In 1928 a retired prizefighter was first referred to as “punch drunk” when he showed signs of chronic traumatic encephalopathy (CTE). Dementia pugilistica as it was officially diagnosed was also discovered in cases of physical abuse, rugby, epilepsy, finally emerging in football players in 2005 after many years of resistance by the NFL.
The determination that an individual had CTE from repeated concussions was done pathologically by slicing thin, translucent, preserved tissue, washing it with chemicals and examining it through a microscope. If some areas remain blotched with reddish brown, CTE can be definitively diagnosed.
Thousands of living former football players and other contact sports participants, as well as war veterans, were not helped at all with their CTE.
On Tuesday, September 27, researchers at the Icahn School of Medicine at Mount Sinai in New York reported their development of a method that can diagnose CTE in living patients. A chemical injection that will flow to the brain, will offer a clarified view of the tissue through a brain scanner.
CTE is a progressive, incurable neurodegenerative disease that can result in depression, anxiety, aggression and also dementia and possible Parkinsonian-like symptoms. A misdiagnosis could be emotionally traumatic, so the importance of this diagnostic method being accurate is paramount.
“There are cases out there, unfortunately, of people who were convinced that they had CTE and committed suicide, and then were found in autopsy not to have CTE,” said Dr. Christopher Giza, director of the UCLA Steve Tisch BrainSPORT program. Dr. Giza was not involved in the study.
The accuracy of the new diagnostic test is inconclusive at this point as this study was conducted on just one retired NFL player, who is still alive.
Another CTE researcher, Dr. Cyrus Raji, at the University of California, San Francisco, who was also not involved in the study said, “These findings in this patient strongly suggest a diagnosis – they probably have CTE – but we can't definitively say that without an autopsy.”
The brain damage associated to CTE is suspected by neurologists to be linked to a protein called tau, an essential part of healthy normal neurons. Dr. Samuel Gandy, the Mount Sinai neurologist who led the new study explained, “The structure is maintained by an internal skeleton of the nerve cell, and that skeleton is composed of tau.”
Scientists think that with each head trauma, some of the neurons release that protein into the brain, and as it moves around, bits of this protein become tangled and stick together. Those small masses of tau are what pathologists look for in autopsies of suspected CTE cases.
Dr. Gandy's goal was to identify the same pattern while the patient is still alive. To accomplish that he used a molecule or ligand, that is safe to inject but would stick to the tangles of tau.
“The shape of the tau in the normal neurons is basically like a piece of spaghetti,” Gandy said. “With the tangles, it's twisted and kinked, and it is those kinks where the ligand binds.”
The patient receives an injection of this molecule linked to a radioactive atom, allowing tracking by a PET scanner. Wherever these radioactive chains hooked up was a tangle of tau. The tangles in this patient were strikingly similar to those seen during autopsies that allow for an official diagnosis.
Gandy described the patient as a 39-year-old retired NFL player whose primary complaints were poor moods and episodes of rage. “He certainly is not demented. He runs his own business. He's Independent and functional and has a family.” Gandy said.
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