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Why doctors can’t diagnose CTE before death

Today, medical experts say that despite the known risks for football players and other athletes with head injuries, it’s still impossible to definitively tell someone they have CTE.

Dr. Michael De Georgia, director of the Neurocritical Care Center at UH Cleveland Medical Center, said despite advances, doctors still can’t definitively diagnose a person with CTE until they’ve examined their brain posthumously.

“There was a case [of] Todd Ewen,” De Georgia recalled. “He’d been playing hockey his entire life and he also developed cognitive problems.”

Ewen developed “memory loss, chronic body pain, diabetes and undiagnosed depression,” according to a report released by the Krembil Neuroscience Centre’s Canadian Concussion Centre.

Ewen eventually died by suicide in 2016. However, doctors found no sign of CTE when they examined his brain.

“We were very surprised by the results, as we were sure Todd must have had CTE,” Kelli Ewen said in a statement about her husband released by the concussion center. “We hope that anyone suffering from the effects of concussion takes heart that their symptoms are not an automatic diagnosis of CTE. Depression coupled with other disorders can have many of the same symptoms as CTE.”

De Georgia said doctors have learned much more about CTE in recent years. He pointed out they now classify the disease into four stages, which can help them treat patients:

  • Stage 1. The earliest stage can lead to headaches, difficulty paying attention, short-term memory problems, among other symptoms, according to a published report by Boston University.
  • Stage 2. This stage can build on the previous symptoms with “depression, explosivity, and short-term memory loss.”
  • Stage 3. In this stage, a patient may start to also exhibit cognitive dysfunction and executive impairment.
  • Stage 4. During this final stage, patients may have “dementia, word-finding difficulty, and aggression,” according to the report.

De Georgia said doctors try to rule out other causes of these symptoms so that the patients can get the best care possible.

But without a better method of testing, he said they can’t definitively tell people whether or not they have CTE and what their symptoms will be in the future.

“Certainly, if your patient is a professional football player with a history of multiple concussions, you’d be attuned to CTE,” he said. “But that’s not always the case. It’s very difficult to tease out.” 

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