The Dangers of Concussions and Chronic Traumatic Encephalopathy (CTE)

The Dangers of Repetitive Concussions and Chronic Traumatic Encephalopathy (CTE)

Information for Research Papers, Reports, Essays, and Speeches

The information provided on this web page is intended to help students write an informative research paper / report / essay on the topic of concussions and chronic traumatic encephalopathy, also known as CTE.  Although the health risks of repeated concussions and traumatic brain injuries have been mentioned for decades, it is only until recently that a lot of media attention has concentrated on the topic of chronic traumatic encephalopathy (CTE). This web page provides a possible introductory paragraph with thesis statement, outline, and a list of resources such as books, journal articles, magazine articles, newspaper articles, and websites. When possible, we try to explain each source and cite the source in MLA format, 2016 Eighth Edition. We try to provide enough information to help you write a paper as easy as possible without actually writing the paper for you.

We know how important it is for students to find credible online resources so that they can do a lot of their work at home. We feel that the list of resources that are presented will provide enough information about concussions, traumatic brain injury (TBI),  and chronic traumatic encephalopathy so that you can write a significant portion of your research paper / report / essay  OR speech, from home. There are some EXCELLENT, credible peer-reviewed journal articles that can be accessed online, FOR FREE.

The intended audience for the information on this web page is the college student. Many of the peer-review journal articles are very scholarly. HOWEVER, many students in middle and high school may find the information helpful, too.

The following information will provide information on a variety of topics related to concussions and CTE such as: statistics; symptoms; tests; signs of concussions and signs of traumatic brain injury (TBI); and more concussion-related material.

The following paragraph includes a possible title and introductory paragraph with thesis statement.

Concussions and Chronic Traumatic Encephalopathy are Serious Health Dangers

     Concussions have received increased attention in the world of sports.  Concussion is an injury that can happen in just about any sport. Indeed, it has been happening to a countless number of athletes for centuries. However, concussions can happen to just about anyone. For example, it is easy to just trip when walking and hit your head on the ground. Throughout history, there has been a tendency for people to ignore a concussion as a serious injury. There will continue to be dangers for athletes in just about any sport. However, concussions can lead to serious health issues such as chronic traumatic encephalopathy (CTE). Concussions and chronic traumatic encephalopathy are serious conditions that have to be taken seriously in order to help prevent serious health disorders later in life for millions of people.

The thesis statement is “Concussions and chronic traumatic encephalopathy are serious conditions that have to be taken seriously in order to help prevent serious health disorders later in life for millions of people.” You are going to prove, or report, on how serious the health risks are for concussions and chronic traumatic encephalopathy.

Here is a possible outline that you may want to consider:

OVERVIEW of Concussion and Chronic Traumatic Encephalopathy (CTE). The resources that provide most of the information for the following overview, or summary, are listed much farther down this web page.

Definition

A concussion is an injury to the brain when something hits the head OR the body to make the brain move within the skull and hit the side of the skull. The brain has the consistency of gelatin and floats, to a degree, in cerebrospinal fluid.  A sudden blow to the head or harsh movement of the body can cause the brain to move within the head to bang against the side of the skull causing some type of injury.

Symptoms

The symptoms can vary due to a number of factors, especially due to the severity of the movement of the brain within the skull. Contrary to popular belief, a person may OR may NOT lose consciousness. Common symptoms include headache, dizziness, fainting, nausea, blurred vision, sensitivity to light, sensitivity to noise, memory loss, confusion, drowsiness, anxiety, irritability, and slurred speech. However, the more severe the concussion, the more severe the symptoms can be.

Who is at Risk?

For many people, when they hear the word concussion they think about the sport of football.  However, just about anyone is at risk of obtaining a concussion. Easily, a concussion can occur to a countless number of people who are walking along and then fall hitting their head on the ground. Many people do this a day and do not realize that they may have just suffered a very mild form of concussion. They do not think about visiting a physician. The same is true for anyone who enjoys, skiing, sledding, tobogganing, ice skating, and riding a bicycle. Research studies indicate that military personnel are at risk of obtaining concussions from a variety of events that they face. With a little imagination, you can think of  SO MANY things that any human person does that might result in a concussion. Contact-sports, such as football, are not the only activities that are the causes of concussions, mild traumatic brain injury, or chronic traumatic encephalopathy.

Some research indicates that genes can play a role in the relationship between trauma, neuropathological changes, and disordered cognition and behavior. The Apolioprotein E gene (ApoE4 allele) has been described in its association with Alzheimer’s disease where individuals with homozygous ApoE4/E4 genotype have a 19-fold increased risk of developing Alzheimer’s disease. This same gene is now thought to possibly have a role in the development of chronic traumatic encephalopathy. A research study by Teasdale et al. reported that patients with ApoE4 allele are more than twice as likely than those without ApoE4 to have unfavorable outcomes 6 months after head injury (Saulle and Greenwald 3).

Age is another risk factor when considering concussions. There is a variety of factors that need to be considered when using age as a risk factor.  At a young age, the brain has more plasticity than an older brain. The younger brain can handle the injury and recovery better than the older brain. HOWEVER, if repetitive concussions start at an early age then that means that there is a greater threat of serious long-term health risks such as chronic traumatic encephalopathy due to the length of time of exposure (over a lifetime) to repetitive concussions.

It is possible that a person’s health conditions that are absent or present during the preclinical stage of CTE may “influence the extent of neurodegeneration of the brain’s ability to compensate for any neurodegeneration. For instance, the presence of chronic inflammation, such as that which accompanies medical conditions such as obesity, hypertension, diabetes mellitus, atherosclerosis, and heart disease, may facilitate neurodegeneration and NFT formation” (Gavett, Stern, and McKee 7).


