Br J Sports Med 47:327-330 doi:10.1136/bjsports-2013-092248
  • Review

What is the evidence for chronic concussion-related changes in retired athletes: behavioural, pathological and clinical outcomes?

Editor's Choice
  1. Andrew Gardner6
  1. 1The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
  2. 2Faculty of Kinesiology, Sport Injury Prevention Research Centre, Calgary, Alberta, Canada
  3. 3Faculty of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
  4. 4Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
  5. 5Burke Rehabilitation Hospital, White Plains, New York, USA
  6. 6Neuropsychiatry Service, HNE Mental Health Service, Newcastle, New South Wales, Australia
  1. Correspondence to Dr Paul McCrory, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC 3084 Australia; paulmccrory{at}
  • Received 25 January 2013
  • Accepted 26 January 2013


Objective The purpose of this paper was to review the current state of evidence for chronic traumatic encephalopathy (CTE) in retired athletes and to consider the potential differential diagnoses that require consideration when retired athletes present with cognitive and psychiatric problems.

Data sources MEDLINE, CINAHL, EMBASE, Mosby's Index, PsycEXTRA, PsycINFO and Scopus. Key words included CTE, dementia pugilistica, punch drunk syndrome, traumatic encephalopathy, CTE, repetitive head injury, sports concussion, multiple concussions, chronic concussions, subconcussive blow and sports-related traumatic brain injury.

Results At present, there are no published epidemiological, cross-sectional or prospective studies relating to modern CTE. Owing to the nature of the published studies, being case reports or pathological case series, it is not possible to determine the causality or risk factors with any certainty. As such, the speculation that repeated concussion or subconcussive impacts cause CTE remains unproven. The extent to which age-related changes, psychiatric or mental health illness, alcohol/drug use or coexisting dementing illnesses contribute to this process is largely unaccounted for in the published literature.

Conclusions At present, the interpretation of causation in the modern CTE case studies should proceed cautiously. The causal assumptions require further prospective or longitudinal studies on the topic.