What Are the Four Stages of CTE?

Many people with chronic traumatic encephalopathy (CTE) live healthy and productive lives.

Chronic traumatic encephalopathy (CTE) can be divided into four stages based on the disease severity:

1. Stage I: Main symptoms during this stage include mild headaches and difficulty with concentration and attention.
2. Stage II: Along with the symptoms in stage I, this stage may present with depression, short-term memory loss, and explosive moods.
3. Stage III: The person presents with various cognitive difficulties including memory impairment and problems with planning, organization, and multitasking.
4. Stage IV: This is the most advanced stage in which the symptoms may become quite severe, such as profound memory loss, language deficits, and mood disorders such as aggression and other psychotic symptoms. The person presents with severe cognitive problems that lead to personality changes and dementia. There may be motor symptoms such as problems with balance and movement. The person may have substance abuse disorder and suicidal thoughts and needs prompt treatment.

Chronic traumatic encephalopathy (CTE) is a progressive degenerative brain disease that affects individuals who have repeated head injuries such as concussions and traumatic brain injuries.

• The term CTE was previously known as dementia pugilistica to describe the various motor and mental problems that occurred in boxers who sustained repeated head trauma.
• Later, the disease came to be known as CTE (encephalopathy, Gk: “kephale” which means head, and “patheia” which means suffering).

CTE occurs over a period of several months and years due to repeated injuries that may or may not cause immediate symptoms. Such repeated injuries cause gradual deterioration of the brain that may lead to atrophy (shrinking) areas in some areas of the brain and swelling or enlargement in others.

Moreover, there is an accumulation of a type of substance in the brain called tau protein. Tau protein normally stabilizes and protects the neurons, but in CTE, it becomes defective and interferes with normal brain functioning.

Chronic traumatic encephalopathy (CTE) typically affects individuals who sustain repeated head injuries. Not everyone who sustains repeated head injuries, however, develops CTE. 

The following people are at a high risk of head trauma and CTE:

• Military personnel in war zones
• Boxers
• Footballers
• Ice hockey players
• Rugby players
• People practicing martial arts
• Hockey players
• People with uncontrolled seizure disorders

The diagnosis of chronic traumatic encephalopathy (CTE) is mainly done by taking the person’s detailed medical history.

• A history of repeated head trauma along with neurological symptoms prompts the doctor to diagnose CTE.
• They may advise blood tests and imaging studies such as magnetic resonance imaging (MRI) and positron emission tomography (PET) scans to exclude other conditions that may cause similar symptoms.
• A PET scan may help detect abnormal tau protein deposits.

Other investigations that are being studied for CTE diagnosis include diffuse tensor imaging, magnetic resonance spectroscopy, and functional MRI.

A definitive diagnosis of CTE, unfortunately, can only be done through an autopsy. The examination of the brain tissue of the deceased person with CTE shows characteristic changes such as brain atrophy, neurofibrillary tangles, and abnormal tau protein deposits.

Presently, there is no definitive treatment for chronic traumatic encephalopathy (CTE). The disease has a progressive course with symptoms worsening over the years.

Nonetheless, with appropriate medical help, the person’s symptoms may be relieved to some extent, which may include:

• Psychiatric counseling for mood changes including depression, aggression, and suicidal thoughts
• Anti-depressant and anti-psychotic medications
• Pain medications and alternative therapies such as acupuncture, biofeedback, and massages to manage pain 
• Speech therapy
• Memory exercises to deal with memory issues

Many people with CTE live healthy and productive lives. Regular consultation with your doctor along with good nutrition, regular exercise, and stress management can help the person deal with this disease in a better way.