Running head: DETECTING CTE SYMPTOMS !

Detecting Symptoms of Chronic Traumatic Encephalopathy Antemortem

Alexandria Quigley

Towson University
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Chronic traumatic encephalopathy (CTE) is a traumatic brain injury that can be found in

football players, military veterans, and even victims of domestic abuse. It is caused by repeated

hits to the head affecting the brain that can result in many changes in behavior such as

aggression, depression, paranoia and more (Chronic traumatic encephalopathy, 2016). As Tau

proteins form in clumps throughout the brain, these clumps spread and eventually kill brain cells.

As brain cells die, CTE can also cause problems in memory and thought such as memory loss,

debilitated judgment, and even dementia (Chronic traumatic encephalopathy, 2016). As this has

becoming an increasingly prevalent disease, more and more research has been conducted in order

to better understand what individuals who suffer from chronic traumatic encephalopathy

experience as well as cognitive effects of the disease.

CTE is a very serious disease that is preventable, and it is important to understand its

causes so that it can be prevented. Throughout the review of literature, causes of CTE will be

determined by discussing what current research has found in regard to how chronic traumatic

encephalopathy affects individuals. As mentioned previously, the topic of CTE is a current issue

in football. While there are many American football players who continue to play regardless of

reports of CTE, a study by Mez et al, (2017) reports that almost every single brain studied from

deceased National Football League players were diagnosed with CTE. Some have even

committed suicide which raise the question of whether or not CTE can be a cause of suicide

among those who have this injury.

Football players are constantly facing hits to the head during practices and games. Mez et

al. (2017) conducted research surrounding clinicopathological evaluation of CTE in regard to

American football players. This study and its implications have been extensively discussed in the
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mainstream news as well as amongst the NFL community. Using individuals who participated in

American football at any level of play, they determined “neuropathological and clinical features

of deceased football players with CTE” (p. 360). Through the utilization of a brain bank, Mez et

al. were able to evaluate and examine the neuropathology with the help of certain questions such

as military and athletic participation, as well as using the criteria for diagnoses of CTE. By doing

this, it is necessary to confirm that the participants’ brain is useable for research. Mez et al.

(2017) found that 110 of the 111 NFL players were neuropathologically diagnosed with CTE.

According to Mez et al. (2017), these results strongly suggest that CTE may be related to

connected to playing football as a high percentage of participants were diagnosed with CTE (p.

360).

Many professional football players have even spoken out about CTE explaining that

although there is research showing that 99% of former NFL players were neuropathological

diagnosed with CTE in this study, they are still playing for the love of the game. Carolina

Panthers linebacker Thomas Davis said, "I would be lying if I said I didn't get nervous about that

stat. But this game, I just love it so much” (Chavez, 2017, p. 1). While this is not surprising, it is

still important to understand the implications of this study.

Azad, Li, Pendharkar, Veeravagu and Grant (2016), examined the case of Junior Seau, a

professional NFL football player. Seau was a linebacker who played in the NFL for 20 years and

sustained a number of concussions. Besides these concussions, Seau suffered from headaches as

well as insomnia. He was even arrested on a domestic violence charge, showing that he dealt

with aggression and violence in his life. After committing suicide in 2012, an autopsy confirmed

that he suffered from chronic traumatic encephalopathy. Because one of the major known
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symptoms of CTE is impaired judgment, it could be argued that his suicide was related CTE.

Because Seau was not in a healthy state of mind due to traumatic brain injury, one could argue

that because of the concussions that impacted his brain, he developed CTE which caused

impaired thought and judgment. As described by Azad, Li, Pendharkar, Veeravagu and Grant

(2016), “Postmortem analyses of early clinical symptoms associated with CTE have identified

headaches and behavioral changes that include aggression, mood swings and suicidality” (p. 11).

