An introductory text reads: Chronic traumatic encephalopathy (C T E) is a progressive neurodegenerative disease caused by a single or repeated blow to the head. C T E affects athletes of many types, combat war veterans, and others who experience head trauma (Maroon et al, 2015; McKee et al, 2016). The symptoms, which may not appear for months or years after the injury, include changes to memory, emotions, thinking, and personality. C T E is somewhat similar to other neurodegenerative diseases like Alzheimer’s and Parkinson’s in that it can impair memory, movement, and the ability to plan and carry out everyday tasks (McKee et al, 2013).
Panel 1: A photo shows a football player forcefully holding another player by his head. Text reads: In 2012, after 20 seasons as an NFL player, Junior Seau committed suicide at age 43. In the years leading to his death, Seau's family noticed a change in his thinking, personality, and enthusiasm for the game. Impulsive gambling, alcoholism, and violence became the new conversation around the man once known as a beloved philanthropist (Fainaru-Wada, 2013, February 15). Upon his death, his brain showed the hallmarks of C T E (National Institute of Neurological Disorders and Stroke, 2013, January 10).
Panel 2: A photo shows a Brandi Chastain aiming to hit a soccer ball with her head, without a helmet. Text reads: Retired soccer star Brandi Chastain has announced she will donate her brain to research. Chastain believes this will be a bigger legacy than her game-winning shot in the 1999 World Cup. Like many soccer players, Chastain advocates the banning of headers in youth soccer (Branch, 2016, March).
Panel 3: A photo illustration highlights the external view of a brain within the head of a person wearing a helmet; he is hit on his head by the head of another person who is also wearing a helmet. An arrow on the helmet points down toward the impact. An arrow on the brain points down toward the forehead and another arrow points to the back of the head.
Panel 4: Four stages are depicted under the title, the progression of C T E:
Stage 1 reads: Tau protein accumulates locally in the cortex. Symptoms: headaches, and difficulty maintaining focus. An image shows a cortex with small pores.
Stage 2: The damage spreads to surrounding areas. Symptoms: short-term memory impairment, mood swings, depression, explosive temper, and continued headaches and trouble focusing. An image shows a cortex with several pores.
Stage 3: Damage continues to spread, reaching areas such as the hippocampus, amygdala, and brainstem. Symptoms: memory loss, difficulty planning and carrying out tasks, “visuospatial abnormalities,” and ongoing difficulties with mood and attention. An image shows a cortex with the pores spread around.
Stage 4: Widespread damage across many regions of the brain, including the medial temporal lobe, hypothalamus, and thalamus. Symptoms: worsening of existing symptoms, along with language difficulties and paranoia. Severe memory loss. An image shows a fully damaged cortex.
A text box at the bottom reads: How does C T E differ from other neurodegenerative diseases such as Alzheimer’s? Symptoms associated with C T E typically present around age 40, while those of Alzheimer’s generally appear around 60. Changes in thinking, cognition, and personality are common symptoms of C T E, while Alzheimer's is typically associated with memory problems (Frequently Asked Questions, n.d.). However, emerging research suggests that behavioral changes and “neuropsychiatric symptoms” (depression or anxiety, for example) may signal the beginning of the disease process in Alzheimer's patients (Donovan et al, 2014; Ismail, 2016)