LAUSR

Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative condition which can lead to dementia and is found in a proportion of individuals with a history of repetitive head injury. Clinical features are variable but include cognitive dysfunction, behavioural changes, Parkinsonism, and gait impairment. CTE has attracted considerable recent interest in both lay and medical literature in particular because of its association with a number of highly visible professional contact sports including American football, football, and rugby. As a result, sports regulatory bodies have had to ensure that updated protocols surrounding head injuries are strictly adhered to ensure player welfare. However, despite the link between head injuries and CTE, the exact mechanism remains poorly defined. To complicate matters further, there are currently no validated clinical diagnostic criteria for CTE, so that a reliable diagnosis can only be made by a post-mortem (PM) neuropathological examination. This inevitably restricts accuracy of prevalence estimates but most importantly is also likely to inhibit potential future therapeutic strategies directed towards at risk or pre-symptomatic individuals. An improved understanding of the mechanics of head injuries and how this might influence the risk of developing CTE would, therefore, be invaluable in providing insights into pathogenesis as well as predicting those at greatest risk. In this month’s journal club, we present three papers, which attempt to answer some of these questions. In the first paper, the authors present a case series of retired footballers with dementia, examining the underlying pathology and highlighting the prevalence of CTE in this particular cohort of sports participants. The second paper attempts to identify cerebrospinal fluid (CSF) biomarkers associated with the presence of persistent symptoms of mild traumatic brain injury (mTBI). It is hoped that this will improve pathological understanding of the neurodegenerative processes triggered by mTBI and also identify individuals at risk of any associated neurodegenerative processes. The final paper offers a novel computational model to detail the location and extent of injuries produced by different mechanisms of head injury to understand the observed distribution of tau pathology in patients with CTE. All these papers highlight the growing need for active, ongoing research into this important area of neurology. A clearer understanding more about the pathogenesis and risk factors for CTE will undoubtedly have wide ranging implications not only for contact sports but also for the wider population.