Statistics

Although many people are at risk of obtaining a concussion, just how many people in the U.S. (or the World) really do get a concussion a year is very difficult to ascertain. Many, many people just do not report the injury or go to a physician for treatment. The Center for Disease Control and Prevention is a credible, well-respected government agency that provides the expertise, information, and tools to help people and communities protect their health. There is way too much information and statistics about concussions and traumatic brain injury (TBI) to mention here, but I will list some links to CDC web pages that you can explore. There are valuable links all over each CDC web page so PLEASE explore each web page.



http://www.cdc.gov/traumaticbraininjury/data/index.html

• In 2014,1 about 2.87 million TBI-related emergency department (ED) visits, hospitalizations, and deaths occurred in the United States, including over 837,000 of these health events among children.
  • TBI contributed to the deaths of 56,800 people, including 2,529 deaths among children.
  • TBI was diagnosed in approximately 288,000 hospitalizations, including over 23,000 among children.  These consisted of TBI alone or TBI in combination with other injuries.
• In 2014, an estimated 812,000 children (age 17 or younger) were treated in U.S. EDs for concussion or TBI, alone or in combination with other injuries.1
• Over the span of eight years (2006–2014), while age-adjusted rates of TBI-related ED visits increased by 54%, hospitalization rates decreased by 8% and death rates decreased by 6%.1

Here are just a few links to all kinds of information AND statistics about concussions, sports-related concussions, mild traumatic brain injury (mTBI), and traumatic brain injury (TBI).

https://www.cdc.gov/traumaticbraininjury/pubs/

http://www.cdc.gov/traumaticbraininjury/data/index.html

http://www.cdc.gov/traumaticbraininjury/get_the_facts.html

http://www.cdc.gov/headsup/youthsports/

http://www.cdc.gov/TraumaticBrainInjury/basics.html/ 

Diagnosis and Treatment of Concussions

When it comes to diagnosing a concussion, usually concussions create a variety of symptoms as we listed above, such as: headache, dizziness, fainting, nausea, blurred vision, sensitivity to light, sensitivity to noise, memory loss, confusion, drowsiness, anxiety, irritability, and slurred speech.

For athletes, many schools incorporate special testing such as imPACT, SAC (Standardized Assessment of Concussion), or SCAT (Sport Concussion Assessment Tool). Basically, the athlete takes a test at a time when he/she is healthy (or not believed to have a concussion like at the beginning of a sport’s season.) This standardized scoring system takes into account symptoms, physical examination findings, cognitive function, balance, and coordination. The baseline results are extremely important for comparison, later when the athlete may be suspected of having a concussion. When the athlete is suspected of having a concussion, the athlete takes the test again. This time the results of the post concussion test is compared to the baseline results PRE concussion. The post concussion results can determine if the athlete has a concussion and the severity of the concussion.  When the post concussion test results have similar results as the pre concussion test than the athlete may be ready to play again.

Treatment of a concussion depends on the severity of the injury. Often, the typical very mild form of concussion is treated with rest and avoidance of physical exertion, and any activity that can create more damage to the brain. The physician is one of the most important professionals to help determine when the patient is able to resume normal activities.

Reporting

There are a number of articles/studies on reporting of concussions. We separated this paragraph from the one above about Diagnosis and Treatment, although maybe reporting is part of the diagnosis and treatment? If is up to you how much you want to write/talk about concussions, BUT there is information in journal articles about various reasons why athletes report or do not report concussions. This topic may add more to your paper or speech.

Long-Term Effects of Concussions and Traumatic Brain Injuries

This is where a lot of recent attention has occurred. We are talking about the long-term effects of repetitive concussions. The key word is “repetitive.” When looking through the literature about concussions and the long-term effects of concussions, it is easy to see that there is quite a bit of knowledge about concussions, BUT not so much knowledge about the long-term effects of repetitive concussions. There is some very good scholarly research that has been done and continues to be done on the long-term effects of concussions. A list of some of the best research studies that have been published is listed farther down this web page. Many of the articles can be located on the Web, for FREE. There is MUCH MORE information in these resources than I can summarize on this web page.

When people talk about the long-term effects of concussions then the medical term chronic traumatic encephalopathy (CTE) is mentioned. Chronic traumatic encephalopathy (CTE) has been defined as a progressive neurodegenerative disease caused by repetitive trauma. “CTE was first described in 1928 when Dr. Harrison Martland, a New Jersey medical examiner began to note a constellation of symptoms in boxers.” Dr. Martland called the medical condition “Punch Drunk.”  “Punch Drunk was later termed dementia pugilistica, literally meaning dementia of a fighter. However, with the evolution of sports like American football, these symptoms were also being reported in athletes other than boxers and was renamed chronic traumatic encephalopathy in the 1960s” (Saulle and Greenwald 1).

The symptoms of concussions are immediate and obvious. However, typically the symptoms of CTE start later in life. For athletes, often the symptoms start after they retired from their sport. The symptoms and timeline for these symptoms can vary per person. Currently, the only way to definitively diagnose chronic traumatic encephalopathy is through postmortem neuropathological autopsy.      Mckee et al. provides, at least two different, very informative case studies of CTE in athletes. I will quote from one of the studies to give you a good idea of the long-term effects/results of chronic traumatic encephalopathy. A group of 51 athletes (various sports) with confirmed CTE presented a variety of symptoms such as “memory loss, irritability, outbursts of aggressive or violent behavior, confusion, speech abnormalities, cognitive decline, gait abnormalities, unsteadiness, headaches, slurred speech, and Parkinsonism.”


