Long-term Effects of Concussion: Fact and Fiction

Rudy Castellani University of Maryland School of Medicine

The speaker has no conflicts of interest

Chronic traumatic encephalopathy: Definition

• Chronic Traumatic Encephalopathy (CTE) is a progressive degenerative disease of the brain found in athletes (and others) with a history of repetitive brain trauma…

• This trauma triggers progressive degeneration of the brain tissue, including the build-up of an abnormal protein called tau…

http://www.bu.edu/cte/about/what-is-cte/

Neurofibrillary tangle(phosphorylated tau)

Alzheimer’s disease and tau protein

+

Tau protein

Immunohistochemical stain for phosphorylated tau (AT8)

Corsellis et al, 1973

CTE as a “tauopathy”

Omalu et al, 2005

CTE as a tauopathy

McKee et al, 2012

CTE as a tauopathy

McKee et al, Omalu et al, Corsellis et al

Gardner et al

Quality of evidence

P-tau at autopsy

• Observable as early as the first decade of life

• Life itself is a progressive tauopathy

P-tau in asymptomatic people

Tau (AT8) immunostain (5 µm), retired NFL players

NFL offensive lineman, with a normal brain for age, and no neuropsychiatric disturbances

NFL offensive lineman with CTE(Neurosurgery 57:128-134, 2005)

P-tau in asymptomatic people

50 year-old man

P-tau in asymptomatic people

Montine et al. Acta Neuropathol 2012; 123:1-11

Aside: Is autopsy a “gold standard”?

Neuropathology-psychiatry correlations?

Neuropathology-psychiatry correlations?

http://www.bu.edu/cte/our-research/case-studies/lou-creekmur/

Completed suicide

Neuropathology-psychiatry correlations?

Baron et al. Am J Cardiol 2012;109:889 – 896

Neuropathology-psychiatry correlations?

Suicide rate by profession• Physician – 1.87x• Dentist – 1.67x• Veterinarian – 1.54x• Finance worker – 151x• Chiropractor – 1.50x• Heavy construction operators – 1.46x• Urban planners – 1.43x• Hand molders – 1.39x• Realtors – 1.38x• Assemblers of electrical equipment – 1.36x• Lawyers – 1.33x• Lathe operators – 1.33x• Farm managers – 1.32x• Operators of heat treating equipments – 1.32x• Electricians – 1.31x • Precision woodworkers – 1.30x• Pharmacists – 1.29x• Natural scientists – 1.28x• NFL athletes – 0.41x

The speaker is a denier of the following…

• CTE is a well-defined entity • Control groups have been adequately studied• Neuropathology predicts psychiatric signs• Neuropathologists have expertise in

concussion

http://www.ichirf.org/sports/

Questions to be explored• Control groups • Empirical, prospective

studies on concussion*• Potential unintended

consequences– Negative impact on

athletic participation?– Negative impact on retired

athletes?– Negative impact on the

mentally ill?

Acknowledgments

SPORT CONCUSSION SUMMIT

September 24, 2015 #uminjuryctr