A look at CTE, or chronic traumatic encephalopathy

We have been talking a lot about concussions, and last week, we reported on soccer moves that can put children at risk. But when I read the results of the autopsy on Derek Boogaard it certainly made me pause. My son who is 16 and plays hockey, who is my go-to sports maven, immediately told me that Derek was known as an enforcer, a term that brings chills to my spine. It is certainly clear to many of us — if not the NHL — that the activity behind being an enforcer which puts the enforcer at risk for repeated blows to the head is the likely cause if not certain cause of what was found in Boogaard’s autopsy: CTE.

CTE stands for chronic traumatic encephalopathy, a degenerative brain disease that results in what we often see associated with Alzheimer’s disease. It’s a form of dementia that has a clear environmental cause, whereas when we think of other dementias, we think of a genetic cause. Conversely, it means that CTE is preventable. CTE was first associated with boxers in the 1920s and was called dementia pugilistica or punch drunk syndrome. The brain of someone with CTE shows changes in its physiology in which abnormal clumpings of a protein called tau aggregate in the brain. Symptoms of CTE vary depending on the stage, but in the early stage, there can be deterioration in memory, attention and concentration. There can be behavioural changes — which begs the question did Boogaard’s known addiction result from CTE? Associated symptoms also include lack of insight and poor judgment and then in more advanced stages are the motor changes, staggering gait, tremors and frank dementia.
Who is at risk? Well anyone at risk for repeated trauma to the head, from football to boxing and wrestling, rugby, hockey, soccer and even skiing. What is not known is how many concussions does it take to put one at risk. How many subconcussions does it take to put someone at risk? We do know that the repetition of brain injuries puts one at risk. Many called Boogard a boxer on skates and the researchers have commented that we cannot trade money for brain cells. As a physician and parent, it is clear what my conversations will be when it comes to at-risk behaviour -don’t do it. Period.

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