Chronic Traumatic Encephalopathy: Where Are We and Where Are We Going?
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DEMENTIA (K MARDER, SECTION EDITOR)
Chronic Traumatic Encephalopathy: Where Are We and Where Are We Going? Jesse Mez & Robert A. Stern & Ann C. McKee
# Springer Science+Business Media New York 2013
Abstract Chronic traumatic encephalopathy (CTE, previously called punch drunk and dementia pugilistica) has a rich history in the medical literature in association with boxing, but has only recently been recognized with other contact sports, such as football and ice hockey, as well as with military blast injuries. CTE is thought to be a neurodegenerative disease associated with repeated concussive and subconcussive blows to the head. There is characteristic gross and microscopic pathology found in the brain, including frontal and temporal atrophy, axonal degeneration, and hyperphosphorylated tau and TAR DNA-binding protein 43 pathology. Clinically, there are characteristic progressive deficits in cognition (memory, executive dysfunction), behavior (explosivity, aggression), mood (depression, suicidality), and motor function (parkinsonism), which correlate with the anatomic distribution of brain pathology. While CTE shares clinical and neuropathological traits with other neurodegenerative
This article is part of the Topical Collection on Dementia J. Mez (*) : R. A. Stern : A. C. McKee Boston University Alzheimer’s Disease Center, Boston University School of Medicine, 72 E. Concord Street, Suite 7800, Boston, MA 02118, USA e-mail: [email protected] J. Mez : R. A. Stern : A. C. McKee Department of Neurology, Boston University School of Medicine, Boston, MA, USA R. A. Stern : A. C. McKee Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine, Boston, MA, USA A. C. McKee United States Department of Veterans Affairs, VA Boston Healthcare System, Boston, MA, USA A. C. McKee Department of Pathology, Boston University School of Medicine, Boston, MA, USA
diseases, the clinical syndrome and the neuropathology as a whole are distinct from other neurodegenerative diseases. Here we review the CTE literature to date. We also draw on the literature from mild traumatic brain injury and other neurodegenerative dementias, particularly when these studies provide guidance for future CTE research. We conclude by suggesting seven essential areas for future CTE research. Keywords Chronic traumatic encephalopathy (CTE) . Dementia pugilistica . Traumatic brain injury (TBI) . Concussion . Tauopathy . Neurofibrillary tangle . TDP-43 . Apolipoprotein E (APOE E)
Introduction In 1928, Martland wrote that “[i]t is easily conceivable…that, after many cranial injuries unassociated with fracture of the skull…a progressive degenerative lesion may be the late manifestation”. He presented a series of boxers who later in life developed a “parkinsonian syndrome [and]… marked mental deterioration … necessitating commitment to an asylum”. He called this condition “punch-drunk” [1•]. In 1934, Parker presented several more cases from the Mayo Clinic in a paper entitled “Traumatic encephalopathy (‘punch drunk’) of professional pu
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