Prevention

Most of the literature suggests that the best answer to preventing chronic traumatic encephalopathy is to reduce the number of concussions that a person receives over a lifetime. I think that most would agree that is “easier said than done.” There are quite a few opinions in the literature on how to help reduce concussions for athletes. Better, safer equipment is a standard answer. However, safety equipment can only help so much.  Proper coaching and techniques can help. Rules may need to be changed for some contact-sports to promote safety.  Athletes need to understand how important it is to their health to report their concussion-like symptoms. Proper assessment and enforcement of treatment, such as REST is very important. Some of the articles listed below provide much more information on prevention to help you fill up those pages with text.

Summary

STILL, A LOT is NOT clear about the long-term effects of concussions, especially the relationship between repetitive concussions and chronic traumatic encephalography. However, physicians and scientists continue to research this topic. Following is a list of books, journal, and magazine articles that will provide enough information on concussions and chronic encephalopathy to help you write a research paper / report / essay OR give a speech. Many of the following journal and magazine articles can be found on the web, FOR FREE. There really is A LOT of information in these resources as well as other articles that can be found within resources such as PubMed and some other free online periodical computer databases.

We know that many students have to write a five  or ten-page paper. Some students need to give a five-minute speech or longer. We provided an example of an outline near the top of this web page. If you need MORE information to help expand your report or speech, we suggest that the following topics may be where it is easier to expand the report or speech:

Case Studies are where you can add a lot of material. “Chronic Traumatic Encephalopathy in Athletes: Progressive Tauopathy after Repetitive Head Injury” has a number of case studies where you can add much more text to your essay. A 17-year old male football player is the case study in “Management of the Athlete with Concussion.”  The two Maclean’s articles “The Aftershocks” and “The Untold Story” present the case studies of NHL hockey players Sidney Crosby, Eric Lindros, and others.

Long-Term Effects and Medical Information is where you can add A LOT of information. Some of the scholarly, journal articles listed below will give a lot of medical pathophysiology of just what happens medically when a concussion occurs. Just a couple, of more articles that I could mention that will give detail, are “The Pathophysiology of Concussions in Youth” and “Chronic Traumatic Encephalopathy: A Potential Late Effect of Sport-Related Concussive and Subconcussive Head Trauma.”

Statistics: A few of the journal and magazine articles listed below will contain some statistics. HOWEVER, The Centers for Disease Control and Prevention (CDC) has an astonishing number of statistics, reports, and information about concussions and traumatic brain injury. There are quite a few links to explore at the CDC website.  The following link can get you started at the CDC: http://www.cdc.gov/TraumaticBrainInjury/   

Prevention: as we mentioned above, about the only way to prevent CTE is to reduce the number of concussions that a person receives. The following articles provide information that can help add more text to your report or more minutes to your speech. Please scroll way down this web page to see more information about each article.

“Stay Ahead of the Game: Get the Facts about Concussion in Sports.”  (Provides some good suggestions including information about the imPACT test.  If you need more information about prevention then you may want to start with this magazine article.)

“A Smack Upside the Head.”

“Management of the Athlete with Concussion.”  (There is some good information about tests such as SAC and SCAT2. imPACT is another standardization test for concussions. If you need more material, then you can find more information about these tests and give more details on how they work.)

“Chronic Traumatic Encephalopathy: A Review.”

“Long-Term Consequences: Effects on Normal Development Profile after Concussion.”

“Chronic Traumatic Encephalopathy: A Potential Late Effect of Sport-Related Concussive and Subconcussive Head Trauma.”

The information mentioned in the “Overview” above, came from information from the following resources. Most of the information came from websites, journals, and magazine articles.

With each source, especially the journal articles, we will write an extensive explanation of the information contained within the source. The following sources are cited according to The MLA Handbook 2016 Eighth Edition. If your local library does not have these books or they cannot interlibrary loan the books, these books are available at Amazon.com. Some of these citations are listed as a "Print" source and some are listed as if you retrieved the article from the "Web."

BOOKS

The contents of this 2012 book contains: What is a concussion? -- Collision sports -- Non-collision sports -- Baseline testing -- Post concussion syndrome and second impact syndrome -- Chronic Traumatic Encephalopathy (CTE) -- Myths -- Moms and dads -- After concussions -- Reforms.

This 2011 book contains information on the following topics: Introduction -- Just a bump on the head -- Emerging epidemic -- Head games -- Sudden impact -- Through the cracks -- Playing defense -- Anatomy of a brain injury -- Deciphering the damage -- Pocketful of mumbles -- Ticking time bombs -- Seeds of change -- Epilogue -- Appendixes 1: Concussion symptoms -- Appendix 2: Resources for patients and families.

Meehan provides a user-friendly explanation on a variety of topics related to concussion:

This books answers questions such as: What is a concussion? How common is concussion? Can an athlete prevent a concusussion? What is the best way to assess a concussion? What can be done to treat a concussion? When is it safe to return to playing after a concussion? What are the risks of suffering multiple concussions? Are there ways of preventing or decreasing the potential effects of multiple concussions? Is it ethical to allow children to participate in sports that carry a high risk of concussion?

