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Insufficient Evidence To Link Sports Concussion And CTE

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There is not enough evidence to establish a causal relationship between sports concussion and neurodegenerative diseases, according to a review published in the June issue of Neurosurgery.

The authors say that, although there have been widely reported and publicised cases in retired athletes, there is insufficient evidence to say that athletes are particularly at risk of chronic traumatic encephalopathy (CTE) or other neurodegenerative disorders.

Dr. Gavin A. Davis of Cabrini Medical Centre in Malvern, Victoria, Australia, and colleagues note that sport-related CTE typically occurs in a retired athlete with or without a history of concussion(s), who presents with a variety of cognitive, mood and/or behavioural symptoms.

Media reports have linked CTE to a history of concussions and “subconcussive impacts” during an athlete´s playing career. However, the limitations of case series analysis mean that no direct causal link between concussion and CTE has been established.

Autopsy studies of athletes with CTE have shown the presence of a protein called tau in the brain. Dr. Davis and colleagues note that similar patterns of tau deposits are found in Alzheimer´s disease and other common neurodegenerative disorders.

They also point out that a wide range of other factors can contribute to brain tau deposition, including genetic mutations, various drugs and toxins, environmental factors and even normal ageing. All these can lead to conditions similar to CTE in people who are not athletes, they said.

“It is likely that many of the cases with neuropathological findings represent the normal ageing process, the effects of opiate abuse, or a variant of frontotemporal lobar degeneration,” the authors wrote.

They went on to suggest that in some cases, the clinical features may reflect depression or other mental health issues, which occur in adults unrelated to exposure to sport and/or repeated head trauma.

The authors hope their findings will draw attention to the limitations of the current evidence on CTE.

“When a previously undescribed condition, such as modern CTE in retired athletes, is proposed based on neuropathological findings in a small and potentially biased sample, then the complex genetic and environmental variables as well as the normal range of age-related brain degeneration implore us to cautiously review the data related to putative CTE,” they said.