Chronic Traumatic Encephalopathy: Where Are We and Where Are We Going?

  • Jesse MezEmail author
  • Robert A. Stern
  • Ann C. McKee
Dementia (K Marder, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Dementia


Chronic traumatic encephalopathy (CTE, previously called punch drunk and dementia pugilistica) has a rich history in the medical literature in association with boxing, but has only recently been recognized with other contact sports, such as football and ice hockey, as well as with military blast injuries. CTE is thought to be a neurodegenerative disease associated with repeated concussive and subconcussive blows to the head. There is characteristic gross and microscopic pathology found in the brain, including frontal and temporal atrophy, axonal degeneration, and hyperphosphorylated tau and TAR DNA-binding protein 43 pathology. Clinically, there are characteristic progressive deficits in cognition (memory, executive dysfunction), behavior (explosivity, aggression), mood (depression, suicidality), and motor function (parkinsonism), which correlate with the anatomic distribution of brain pathology. While CTE shares clinical and neuropathological traits with other neurodegenerative diseases, the clinical syndrome and the neuropathology as a whole are distinct from other neurodegenerative diseases. Here we review the CTE literature to date. We also draw on the literature from mild traumatic brain injury and other neurodegenerative dementias, particularly when these studies provide guidance for future CTE research. We conclude by suggesting seven essential areas for future CTE research.


Chronic traumatic encephalopathy (CTE) Dementia pugilistica Traumatic brain injury (TBI) Concussion Tauopathy Neurofibrillary tangle TDP-43 Apolipoprotein E (APOE E) 



This work was supported by National Institutes of Health (grant numbers 5T32NS007153-27, P30AG13846, and R01 NS078337).

Compliance with Ethics Guidelines

Conflict of Interest

Jesse Mez declares that he has no conflict of interest.

Robert A. Stern has been a consultant for Janssen Alzheimer’s Immunotherapy; has received gifts from Andlinger Foundation; has received honoraria for multiple lectures (paid directly by nonprofit organizations); he receives royalties from Psychological Assessment Resources Inc. for neuropsychological tests developed; and has received an unrestricted grant from the National Football League, and has received support for participant travel from the National Football League Players Association.

Ann C. McKee has received speaker honoraria from various events; has received travel/accommodations expenses covered or reimbursed from various speaking events; and has received unrestricted gifts from National Football League, Andinger Foundation, Worldwide Wrestling Foundation; and has grant support pending from the Department of Veterans Affairs and NIH UO1 grant application.

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.


Recently published papers of particular interest have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Jesse Mez
    • 1
    • 2
    Email author
  • Robert A. Stern
    • 1
    • 2
    • 3
  • Ann C. McKee
    • 1
    • 2
    • 3
    • 4
    • 5
  1. 1.Boston University Alzheimer’s Disease CenterBoston University School of MedicineBostonUSA
  2. 2.Department of NeurologyBoston University School of MedicineBostonUSA
  3. 3.Center for the Study of Traumatic EncephalopathyBoston University School of MedicineBostonUSA
  4. 4.United States Department of Veterans AffairsVA Boston Healthcare SystemBostonUSA
  5. 5.Department of PathologyBoston University School of MedicineBostonUSA

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