTE research and propose key objectives for future studies.