"Ever since the first collegiate football game on November 6, 1869, the need to reduce injuries has played a major role in finding ways to improve the safety of the sport through rule and equipment changes. This new edition includes chapters that discuss the history of football injuries by decade (1931–40, 1941–50, etc.) and critically analyze important circumstances in football that have played a role in fatal and catastrophic football injuries (equipment, rules, coaching, medical care, etc.). The second edition also adds the completion of a chapter covering 2001-2010 and adds data collected for the years 2011-2016. New chapters cover the history of brain and spinal injuries, concussions, CTE, history of NCCSIR, history of NOCSAE, and non-traumatic/exertional injuries. There is also information on how the detection and treatment of football injuries have changed during the past 85 years. "

The contents of this book includes: My professional opinion -- 1. It took us by surprise! -- 2. Why would a football player suffer from dementia and major depression? -- 3. What two and one-tenth brains taught us about dementia and suicide -- 4. The 5. response of the National Football League -- 6. Depression : neurology and family factors -- 7. What should we do? -- pt. 2. The lives and fates of three football players -- 8. Michael "Iron Mike" Webster -- 9. Terry "T-bone" Long -- 10. Andre "Spanky" Waters -- Epilogue -- 11. Why this book was written.

Journal Articles

Many college assignments require the use of scholarly JOURNAL articles. For some topics, that is not always easy to find. However, with the subject of concussion and chronic traumatic encephalopathy, there are some excellent scholarly journal and research study articles on this topic. Some of these credible research studies are able to be located at a variety of credible locations on the Web, FOR FREE. However, not everything is available on the Web. If your local library does not have these journals then PLEASE ask the librarians if they can interlibrary loan the articles, FOR FREE.

The title of this scholarly journal article uses the word "Review" which means that the authors reviewed a variety of studies in order to present information about the "research gaps and controversies" involved with Chronic Traumatic Encephalopathy.

"Scientific and lay interest in negative outcomes associated with exposure to repetitive brain trauma (RBT) continues to strengthen. Concerns about the association between RBT and dementia began more than a century ago, but have resurfaced in the last decade with the more recently described chronic traumatic encephalopathy (CTE). Chronic traumatic encephalopathy is a tauopathy associated with RBT that has become inextricably linked to conversations about sport-related concussion and mild traumatic brain injury. Accordingly, specific populations such as collision sport athletes and certain military personnel are of particular interest owing to their unique exposure to RBT. The gaps and controversies in our understanding of the epidemiologic factors, mechanism, and clinicopathological correlates of CTE reflect the current reliance on postmortem case series investigations. This review discusses the state of the science of CTE and raises considerations for researching and interpreting cognitive changes in members of at-risk populations."

The July 27, 2018 issue of this scholarly journal provides information on what athletes think about reporting, and there are statistics on how many athletes in different countries may have concussions. Some symptoms are mentioned. This article gives a sense of how BIG of issue concussions and Chonic Traumatic Encephelopathy is. Although, many articles and information is about athletes, many people obtain concussions from situations not related to sports.

"Despite the risks, concussion symptoms often go underreported by athletes, leading to delayed or forgone treatment and increased potential for concussion recurrence. One of the most serious long-term consequences of sports-related concussions is Chronic Traumatic Encephelopathy (CTE), a disorder associated with progressive neurological deterioration. The purpose of this study was to explore former collegiate athletes' understanding of concussions and motivations behind concussion non-disclosure in order to better assist family medicine providers in screening for and managing a history of concussions."

"Thirty-two former collegiate athletes (24.5 ± 2.9 years old, 59.4% female, 87.5% white) participated in 7 focus groups. Three predominant themes emerged: 1) Concussions are Part of the Game: Participants believed that concussions were part of sports, and that by agreeing to play a sport they were accepting the inherent risk of concussions. Importantly, many were not familiar with concussion symptoms and what constituted a concussion; 2) Hiding Concussion Symptoms: Participants said they often hid concussion symptoms from coaches and trainers in order to avoid being taken out of or missing games. Participants were able to hide their concussions because most symptoms were indiscernible to others; and 3) Misconceptions about Concussions in Low Contact Sports: Several participants did not understand that concussions could occur in all sports including low contact or noncontact sports. The former athletes who participated in low contact sports and experienced concussions attributed their concussions to personal clumsiness rather than their sport."

This journal article can be located online, FOR FREE at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6064086/

"This cohort study found that concussions among US undergraduate students were common and occurred equivalently between men and women proportionate to university sex distribution. Incidence of concussion in undergraduate students was higher than that reported in other studies examining this age range and, importantly, were more commonly found to be caused by non–sport-related activity compared with sport-related activity. Our findings suggest that concussion among US undergraduate students is a significant health care burden for student health care centers."

This scholarly journal can be found at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6991304/

The abstract for this article in the March 2020 issue of Medical Clinics of North America says "Traumatic brain injury (TBI) is an acquired insult to the brain from an external mechanical force that may result in temporary or permanent impairment. The goal of this article is to provide a general review of the epidemiology, pathophysiology and medical management of adult patients with TBI for providers practicing outside the field of physical medicine and rehabilitation. The medical and rehabilitation management of moderate to severe TBI is the focus of this article, with a brief discussion of the management of mild injuries."

Medical Clinics of North America is a scholarly journal, but it may appear on the journal or book shelf in an academic library as a thin hardcover book. Usually, there are chapters in each monthly journal covering different topics. If your library does not have this series of specific journal, then please ask the librarians if they can interlibrary loan this article, for free. Usually, the information presented is very helpful.

Some of the topics covered are: long-term effects of post concussion syndrome; effects of behavior; when to retire after a concussion; degenerative disease such as Alzheimer’s and Parkinson, chronic traumatic encephalopathy, and motor neuron disease. About a page of information is given for “implications on athletic participation” that includes advice on prevention.

