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Chronic traumatic encephalopathy in contact sports: A systematic review of all reported pathological cases

Maroon, JC and Winkelman, R and Bost, J and Amos, A and Mathyssek, C and Miele, V (2015) Chronic traumatic encephalopathy in contact sports: A systematic review of all reported pathological cases. PLoS ONE, 10 (2).

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© 2015 Maroon et al. Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with head trauma. Although initially believed to affect only boxers, the at-risk population has expanded to encompass a much wider demographic, including American football players, hockey players, wrestlers, and military veterans. This expansion has garnered considerable media attention and public concern for the potential neurodegenerative effects of head trauma. The main aim of this systematic review is to give a complete overview of the common findings and risk factors for CTE as well as the status quo regarding the incidence and prevalence of CTE. This systematic review was performed using PubMed and MEDLINE and includes all neuropathologically confirmed cases of CTE in the medical literature to date, from the first published case in 1954 to August 1, 2013 (n = 153). The demographics, including the primary source of mTBI (mild Traumatic Brain Injury), age and cause of death, ApoE genotype, and history of substance abuse, when listed, were obtained from each case report. The demographics of American football players found to have CTE are also presented separately in order to highlight the most prevalent group of CTE cases reported in recent years. These 153 case reports of CTE represent the largest collection to date. We found that a history of mTBI was the only risk factor consistently associated with CTE. In addition, we found no relationships between CTE and age of death or abnormal ApoE allele. Suicide and the presence of premorbid dementia was not strongly associated with CTE. We conclude that the incidence of CTE remains unknown due to the lack of large, longitudinal studies. Furthermore, the neuropathological and clinical findings related to CTE overlap with many common neurodegenerative diseases. Our review reveals significant limitations of the current CTE case reporting and questions the widespread existence of CTE in contact sports.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Maroon, JC
Winkelman, R
Bost, J
Amos, A
Mathyssek, C
Miele, V
ContributionContributors NameEmailPitt UsernameORCID
Date: 11 February 2015
Date Type: Publication
Journal or Publication Title: PLoS ONE
Volume: 10
Number: 2
DOI or Unique Handle: 10.1371/journal.pone.0117338
Schools and Programs: School of Medicine > Neurological Surgery
Refereed: Yes
Article Type: Review
Other ID: NLM PMC4324991
PubMed Central ID: PMC4324991
PubMed ID: 25671598
Date Deposited: 12 May 2015 18:18
Last Modified: 20 Dec 2018 00:55


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