How Are CTE and Behavior Linked? The Answer Requires More in-Depth Research, Scientists Say

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Newswise BUFFALO, N.Y. Aggression, violence, depression, suicide. Media reports routinely link these behavioral symptoms with chronic traumatic encephalopathy (CTE), the neurodegenerative brain disease, in former football players.

But just how CTE and behavioral changes are related is an extremely complex and, as yet, poorly understood issue, write University at Buffalo researchers in a new research paper.

Published last month in the Journal of Neuropsychiatry and Clinical Neurosciences, the UB paper traces the reporting of neuropsychiatric symptoms now associated with CTE back to the 1928 publication by H.S. Martland in the Journal of the American Medical Association titled Punch Drunk.

That publication chronicled behavioral problems in individuals, presenting as cuckoo, goofy, or slug nutty, following one or more blows to the head. Martland discussed the similarity of these symptoms to other brain disorders that involved encephalitis, inflammation of the brain.

Since then, the UB researchers write, discussion of these symptoms has evolved as new technologies have helped identify specific brain changes that occur after blows to the head result in forces being transferred to the brain.

The UB researchers conclude that the paucity of longitudinal, prospective studies on CTE and the absence of research-accepted diagnostic criteria for identifying individuals who are considered at risk for CTE are a hindrance to establishing and understanding the causal relationship between CTE and behavioral health symptoms.

According to the research community, there is a need for more empirical evidence, says Daniel Antonius, PhD, lead author and assistant professor in the UB Department of Psychiatry in the School of Medicine and Biomedical Sciences. In order for a causal relationship between CTE and behavioral changes to be established, this phenomenon needs to be systematically studied in a large sample of contact and non-contact sports athletes over a long period of time, ideally starting early in their careers.

So far, Antonius notes, peer-reviewed literature on CTE consists primarily of case review studies about specific individuals and post-mortem research. We did a thorough review of the literature and what stood out is that case studies predominate, he says. Case studies are illuminating and important but they cannot be used to properly establish clinical criteria for diagnosing a medical or psychiatric condition.

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How Are CTE and Behavior Linked? The Answer Requires More in-Depth Research, Scientists Say