Abstract
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.
Highlights
The authors wish to amend the Competing Interests Statement for this article, which should have included additional information in relation to potential competing interests relevant to this work
Dr Maroon is a founder and shareholder in ImPACT (Immediate Post Concussion Assessment and Cognitive Testing), and the WWE has partnered with ImPACT to provide concussion management
The text in the last box of the flow chart should read "40 studies included in quantitative analysis." For the qualitative analysis of 58 studies, the authors gathered information on observed pathology, associated symptoms and suspected risk factors of chronic traumatic encephalopathy (CTE)
Summary
The authors wish to amend the Competing Interests Statement for this article, which should have included additional information in relation to potential competing interests relevant to this work. He has served on the National Football League's Head, Neck and Spine Committee since 2007 and is currently a consultant to the committee. The authors would like to correct statements in the published article and provide additional clarification regarding the searches underlying the systematic review: Figure 1 indicates that the authors conducted a meta-analysis on 40 studies, which is incorrect.
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