Cognitive reserve and the clinical manifestations of chronic traumatic encephalopathy
Frank, Kyle Gregory
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Chronic Traumatic Encephalopathy (CTE) is a neuropathological disease that has been associated with contact sports involving repetitive brain injury. This disease is becoming more well-known due to an increase in media coverage, most notably for its possible association with professional football players. This has led to growing concern for the risks of participating in contact sports and the need for further research. There still remains much to be learned about this neurodegenerative disease. The current understanding of the epidemiology and risk factors for this disease are limited by biases in methodology, generalizability, and the use of retrospective data. The only method to diagnose CTE is via autopsy, which has contributed to some of these limitations. The pathogenesis of the disease involves hyper-phosphorylated (p-tau) tau accumulation in distinct areas in the cerebral cortex, leading to neuronal disfunction. The most accepted risk factor for this disease is recurrent brain trauma. Clinically, it can present with varying cognitive, mood, and behavior symptoms and different ages of onset, which often leads to a misdiagnosis of other neurodegenerative diseases. There are a few proposed treatments for CTE but more clinical trials must be performed before any are accepted in clinical practice. One potential modifying factor for CTE symptomology is cognitive reserve (CR). CR is an individual brain’s ability to cope with insults such as neuropathological disease, trauma, and the normal ageing process. Higher CR has shown to have a positive effect on other neuropathologies such as Alzheimer’s Disease (AD). This led to a preliminary study of CR which showed that one measure of CR, occupational attainment, was associated with delayed onset of symptoms of CTE. Our study builds upon this preliminary study by also examining the effect of CR on clinical symptoms of CTE. We expand on this study by using a previously validated tool to measure CR, including aspects such as education, occupational attainment, and social/leisure activities. Our study also includes subjects from other contact sports at varying levels of participation. The results of our study will provide a better understanding of the relationship between CR and clinical symptoms of CTE. This will allow future research to build upon these results and continue to advance our knowledge of this disease. These advances allow changes to be made in clinical practice and athletic organizations in order to improve an individual’s quality of life.