This article can be located online, FOR FREE at: http://www.ncbi.nlm.nih.gov/pmc/articles/PM

There is a lot of information within this article on assessment and testing for concussions.

"Sports-related concussion has emerged as a public health crisis due to increased diagnosis of the condition and increased participation in organized and recreational athletics worldwide. Under-recognition of concussions can lead to premature clearance for athletic participation, leaving athletes vulnerable to repeat injury and subsequent short- and long-term complications. There is overwhelming evidence that assessment and management of sports-related concussions should involve a multifaceted approach. A number of assessment criteria have been developed for this purpose. It is important to understand the available and emerging diagnostic testing modalities for sports-related concussions. The most commonly used tools for evaluating individuals with concussion are the Post-Concussion Symptom Scale (PCSS), Standard Assessment of Concussion (SAC), Standard Concussion Assessment Tool (SCAT3), and the most recognized computerized neurocognitive test, the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). The strengths and limitations of each of these tools, and the Concussion Resolution Index (CRI), CogSport, and King-Devick tests were evaluated. Based on the data, it appears that the most sensitive and specific of these is the ImPACT test. Additionally, the King-Devick test is an effective adjunct due to its ability to test eye movements and brainstem function."

Cureus is an online open access medical journal. This journal article can be located at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5802754/

This scholarly journal article is considered a REVIEW article as the author "reviews" a number of studies. This article gives a good overview of chronic traumatic encephalopathy. Many long term effects that can be associated with chronic traumatic encephalopathy are mentioned in a number of studies. "Chronic Traumatic Encephalopathy (CTE) is a debilitating neurodegenerative disease, which has been increasingly reported in athletes, especially American football players, as well as military veterans in combat settings, commonly as a result of repetitive mild traumatic brain injuries (TBIs). CTE has a unique neuropathological signature comprised of accumulation of phosphorylated tau (p-tau) in sulci and peri-vascular regions, microgliosis, and astrocytosis."

This article can be located online, FOR FREE at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6616127/

"Traumatic brain injury (TBI) presents in various forms ranging from mild alterations of consciousness to an unrelenting comatose state and death. In the most severe form of TBI, the entirety of the brain is affected by a diffuse type of injury and swelling. Treatment modalities vary extensively based on the severity of the injury and range from daily cognitive therapy sessions to radical surgery such as bilateral decompressive craniectomies. Guidelines have been set forth regarding the optimal management of TBI, but they must be taken in context of the situation and cannot be used in every individual circumstance. In this review article, we have summarized the current status of treatment for TBI in both clinical practice and basic research. We have put forth a brief overview of the various subtypes of traumatic injuries, optimal medical management, and both the noninvasive and invasive monitoring modalities, in addition to the surgical interventions necessary in particular instances. We have overviewed the main achievements in searching for therapeutic strategies of TBI in basic science. We have also discussed the future direction for developing TBI treatment from an experimental perspective."

This July 2017 scholarly journal article is located online, FOR FREE at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5657730/

Definitely, this journal article is written in medicalese. Probably, someone with a health-related background will be able to understand this article. Part of the conclusion gives you an idea what is covered: “CTE is a neurodegenerative disease that occurs later in the lives of some individuals with a history of repeated head trauma. The exact relationship between repetitive mild traumatic brain injury, with or without symptomatic concussion, and CTE is not entirely clear, although it is possible that repetitive axonal injury sets up a series of metabolic, ionic, and cytoskeletal disturbances that trigger a pathological cascade leading into CTE in susceptible individuals.” Some of the subject headings are: clinical signs and symptoms of CTE; neuropathology of CTE including gross pathology and microscopic neuropathology; potential late effect of repeated head injuries, diagnosis of CTE; and risk and protective factors. There is a long reference list at the end of this article that can lead you to more articles in other publications. 

This article can be located online, FOR FREE at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2995699/

"Recurrent mild traumatic brain injuries (mTBIs) are regarded as an independent risk factor for developing dementia in later life. We here aimed to evaluate associations between recurrent mTBIs, cognition, and gray matter volume and microstructure as revealed by structural magnetic resonance imaging (MRI) in the chronic phase after mTBIs in young adulthood. Our results suggest persistent detrimental effects of recurrent mTBIs on CT already in young-to-middle-aged adults. If additional structural deterioration occurs during aging, subtle neuropsychological decline may progress to clinically overt dementia earlier than in age-matched controls, a hypothesis to be assessed in future prospective trials." This journal article can be found for free at: http://www.ncbi.nlm.nih.gov/pubmed/?term=list+cognitive+function+and+brain+structure++after+recurrent

This scholarly journal article is kind of a “review” article. A very short history of chronic traumatic encephalopathy is given. However, one of the real important features of this article is that the authors present a number of CASE STUDIES of athletes that show the physical and mental results of a career with repeated concussions. A majority of the article is difficult to understand for the layperson. Much of the article explains in medical/physiology terms what happens to the body/brain when a concussion occurs. However, there is just enough very good information that anyone can understand to give the reader a good picture of the health dangers of repeated concussions and chronic traumatic encephalopathy (CTE).

