Jalin Couper & Jason Freeman

DAILY IMPACT: A LOOK INTO CHRONIC

TRAUMATIC ENCEPHALOPATHY

Concussions What is CTE? Stages of CTE First Documented Cases Boston University’s Research Case Studies:

Boxing Football Hockey

Future Research

OVERVIEW

Concussions are a brain injury and are defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces.

80-90% are resolved in 7-10 daysSymptoms may include:

Headache Loss of consciousness Behavioural changes Cognitive impairment Sleep disturbances

CONCUSSION

• CTE is defined as the long-term neurological consequence of repetitive head trauma, ranging from concussive to sub-concussive hits.

• Main Symptoms include • Memory disturbances• Behavioural and personality changes• Parkinsonism • Speech impediments • Gait abnormalities

WHAT IS CHRONIC TRAUMATIC ENCEPHALOPATHY (CTE)?

•Tau is a protein that works to stabilize microtubules located in the neurons of the central nervous system•Mictrotubules: transport nutrients, organelles and other essential material from body to the axon•Neurofibrillary Tangles: when tau protein separates from microtubules and form tangles this stops transmissions along neurons.

TAU PROTEIN

COMPARISON BETWEEN HEALTH AND UNHEALTHY NEURONS

COMPARISON

1.First stage is characterized by affective disturbances and psychotic symptoms.

2.Second stage social irritability, erratic behavior, memory loss, and initial symptoms of Parkinson disease are present.

3.Third stage is described as general cognitive dysfunction progressing to dementia and is often accompanied by Parkinsonism along with speech and gait abnormalities.

3 STAGES OF CTE

• First discovered in 1928 by Dr. Martland, described it as Punch Drunk where it was later defined as Dementia Pugislistica due to symptoms first being found in boxers

• Punch drunk is a definitive brain injury due to single or repeated blows to the head or jaw which results in multiple hemorrhages in the deeper portions of the cerebrum

• It was later renamed CTE in the 1960s as it was found in multiple sports besides boxing

FIRST DOCUMENTED

BOSTON UNIVERSITY

Established a CTE research center in 1996 Conduct research on

Neuropathology & Pathogenesis Clinical presentation Genetics & other risk factors Biomarkers Methods of detection during life Prevention & treatment

DETECT Study Diagnosis and Evaluating Traumatic Encephalopathy Using Clinical

TestsLEGEND Study

Longitudinal Examination to Gather Evidence of Neurodegenerative Disease

• Estimated that approximately 17% of retired professional boxers will express some signs of CTE.

• Boxers in the early 1900s would participate in 400-700 fights throughout their career, some would fight in 30-40 fights a day.

BOXING

•Started boxing at age 11, fought as an amateur for 9 years and professionally for 3 years, retiring at the age of 33.

•He developed increasing levels of anxiety, aggression, agitation and would even periodically become verbally and physically aggressive towards his wife.

•After neurological testing he was found to be disoriented, inattentive, with poor immediate and remote memory along with impaired visuospatial skills. Neuropsychological testing further showed deficits in all cognitive domains.

•By 70 symptoms such as severe swallowing difficulties, speech impediments and a slow, shuffling gait began to arise

73 YEAR OLD BOXER

Interest to CTE researchers due to amount and magnitude of impacts in a season

420-2492 impacts in a college football season Potential for 2000 impacts for a high school football player

Upwards of 18 000 impacts before playing pro

AMERICAN FOOTBALL

JOHN GRIMSLEYAMYGDALA & TEMPORAL CORTEX

Earliest evidence of CTE ever recordedMulti-sport athlete including high school footballAlthough asymptomatic, shows CTE development is

independent of age

18-YEAR-OLD

18-YEAR-OLDFRONTAL CORTEX

COMMON INCIDENTS

“please, see that my brain is given to the NFL’s brain bank”

Relatively new in the CTE research4 confirmed cases in former NHL playersRole of fighting and hits to the head

ICE HOCKEY

Died at the age of 28 from drug overdosePlayed 6 seasons in the NHL for the Minnesota Wild &

New York RangersPlayed the enforcer role for his team with 70 career

fights

DEREK BOOGAARD

DEREK BOOGAARDFRONTAL CORTEX

FUTURE RESEARCH