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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