Concussion in Chronic Traumatic Encephalopathy

  • Thor D. SteinEmail author
  • Victor E. Alvarez
  • Ann C. McKee
Concussion and Head Injury (S Lucas, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Concussion and Head Injury


Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disease that occurs in association with repetitive mild traumatic brain injury. It is associated with a variety of clinical symptoms in multiple domains, and there is a distinct pattern of pathological changes. The abnormal tau pathology in CTE occurs uniquely in those regions of the brain that are likely most susceptible to stress concentration during trauma. CTE has been associated with a variety of types of repetitive head trauma, most frequently contact sports. In cases published to date, the mean length of exposure to repetitive head trauma was 15.4 years. The clinical symptoms of the disease began after a mean latency of 14.5 years with a mean age of death of 59.3 years. Most subjects had a reported history of concussions with a mean of 20.3. However, 16 % of published CTE subjects did not have a history of concussion suggesting that subconcussive hits are sufficient to lead to the development of CTE. Overall, the number of years of exposure, not the number of concussions, was significantly associated with worse tau pathology in CTE. This suggests that it is the chronic and repetitive nature of head trauma, irrespective of concussive symptoms, that is the most important driver of disease. CTE and exposure to repetitive head trauma is also associated with a variety of other neurodegenerations, including Alzheimer disease. In fact, amyloid β peptide deposition is altered and accelerated in CTE and is associated with worse disease. Here, we review the current exposure, clinical, and pathological associations of CTE.


Chronic traumatic encephalopathy Concussion Head injury 



We gratefully acknowledge the use of resources and facilities at the Edith Nourse Rogers Memorial Veterans Hospital (Bedford, MA) as well as all the individuals whose participation and contributions made this work possible. This work was supported by the Department of Veterans Affairs, Veterans Health Administration, Clinical Sciences Research and Development Merit Award; Alzheimer’s Association (NIRG-305779); National Institute of Neurological Disorders and Stroke, National Institute of Biomedical Imaging and Bioengineering (U01NS086659-01); National Institute of Aging Boston University AD Center (P30AG13846; supplement 0572063345-5); and Sports Legacy Institute. This work was also supported by unrestricted gifts from the Andlinger Foundation and WWE.

Compliance with Ethics Guidelines

Conflict of Interest

Thor D. Stein, Victor E. Alvarez, and Ann C. McKee each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


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Copyright information

© Springer Science+Business Media New York (outside the USA) 2015

Authors and Affiliations

  • Thor D. Stein
    • 1
    • 2
    • 3
    • 4
    Email author
  • Victor E. Alvarez
    • 3
    • 5
  • Ann C. McKee
    • 1
    • 2
    • 3
    • 4
    • 5
  1. 1.VA Boston Healthcare SystemBostonUSA
  2. 2.Department of Veterans AffairsBedford VA Medical CenterBedfordUSA
  3. 3.Alzheimer’s Disease & Chronic Traumatic Encephalopathy CenterBoston University School of MedicineBostonUSA
  4. 4.Department of Pathology and Laboratory MedicineBoston University School of MedicineBostonUSA
  5. 5.Department of NeurologyBoston University School of MedicineBostonUSA

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