Brain Trauma and Dementia Risk: The Four Stages of CTE

Written by John Lauer

Fact checked by The Brain Blog Team

Brain Trauma and Dementia Risk

Many young people are involved in high-impact sports like football, soccer, and hockey, so Chronic Traumatic Encephalopathy (CTE), as a result of repeated Traumatic Brain Injury (TBI), is a public health concern that deserves our attention. Here, we will look at the four stages of CTE and how CTE impacts a patient’s risk of dementia and Alzheimer’s disease.

What is Chronic Traumatic Encephalopathy (CTE)?

According to the Alzheimer’s Association, CTE is a brain disease that typically occurs after repeated traumatic brain injuries (TBIs). It’s progressive and fatal and is associated with concussions and repeated blows to the head from sports, accidents, or other incidents. People who have had a TBI in early to midlife are 200% to 400% more likely to develop dementia later in their lives, and it appears the risk may increase for those who have had several TBIs. The disease is progressive and doctors can track four stages of CTE as the patient moves through them.  

“CTE is a progressive change in the brain characterized by inflammation in the nervous system and the abnormal build-up of a protein called tau. The condition can lead to memory loss, confusion, impaired judgment, aggression, depression, and, eventually, full-blown dementia.” - The Alzheimer’s Society, United Kingdom 

CTE’s biological signature is the development of tangles of a toxic build-up of a protein called tau in the crevasses in the brain’s wrinkles (called sulci). Only through an autopsy of the brain can it be determined if someone has had CTE and not another type of neurodegenerative disorder or brain injury.

The Four Stages of CTE - Biologically

Psychiatric Times describes the biological advancement of the four stages of CTE as follows: “In stage I, there are few loci of p-tau in the sulci of lateral frontal cortices. The advancement of the disease involves areas of the brain, including the temporal and parietal lobes and the insula. By stage 4, there is a global spread of p-tau, as well as phosphorylated 43 kDa TAR DNA binding protein (TDP-43).”

The Four Stages of CTE - Behavioral

The biological stages of CTE appear to correlate with four stages of behavioral change, based on National Institutes of Health research. Symptoms can include:  

1. Stage One:  May be asymptomatic or complain about mild memory loss, depression, or mild aggression
2. Stage Two:  May have outbursts and severe depression
3. Stage Three:  Memory loss, executive functioning problems, apathy 
4. Stage Four:  Advanced language deficit, paranoia, motor control deficits, tremors

Who Gets CTE?

People who get CTE run the entire spectrum of human demographics, though one group has been exceptionally hard-hit—football players in professional leagues. CTE has been found in the brains of dozens of NFL Football players, according to posthumous diagnoses. (There is no specific way to diagnose CTE in the living.)

A Washington Post story found that CTE is linked to aggressive behavior, depression, thoughts of suicide, poor impulse control, poor judgment skills, and dementia. Linked to aggression, depression, suicidal thoughts, impaired judgment, impulse control problems, and dementia, in just one example, CTE was found in the brain of Aaron Hernandez, the 27-year-old former NFL player. He hung himself in his cell while he was serving a life sentence for murder.  

 Thousands of lawsuits have been filed against the NFL, leading to a settlement of close to $790 (so far) for retirees who have cognitive impairment issues, dementia, Parkinson’s, or Alzheimer’s disease. Other CTE settlements have occurred (or are in progress) within the NCAA and other athletic conferences and school football programs. 

The Connection Between CTE and Dementia

CTE is considered a neurodegenerative disease and a form of dementia. While CTE and Alzheimer’s disease may seem similar, but they are significantly different. According to Indiana University, “Alzheimer’s disease typically presents with memory complaints and problems, whereas the initial symptoms of CTE are often problems with impaired judgment and reasoning, impulse control and aggression.” 

Memory Health, CTE, and Dementia

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