The issue of sports-related head injuries and their long-term consequences has gained significant attention in recent years. Among the numerous concerns is chronic traumatic encephalopathy (CTE), a neurodegenerative disease that has been linked to repetitive head impacts (RHIs).
A Surprising Discovery: CTE in Young Athletes
In a groundbreaking revelation, a cohort of 152 brain donors exposed to RHIs who participated in contact sports and were under the age of 30 at the time of their demise displayed a remarkable 41.4% prevalence of autopsy-confirmed CTE. What made this discovery even more noteworthy was the inclusion of a female collegiate soccer player diagnosed with stage I CTE. This finding challenged prior assumptions that CTE primarily affects males or professional athletes. In fact, the study indicated that amateur athletes, especially those playing contact sports, are also susceptible to CTE.
Diverse Athletes Affected
This study underscored the wide-ranging impact of CTE across various sports and athlete categories. The cohort included American football players, ice hockey players, soccer and rugby players, amateur wrestlers, military veterans, and even a professional wrestler. Notably, a significant portion (71.4%) of the athletes diagnosed with CTE had only played at the high school or college level, emphasizing that CTE is not limited to the professional ranks.
Factors Influencing CTE Development
While the study offered insight into the prevalence of CTE in young athletes, it also highlighted several factors that contribute to its development. Age and duration of exposure to RHIs were identified as critical elements in CTE manifestation. Athletes who were older, played American football, had longer careers, and competed at elite levels exhibited higher rates of CTE. This underscores the importance of recognizing the interplay between age, exposure duration, and the risk of developing this condition.
Pathological Abnormalities and Markers of CTE
The study delved into the various pathological abnormalities and markers associated with CTE. Brain donors with CTE often displayed additional abnormalities, such as cavum septum pellucidum degeneration, thinning of the fornices, enlargement of the frontal horns of the lateral ventricles, and notching of the medial thalamus.
The study also identified neuronal p-tau aggregates, including neurofibrillary tangles (NFTs) and dotlike neurites, around small vessels in specific brain regions. Interestingly, the predominant p-tau isoform in CTE lesions was 4R p-tau. Additionally, the presence of perivascular pigment–laden macrophages in the frontal white matter suggested a potential role of blood-brain barrier dysfunction in CTE pathogenesis.
Clinical Symptoms and Implications
Clinical symptoms reported by the next of kin were common among young donors exposed to RHIs, both with and without CTE. These symptoms included executive dysfunction, behavioral dysregulation, impulse control difficulties, depression, and apathy. Surprisingly, there were no significant differences in clinical symptoms between those with CTE and those without. This led to speculations about potential selection bias and the challenges of retrospectively assessing symptoms with family members.
The Call for Prospective Research
The study emphasized the urgent need for comprehensive and prospective research on young athletes exposed to RHIs. Prospective studies, utilizing objective assessments, can provide valuable insights into the progression of symptoms and potential interventions. With the psychological stress faced by athletes due to uncertainty about their cognitive health, such research is crucial in enhancing our understanding and management of CTE-related concerns.
Conclusion
reference link : https://jamanetwork.com/journals/jamaneurology/fullarticle/2808952?resultClick=1
