Journal
ALZHEIMERS & DEMENTIA
Volume 10, Issue 3, Pages S242-S253Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jalz.2014.04.003
Keywords
Chronic traumatic encephalopathy; Veterans; Neurodegeneration; Traumatic brain injury; Tauopathy; TDP-43; Alzheimer's disease
Categories
Funding
- Department of Veterans Affairs
- Veterans Affairs Biorepository [CSP 501]
- Translational Research Center for Traumatic Brain Injury and Stress Disorders (TRACTS) Veterans Affairs Rehabilitation Research and Development Traumatic Brain Injury Center of Excellence [B6796-C]
- National Institute of Neurological Disorders and Stroke
- National Institute of Biomedical Imaging and Bioengineering [UO1NS086659-01]
- National Institute of Aging Boston University Alzheimer's Disease Center [P30AG13846, 0572063345-5]
- Sports Legacy Institute
- National Operating Committee on Standards for Athletic Equipment
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Mild traumatic brain injury (mTBI) includes concussion, subconcussion, and most exposures to explosive blast from improvised explosive devices. mTBI is the most common traumatic brain injury affecting military personnel; however, it is the most difficult to diagnose and the least well understood. It is also recognized that some mTBIs have persistent, and sometimes progressive, long-term debilitating effects. Increasing evidence suggests that a single traumatic brain injury can produce long-term gray and white matter atrophy, precipitate or accelerate age-related neurodegeneration, and increase the risk of developing Alzheimer's disease, Parkinson's disease, and motor neuron disease. In addition, repetitive mTBIs can provoke the development of a tauopathy, chronic traumatic encephalopathy. We found early changes of chronic traumatic encephalopathy in four young veterans of the Iraq and Afghanistan conflict who were exposed to explosive blast and in another young veteran who was repetitively concussed. Four of the five veterans with early-stage chronic traumatic encephalopathy were also diagnosed with posttraumatic stress disorder. Advanced chronic traumatic encephalopathy has been found in veterans who experienced repetitive neurotrauma while in service and in others who were accomplished athletes. Clinically, chronic traumatic encephalopathy is associated with behavioral changes, executive dysfunction, memory loss, and cognitive impairments that begin insidiously and progress slowly over decades. Pathologically, chronic traumatic encephalopathy produces atrophy of the frontal and temporal lobes, thalamus, and hypothalamus; septal abnormalities; and abnormal deposits of hyperphosphorylated tau as neurofibrillary tangles and disordered neurites throughout the brain. The incidence and prevalence of chronic traumatic encephalopathy and the genetic risk factors critical to its development are currently unknown. Chronic traumatic encephalopathy has clinical and pathological features that overlap with postconcussion syndrome and posttraumatic stress disorder, suggesting that the three disorders might share some biological underpinnings. (C) 2014 Published by Elsevier Inc. on behalf of The Alzheimer's Association.
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