“Chronic Traumatic Encephalopathy In Athletes: Progressive Tauopathy After Repetitive Head Injury” AND Saulle's “Chronic Traumatic Encephalopathy: A Review” really are two EXCELLENT  JOURNAL articles that present astonishing evidence on the long-term dangers of repeated concussions which can lead to chronic traumatic encephalopathy (CTE). “Chronic Traumatic Encephalopathy In Athletes: Progressive Tauopathy After Repetitive Head Injury” can be located online, FREE at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945234/

This is a GREAT Academic Summary. All kinds of aspects of this condition is covered such as different injuries, prognosis, “Chronic effects of traumatic brain injury” and more. There are graphics that could be used for a presentation. This journal article can be found for free at: http://www.ncbi.nlm.nih.gov/pubmed/25702209

"Sport-related concussion (SRC) is a highly prevalent injury predominantly affecting millions of youth through high school athletes every year. In recent years, SRC has received a significant amount of attention due to potential for long-term neurologic sequelae. However, the acute symptoms and possibility of prolonged recovery account for the vast majority of morbidity from SRC. Modifying factors have been identified and may allow for improved prediction of a protracted course. Potential novel modifying factors may include genetic determinants of recovery, as well as radiographic biomarkers, which represent burgeoning subfields in SRC research. Helmet design and understanding the biomechanical stressors on the brain that lead to concussion also represent active areas of research. This narrative review provides a general synopsis of SRC, including relevant definitions, current treatment paradigms, and modifying factors for recovery, in addition to novel areas of research and future directions for SRC research.."

"Medical Sciences (ISSN 2076-3271; CODEN: MSECFJ) is an international peer-reviewed open access scientific journal, providing a platform for advances in basic, translational and clinical research. The journal aims to publish original research, review articles and short communications about molecular and cellular processes in disease, in order to increase understanding of the fundamental principles and biological questions of medicine."

This scholarly journal article is available for viewing FOR FREE at the journal's online website: https://www.mdpi.com/2076-3271/7/3/44/htm

"Geographic location, sport, parental attitudes about concussion, and athlete's age influenced athletes' concussion-related perceptions, indicating the need to address multiple levels of the socioecological model when targeting youth sport interventions. Parental interventions that translate to an improved culture of youth sport by improving youth athletes' perceptions and experiences are key areas for future work."

"Athletic trainers should be mindful of the many factors that may influence concussion knowledge and beliefs and the role they can play in improving these important factors among young athletes. Our data support the use of age, geographic location, and sport to differentiate messaging and highlight the role of parental attitudes in youth athlete concussion knowledge. These findings also highlight the need for interventions targeting multiple levels of the socioecological model. Such interventions may include athletes, parents, coaches, administrators, health care providers, organizational change, team culture, and societal “buy-in.” Our data and recent literature, emphasize that the current “one-size-fits-all” approach may not be an effective mandate for concussion education."

This August 2018 journal article can be found at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6188083/

There is A LOT in this October 2017 journal article about REPORTING of concussions by young athletes. Many studies are reviewed. As can be seen in other articles about reporting of concussions, young athletes do not regularly report their symptoms. A variety of reasons is given in this scholarly journal article.

This article can be located FREE online at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6211168

"This paper sought to examine the frequency of self-reported sports- and recreation-related (SRR) concussion, as well as care-seeking behaviors and potential activity restrictions after concussions, in a sample of youth.

Methods: A sample of 845 youth ages 12-17 years responded to the web-based YouthStyles survey in 2018. The survey measured the frequency of self-reported lifetime SRR concussion, the setting of their most recent SRR concussion, whether a doctor or nurse evaluated them, and the types of activity restrictions they experienced.

Results: Forty-three percent of youth surveyed sustained their most recent concussion while playing on a sports team, 21.1% while playing on a community-based team, and 36.0% while engaged in a sport or recreational activity. Nearly half (45.3%) reported having to miss playing sports or participating in physical activity for at least one day; about two in ten (19.7%) reported having to miss time on their phone or computer for at least one day

Conclusion: Despite wide-spread efforts to promote protocols for SRR concussion among youth, a third of participants in this study did not seek medical care and more than half did not miss at least one day of sports or physical activity participation following a concussion."

“Chronic Traumatic Encephalopathy: A Review” is an EXCELLENT “review” journal article. The entire article can be retrieved through the scholarly, medical, FREE database called PubMed. PubMed is a credible database full of all kinds of scholarly, medical articles. The database is maintained by U.S. National Library of Medicine / National Institute of Health.  This particular article is a “review” article. This means that authors searched through A LOT of the scholarly research studies on this topic and presents in this specific article a summary (or review) what the scholarly literature says about a variety of topics related to chronic traumatic encephalopathy (CTE). This one journal article has A LOT of very good information about the history, epidemiology (cause), statistics, who is at risk and why (such as genetics), clinical presentation (diagnosis), pathophysiology (the physical, medical things that happen in the body), treatments/prevention, and future considerations. If you need JUST one source, then this excellent article has such a variety of information on chronic traumatic encephalopathy that it could be the one source that you need to write a four or five-page paper. Okay, we admit that you may need one or two more sources to help fill up those research paper pages, BUT there really is a lot of good information within this article. A majority of the information is understandable, too. You do not have to have a degree in the health field in order to understand most of what is presented in this journal article.

This journal article can be found, FREE, online at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3337491/  You can choose to read the “full-text” OR click on the PDF edition link (scanned image of the pages).

The authors of this journal article question if some of the opinions and studies have been exaggerated.

"Chronic traumatic encephalopathy (CTE) is considered to be a progressive neurodegenerative disease caused by mild traumatic brain injury (mTBI). Recently there has been a significant amount of media attention surrounding the commonness of CTE in professional athletes, particularly American football, based on several postmortem case series. However, despite the persuasive claims made by the media about CTE, research on the disease and the effects of mTBI in general remain in its infancy. Commonly cited case series studying CTE are limited by methodological biases, pathological inconsistencies, insufficient clinical data, and a reliance on inherently biased postmortem data. These case series do not allow for the collection of any epidemiological data and are not representative of the general population. The exaggerated assumptions and assertions taken from these studies run the risk of creating a self-fulfilling prophecy for individuals who believe they are at risk and have the potential to negatively influence sports-related policymaking. This review outlines the status and limitations of recent CTE case series and calls for future prospective, longitudinal studies to further characterize the pathological and clinical hallmarks of CTE."

