What are the signs and symptoms of CTE?

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In contrast to what might be thought based on the public attention and media focus that CTE has received in recent years, there remain several gaps in scientific and medical knowledge about the disease. One such gap is a clear understanding of the clinical manifestations of the underlying brain changes. At this time, CTE can only be diagnosed after death through careful neuropathological examination of the brain. Much of what we currently know about the signs and symptoms of CTE is based on interviews of next of kin of deceased individuals whose brains have been examined postmortem and found to have CTE. Based on these reports, the clinical features of CTE can be broken down into four major areas: mood, behavior, cognition, and movement.

Mood: Problems with mood and emotion can include feelings of depression, hopelessness, or anxiety. Some people are described as having apathy, i.e., the lack of motivation, emotional connection, or drive. Others have been described as being angry and irritable.

Behavior: Behavioral changes can include acting impulsively, having a short fuse, being out of control, or having excessive rage. Some individuals become physically and verbally explosive and can become violent. Addictive behaviors are not uncommon.

Cognition: Cognitive difficulties include problems with memory, specifically difficulty learning and recalling new information. This can result in forgetting conversations or experiences that happened just hours or days earlier, or repeating oneself. Forgetting things that occurred years earlier (prior to the symptoms) is rare. Other problems include difficulties with attention, as well as what is referred to as “executive functions.” This includes problems with planning, organization, multitasking, judgment, and decision-making. As these problems worsen and have a negative impact on routine daily functioning, the person can be described as having dementia.

Movement: Movement difficulties are not seen in all cases of CTE but are more likely in individuals who participated in boxing, mixed martial arts, or other forms of hand-to-hand fighting. Movement problems can include tremors and issues with walking, balance, and speaking.

Having all or even some of these signs and symptoms may be indicative of having CTE. There is no one uniform expression of how and when these symptoms will present in an affected individual. Research suggests that in some people, the behavioral and mood changes may begin earlier in life (30s to 50s) compared with cognitive problems that may start later. However, the research into CTE is in its early stages, so it is important to note that while the signs and symptoms described above can be caused by CTE, they can also be caused by several other diseases and illnesses. Our picture of CTE may change as new research comes out; the specific symptoms of CTE may be different from what scientists currently believe. In the meantime, it is important to know that just because someone has many of the clinical features of CTE described above, that does not mean they have CTE.