Although chronic traumatic encephalopathy (CTE) cannot yet be diagnosed during life, a new study provides the best evidence to date that a commonly-used brain imaging technique – MRI – may show the neurodegenerative disease in the living.
Researchers have found that participants diagnosed with CTE at postmortem had shrinkage in regions of the brain associated with CTE, as well as other abnormalities, compared with healthy controls.
“Specifically, those with CTE had shrinkage in the frontal and temporal lobes of the brain, the regions most impacted by CTE, and they were nearly seven times more likely to have an abnormality called a cavum septum pellucidum (CSP),” said Jesse Mez, director of the Boston University (BU) Alzheimer’s Disease Center Clinical Core and a BU CTE Center Investigator.
The study’s findings align with newly-disclosed imaging in former England football captain Dave Watson, who revealed earlier this year that he is living with dementia.
Watson’s dementia could be related to the progressive brain disease CTE and his family believes that his years of heading the ball in football may be the cause. They said the ability to diagnose CTE in life would be a “total gamechanger”.
“We have been told by more than one specialist in this field that my husband Dave has one of the largest tears in his CSP they have ever seen,” said Penny Watson, wife and caregiver to Dave.
“We believe this latest study reinforces the strong suspicion of the connection between CSP and CTE as Dave never suffered any other brain injury during his life – for instance, he was never in a car accident and never played other sports where he might have been exposed to head impacts.
“Furthermore, we have also been told that CSP is seen commonly in people with CTE, and seeing it in Dave’s brain raises the likelihood that he has CTE.
“My family and I strongly believe this is evidence that the trauma to his brain that Dave sustained throughout his professional footballing life was significant enough to cause neurodegenerative disease.”
However, scientists note that CSP alone is insufficient for diagnosis and should be considered one of many supporting data points.
CTE is a progressive brain disease associated with repetitive head impacts. It has been diagnosed after death in American football players and other contact sport athletes, as well as members of the armed services and victims of physical abuse. Earlier this year, efforts to find a cure for the condition were stepped up, with the creation of a UK Brain Bank and a target to end CTE by 2040.
To learn how to diagnose neurodegenerative diseases like Alzheimer’s disease, scientists usually study a population during life and confirm a diagnosis after death, which can take decades.
To shorten this timeline, Mez and colleagues worked backwards, reviewing the medical records of deceased brain donors and analysing MRIs obtained during life an average of four years prior to death.
They compared the MRIs of 55 men diagnosed with CTE to 31 male healthy controls with normal cognition at the time of their scan.
“MRI is commonly used to diagnose progressive brain diseases that are similar to CTE, such as Alzheimer’s disease. Findings from this study show us what we can expect to see on MRI in CTE. This is very exciting because it brings us that much closer to detecting CTE in living people,” said first author Dr Michael Alosco, associate professor of neurology at BU School of Medicine, co-director of the BU Alzheimer’s Disease Center Clinical Core, and a lead BU CTE Center investigator.
“There is more to do as we still need to understand whether the patterns we saw on MRI are specific to CTE, that is, do they differentiate CTE from Alzheimer’s disease and other causes of dementia.”
“While this finding is not yet ready for the clinic, it shows we are making rapid progress, and we encourage patients and families to continue to participate in research so we can find answers even faster,” adds Mez.
Mrs Watson said: “It’s encouraging to see this progress, along with the recent announcement about the Joint Action Plan on brain health in English football. We hope this impetus continues.
“This new information is significant because it’s just more evidence that neurodegenerative diseases like CTE should be considered an industrial disease for professional footballers. No longer should those in authority continue to prevaricate – at the very least they should expedite their investigations on this issue.”
