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Health Notes from Dartmouth-Hitchcock -- CTE: Sorting out facts from frenzy

Children's Hospital at Dartmouth-Hitchcock

October 09. 2017 10:13PM

jonathan lichtenstein

CTE stands for Chronic Traumatic Encephalopathy. Let’s break that down, shall we?

“Chronic” means persisting or recurring, “Traumatic” denotes physical injury, and “Encephalopathy” refers to a process that affects the functioning of the brain. So, CTE is a persistent, brain-related process related to physical injury.

If you have a son or daughter who plays contact sports, there is little doubt that you have heard those three letters before. That is because there is an overwhelming amount of media attention paid to CTE these days after some medical research has suggested that CTE is the result of concussions or repeated hits to the heads of athletes, namely football players.

However, the media is often not a great filter for medical research, and in the case of CTE, much reporting has contained inaccurate information. The purpose of this piece is to provide you with the facts regarding what science currently knows about CTE.

FACT 1: CTE is a syndrome of abnormal changes in brain cells. Scientifically, these abnormal cells are called “hyperphosphorylated tau proteins.” The presence of these cells may or may not be accompanied by changes or problems in thinking, behavior, and mood.

FACT 2: The brain cell abnormalities found in patients with CTE are not necessarily unique to CTE. These abnormalities are often found in the brains of individuals with other neurological conditions including those who did not play contact sports.

FACT 3: CTE occurs in varying stages. The more significant stages appear to differ from other neurological conditions that have similar symptoms, such as Alzheimer’s disease. Importantly, research in CTE is in its infancy; we really know very little about it.

FACT 4: CTE can only be diagnosed after death, via a brain autopsy. Accurately diagnosing CTE in a living person based on behavior alone is impossible. Science and medicine have not yet been able to determine how CTE might be identified reliably in living people.

FACT 5: Since the symptoms associated with CTE exist in a wide variety of other conditions, there are no neurological or psychological signs that are completely unique to CTE.

While there may be a relationship between concussions and the development of CTE, this has not been scientifically proven. Other environmental and lifestyle factors may play a role in the disease’s development.

Training adults and children to recognize concussions and manage them appropriately is of the utmost importance. Drills that limit contact during practice, teaching proper skill development, and ensuring positive sportsmanship should be required elements of all youth sports.

From the sideline to the classroom, comprehensive education regarding what to do after a suspected concussion is needed across all levels of participation.

Neuropsychologists are ideal for providing this sort of education to schools, youth organizations, and parent groups.

We want our children to lead happy and healthy lives. Playing sports is part of that for many kids. However, all sports involving contact come with a risk for head injury.

Therefore, focusing on what comes after the injury is how we can help youth athletes the most. This involves completing a standardized recovery plan, receiving medical clearance before returning to the play, managing a proper return to academics, and making sure that children remain involved in their social lives throughout recovery to minimize adverse psychological effects.

While CTE gives us a lot to think about, and we can all agree that hitting your head over and over again is a bad idea, our communities should invest time and energy into optimizing the lives of active children today.

Jonathan Lichtenstein, PsyD, MBA is the Director of Pediatric Neuropsychological Services at Children’s Hospital at Dartmouth-Hitchcock and an Assistant Professor of Psychiatry at The Dartmouth Institute at the Geisel School of Medicine at Dartmouth. For more information visit


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