This is a VERY GOOD overview / summary of this condition.  This, as most of the articles found in PubMed, is a scholarly journal article. The journal article can be found online for free at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4453625/.

"Mild traumatic brain injury, especially sport-related concussion, is particularly common among young persons. Consequences of transient pathophysiological dysfunction must be carefully considered in the context of a developing or immature brain, as must the potential for an accumulation of damage with repeated exposure over time. This review will summarize the underlying neurometabolic cascade of concussion with emphasis on the young brain in terms of acute pathophysiology, vulnerability, alterations in plasticity and activation, axonal injury, and cumulative risk from chronic, repetitive damage. The implications of these physiological changes will be discussed in the context of clinical care for the concussed youth, and areas for future investigation will be highlighted."

This article can be located online FREE at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3211100/

This is a VERY GOOD overview / summary of this condition. The article gives known facts, but some that are not as known. A good history is given. The authors seem to question some of the known facts. This, as most of the articles found in PubMed, is a scholarly journal article. The journal article can be found online for free at:.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6532781/

"The term chronic traumatic encephalopathy (CTE) has recently entered public consciousness via media reports and even a Hollywood movie. However, in contrast to general impressions, the incidence of CTE is unknown, the clinical diagnostic criteria have not been agreed upon and the current neuropathological characterization of CTE is acknowledged as preliminary. Additionally, few studies have compared the pathologies of CTE with those of other neurodegenerative disorders or of age-matched controls. Consequently, disagreement continues about the neuropathological aspects that make CTE unique. Furthermore, CTE is widely considered to be a consequence of exposure to repeated head blows, but evidence suggests that a single moderate or severe traumatic brain injury can also induce progressive neuropathological changes. These unresolved aspects of CTE underlie disparate claims about its clinical and pathological features, leading to confusion among the public and health-care professionals alike."

"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. 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. "

The journal article can be found online for free at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4633042.

Provides a case study of a high school football player who suffered a helmet-to-helmet collision.  This is a very good case study in a scholarly journal that provides information about symptoms, treatment, and information about useful tools such as the Standardized Assessment of Concussion (SAC) and the SCAT2 tests. These tests can help in the diagnosis and the decision-making process of when the athlete is ready to play again.
This three-page case study can be found online, FOR FREE at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383163/

This June 19, 2018 scholarly journal article can be located online, FOR FREE at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6018081/

"Over the past 20 years, sports concussion has become one of the most researched topics in sports medicine. Significant resources have been allocated to the study of this issue, with a dramatic increase in information concerning most aspects of this common sports injury. In light of this considerable increase in research, this review is offered to provide clinicians involved in the care of athletes a summary of key features of the evaluation and management of sports concussion with attention to recent contributions to the literature. Some of the topics covered is short history, epidemiology, evaluation, treatment and return to play, complications of concussion, and prevention." The journal article can be found online for free at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4596213.

This August 10, 2017 journal article gives a very good review of brain trauma and youth. It can be found online for free at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6093851/

"Accidents can happen. Children and adolescents are often involved in accidents leading to traumatic brain injuries (TBI). The incidence of TBI in children between 0 and 18 years is 280–1373 per 100,000, but there is a large variation between studies and countries; most of these injuries are mild (mTBI)."

"Mild traumatic brain injury in children can lead to persistent cognitive and physical symptoms which can have a negative impact on activities and participation in school and at play. Preventive treatment strategies are preferred because these symptoms are often not recognized and therefore not treated adequately. In this review clinical studies investigating interventions directed at pediatric mild traumatic brain injury are summarized, and clinical recommendations and directions for the future are provided. Results show that the literature is scarce and more high quality studies are needed. Information and education about the injury and its consequences are recommended, with additional follow-up consultation, including individualized advice and reassurance. The interventions should be family-centered and, ideally, the return to activity and participation should be graded and done step-by-step."

This journal article provides information that appears to be a good OVERVIEW of "Chronic Traumatic Encephalopathy and Neurodegeneration in Contact Sports and American Football."

"Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease characterized by the presence of abnormally phosphorylated tau protein in the depths of one or more cortical sulci. Controversy over the risk of CTE and neurologic disorders later in life among contact sport athletes has taken hold in the public spotlight, most notably in American football. Players, parents, coaches, and legislators have taken action based on the commonly held notion that contact sports invariably lead to neurodegenerative disorders. However, to fully understand the science behind this assumed association, a critical appraisal of the evidence is warranted. With regards to CTE in sports, the objectives of the current report are to: 1) describe the history of CTE, 2) review current CTE definitions, 3) critically evaluate the empiric data, divided into all contact sports and exclusively American football, and 4) summarize notable themes for future research."

Magazine Articles / REPORTS

The Centers for Disease Control and Prevention (CDC) is a government agency that monitors and provides A LOT of information about health risks. One of the publications of the CDC is the weekly Morbidity and Mortality Weekly Report. The October 7, 2011 weekly issue of this publication provides valuable statistics about concussions as well as links to more information on this topic.