While they describe this clinical aspect, there is certainly a cognitive aspect as well. As stated by

Azad, Li, Pendharkar, Veeravagu and Grant (2016), “CTE is also associated with a range of

cognitive impairment and motor deficits that can manifest after a period of latency after mild

TBI” (p. 11). The conclusion of this case study discusses how awareness of CTE has been

becoming increasingly prevalent especially in the sports community, yet whether or not head

injuries are being reported

While CTE has been studied usually in humans, a study by Harch, Kriedt, Van Meter and

Sutherland (2007) examined the effect of hyperbaric oxygen therapy on rats who exhibited a

model of chronic traumatic brain injury. This mode of therapy was shown to improve spatial

learning and memory, relating to cognitive functioning. This has important applications for the

future of CTE because there are no known treatments since it is only diagnosed postmortem. As

concluded by Harch, Kriedt, Van Meter and Sutherland (2007), hyperbaric oxygen therapy

increased the vascular density of the hippocampus, which cognitive functioning is linked to (p.

120). By examining rats that exhibited brain injury comparable to CTE, researchers are able to

learn more about this disease in order to better assist humans.

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Chronic traumatic encephalopathy has not only been widely researched in recent times,

but these studies have shown alarming findings about this traumatic brain injury and disease. Not

only did one study find that out of the selection of former professional football players who were

deceased, 99% of them had CTE, but another case found that a football player who committed

suicide also had CTE. Chronic traumatic encephalopathy presents itself through various

symptoms such as memory loss and issues with thinking, but the implication that suicide could

be associated with people who have CTE is important. Therapy for rats modeling chronic

traumatic brain injury showed promise in the future of treating CTE as treatment was helpful in

improving cognitive functioning. This research surrounding this disease is key in leading the

future of CTE. Because it is preventable, the research presented to the public can be used in

order to make informed decisions about playing football or joining the military and these articles

show how truly frightening the effects of CTE can impact the life of an individual in various

ways.

The proposed study aims to examine the symptoms of chronic traumatic encephalopathy

in individuals who have suffered multiple traumatic brain injuries. While many studies focus on

diagnoses and treatments as previously discussed, these articles tend to simply list what

symptoms individuals with CTE may have presented before death. In order to be able to

diagnose CTE in the future before death, more research of symptoms as well as showing

evidence of symptoms in individuals who are suspected to be living with CTE is needed. It is

predicted that individuals who experienced repeated traumatic brain injury will exhibit and report

symptoms that correlate with symptoms of chronic traumatic encephalopathy.

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Method

Participants

Individuals participating in this study will be accepted because they have been impacted

with some kind of repeated, major traumatic injury to the head, consequently affecting the brain.

Participants will be both women and men, all of whom will be volunteers. There will be 50

participants, and ages of the participants will vary between 18 to 50. In order to avoid confusion

with other disease that may be age-related but present similar symptoms, elderly individuals will

not be tested. Participants will be recruited by advertisements across various media platforms

such as newspaper advertisements, social media advertisements, and local television

advertisements. A stipend of $25 will be granted to each participant who elects to partake in this

study.

Materials

Two pieces of questioning will be used in this study (A. Quigley, CTE Symptom Survey

and Questionnaire, November 11, 2017). A 22-question survey created by experimenters will be

given to participants, using a 5-point Likert scale where (1 = strongly do not feel) and (5 =

strongly feel) which will assess emotions as well as lifestyle changes participants may have

noticed in their life due to their injury (see Appendix A). A post-survey interview will be

facilitated by experimenters, and experimenters will use open-ended questions in this interview

(see Appendix B).

Procedure

Symptoms or experiences resulting from repeated head injury will be studied. Upon

arrival to the laboratory, participants will be asked to recall details about their head injuries such
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as what events they are able to recall surrounding the injury as well as reporting what the injury

to the head was. They will also be asked to recall certain aspects of their life, which will be in

relation to suspected symptoms of chronic traumatic encephalopathy, for instance, if there has

been a change in mood regarding irritability or aggression. After recalling these details,

participants will be given a survey and will be asked to identify on a Likert scale how closely

they identify with the questions and statements being presented to them. After completing the

survey, participants will be interviewed and asked open-ended questions pertaining to the survey

questions they will have just answered. Experimenters will be able to record and review more in-

depth responses given by participants to offer more insight to their survey answers. Surveys and

interview questions will be given in the same order to each participant.

