How do I get CTE?

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In recent years, it has become clear that the most significant risk factor for developing CTE is a history of repetitive head impacts. The symptoms of CTE may not show up for many years after exposure to these hits, but in almost all autopsy cases of confirmed CTE, the individual experienced repetitive hits to the head over an extended period of time. Most people think of contact or collision sports, like American football or boxing, as being the main activities that can lead to CTE, but other sports, such as soccer (because of heading the ball) and rugby, have been linked to CTE. In addition, CTE has been found in the brains of combat military veterans, a victim of domestic abuse, and a developmentally disabled person who was a headbanger, as well as others. Persons with CTE may have had several diagnosed concussions, or they may not have had even a single concussion.

Repeated concussions are certainly a factor in the development of CTE, but researchers believe that the main concern is with subconcussive hits—impacts that happen with some force but do not necessarily result in any concussive symptoms. Someone who has had a subconcussive impact will often feel fine and can continue their activity without any problem. Think of a lineman in American tackle football who, at every play of every game and every practice, hits their head against their opponent. The hard plastic helmet and facemask prevent the player from feeling pain and allow the player to keep receiving these repetitive subconcussive blows.

It remains unclear what aspects of the repetitive head impacts (e.g., type, severity, cumulative amount, duration, age of first exposure to the hits) lead to the development of CTE. And, not everyone with even tremendous exposure to these hits gets CTE. It is likely that there are modifying factors, such as genetic predisposition or other variables, leading to increased resilience. Like all neurodegenerative diseases, the elements that cause CTE and its symptoms are complex. Each individual has a different level of risk and resilience that will influence the disease progression and presentation.