Here is an excerpt: “During 2001--2009, an estimated 2,651,581 children aged ≤19 years were treated annually for sports and recreation--related injuries. Approximately 6.5%, or 173,285 of these injuries, were TBIs (Table 1). Approximately 71.0% of all sports and recreation--related TBI ED visits were among males; 70.5% were among persons aged 10--19 years. An estimated 2.5% of children and adolescents with sports and recreation--related injuries were hospitalized or transferred to other facilities, compared with an estimated 6.6% of those with sports and recreation--related TBIs. From 2001 to 2009, the estimated number of sports and recreation--related TBI visits to EDs increased 62%, from 153,375 to 248,418, and the estimated rate of TBI visits increased 57%, from 190 per 100,000 population to 298. During this same period, the estimated number of ED visits for TBIs that resulted in hospitalization ranged from 9,300 to 14,000 annually but did not show a significant trend over time.

Overall, the activities associated with the greatest estimated number of TBI-related ED visits were bicycling, football, playground activities, basketball, and soccer (Table 2). Activities for which TBI accounted for >10% of the injury ED visits for that activity included horseback riding (15.3%), ice skating (11.4%), golfing (11.0%), all-terrain vehicle riding (10.6%), and tobogganing/sledding (10.2%).”
This credible CDC document can be found online, FOR FREE at:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6039a1.htm

Many of the articles listed above are scholarly journal articles intended for a medical or allied health-related audience. However, Men’s Health is a magazine intended for the general public. The information within this magazine article is understandable and informative. Some of the information mentioned is that a “vast majority of concussion victims are ordinary citizens.” “The American Association of Neurological Surgeons reports that more sports-related head injuries in 2009 occurred on bicycles than on football, baseball, and softball fields combined.” “But experts acknowledge that we don’t know the true scope of the TBI epidemic. The CDC’s tally of annual TBIs treated in ERs or admitted to hospitals is about 1.7 million, but almost no one believes this figure accounts for all of them. There’s a vast undercounting of the concussions in the general population.”  This article gives a real good easy-to-understand explanation on what happens to the brain when a concussion occurs. Some information on symptoms and treatment is provided. A list of the 12 sports with the most “head-banging” injuries is given near the end of the article.

This is a VERY GOOD magazine article on the subject of sports-related concussions. 
This article can be located online for FREE at:
http://www.menshealth.com/health/smack-upside-head?fullpage=true

Exceptional Parent is a respected magazine that is devoted to providing child development information to the public, especially parents. Cynthia Boyer provides helpful, easy-to-understand information about concussions including: understanding concussion, ways to prevent and prepare, what to look for, after the diagnosis, and calls to action. This article can be found online, for FREE within the “The Free Library” at http://www.thefreelibrary.com/Stay+aHEAD+of+the+game%3A+get+the+facts+about+concussion+in+sports.-a0252006480

Above, I am going to list the two separate Maclean’s magazine articles, together. The content of both articles are similar and are EXCELLENT for showing the public the dangers of repetitive concussions. Both provide good “case studies” of two famous hockey stars. “The Aftershocks” gives information about Sidney Crosby’s concussion. “The Untold Story” is about “Eric Lindros and other pro hockey players speak for the first time about depression, anxiety, and suicidal thoughts. Cathy Gulli reports on the mental and emotional toll of head injuries.” Between the two articles, there is A LOT of information that can help with writing a research paper / essay OR giving a speech on the health risks of concussions, as well as CTE. Added features in the “The Aftershocks” story is information about experimental test lab results and also a very brief history of NHL and its attempts to make the sport safer. “The Untold Story” is more about the effects that the trauma of repetitive injuries had on NHL athletes. This article gives valuable “case studies.”  These two articles are intended for the general public so the information is written in a way that is easy-to-understand.

Websites

Medline Plus is a very credible, valuable online source for all kinds of health-related topics. Medline Plus is a service of U.S. National Library of Medicine / National Institute of Medicine. The information that can be found at Medline Plus is for a variety of interests. A lot of the information is in an easy-to-understand language for the general public. However, there are resources listed for the health professional that can lead to more research, such as clinical trial research studies.
The topic Traumatic Brain Injury and the topic Concussion provide a number of resources that you can access online that give very good overall information about traumatic brain injuries, including concussions (CTE).  The information provided includes the latest news, causes, treatment, prevention and more.

Traumatic Brain Injury is located within Medline Plus at:http://www.nlm.nih.gov/medlineplus/traumaticbraininjury.html

Concussion is located with Medline Plus at http://www.nlm.nih.gov/medlineplus/concussion.html#cat1

The Centers for Disease Control and Prevention (CDC), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting public health activities in the United States. The CDC provides A LOT of credible information about ALL KINDS of health issues, including concussions. There are plenty of articles as well as statistics.  Just a few links, among many, are:

Statisitics:http://www.cdc.gov/traumaticbraininjury/data/index.html

http://www.cdc.gov/traumaticbraininjury/get_the_facts.html

http://www.cdc.gov/headsup/youthsports/

http://www.cdc.gov/TraumaticBrainInjury/basics.html/ 

https://www.cdc.gov/traumaticbraininjury/pubs/

How to Cite this Web Page According to The MLA Handbook Eighth Edition 2016

Double-space the lines. Use hanging indentation with the second line (if needed) and is indented about 7 or 10 spaces.  The title of the web page is "The Dangers of Concussions and Chronic Traumatic Encephalopathy (CTE)."  There is no official author so place the title first and in quotes as seen above. The official website is called The College and Career Library and is placed in ITALICS.   26 Mar. 2020 is when the web page was updated. Type, or cut and paste, the URL into the citation. After the URL, you can type the date that you accessed the web page, such as 27 Mar. 2020.

This web page was updated March 26, 2020.