Discussion

Currently, CTE is only diagnosable in people who are already deceased. Because this

disease is so serious, taking all necessary precautions in order to prevent it is vital because it can

cause significant problems regarding cognitive abilities. Simple things like focusing or memory

are cognitive processes that many individuals take for granted, and this disease can alter that.

Anyone who lives with a presently incurable disease most likely wishes for a cure, and

researchers from every field work with determination in order to help find cures and treatments

for many diseases. A serious disease like CTE is preventable by not enduring any head injuries.

Nevertheless, accidents can occur. By researching symptoms in individuals who have

experienced a brain injury and may be suspected to have chronic traumatic encephalopathy,

researchers will be able to gather more information about how CTE presents itself in living
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people. Learning more about what specific symptoms are related to this disease may eventually

allow professionals to diagnose CTE antemortem.

Although this disease is very common amongst the football community, as hits to the

head and brain injuries are prevalent in this sport, anyone who has suffered multiple brain

injuries may acquire CTE such as veterans or domestic abuse victims. Even those who have

sustained multiple concussions for whatever reason may also succumb to CTE, which is why

research is beneficial to real world application. Recently, more and more professional football

players have been speaking out in regard to CTE, but parents and individuals should be aware of

this disease in order to take the necessary steps to prevent it. Whether that means not enrolling a

child in a football program, or deciding against enlisting in the military because of the unknown

consequences, knowledge of this disease can be life changing for many people. Knowing

symptoms and being educated may lead people who have known brain injuries to seek proper

assistance. Many people may not be aware of CTE, which is why more research and more

awareness is important. More research on chronic traumatic encephalopathy in general will be

important and beneficial not only to the psychology community, but to the general public all over

the world.
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References

Azad, T., Li, A., Pendharkar, A., Veeravagu, A., & Grant, G. (2016). Junior Seau: An illustrative

case of chronic traumatic encephalopathy and update on chronic sports-related head

injury. World Neurosurgery, 86, (515.e11-6). doi:10.1016/j.wneu.2015.10.032

Chavez, C. (2017, July 26). Current and former NFL players, coaches discuss latest CTE

brain study findings. Retrieved October 16, 2017, from https://www.si.com/nfl/

2017/07/26/nfl-players-coaches-reactions-cte-brain-injury-findings

Chronic traumatic encephalopathy. (2016, April 20). Retrieved December 08, 2017, from https://

www.mayoclinic.org/diseases-conditions/chronic-traumatic-encephalopathy/symptoms-

causes/syc-20370921

Harch, P. G., Kriedt, C., Van Meter, K. W., & Sutherland, R. J. (2007). Hyperbaric oxygen

therapy improves spatial learning and memory in a rat model of chronic traumatic brain

injury. Brain Research, 1174, 120-129. doi:10.1016/j.brainres.2007.06.105

Mez, J., Daneshvar, D. H., Kiernan, P. T., Abdolmohammadi, B., Alvarez, V. E., Huber, B. R.,

& ... McKee, A. C. (2017). Clinicopathological evaluation of chronic traumatic

encephalopathy in players of American football. Jama, 318(4), 360-370. doi:10.1001/

jama.2017.8334
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Appendix A

CTE Symptom Survey

Using this self-created survey as well as post-survey questions, researchers will be able to gather

data about symptoms that may occur with a traumatic head injury in order find a correlation

between head injury and these symptoms. Although CTE is not diagnosed until postmortem, it is

important to examine the symptoms that are suspected to occur in people with CTE to learn more

about this disease in pursuance of finding a way to diagnose individuals before death.
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Appendix B

CTE Symptom Questionnaire

Researchers will use these open-ended questions to gain more insight to responses given by

participants. If participants felt that something was left out of the scaled survey, experimenters

will be able to collect that information using these questions.