Neuropathological Landscape of Repetitive Brain Trauma and CTE in Modern Sport
DOI:
https://doi.org/10.12775/QS.2026.54.70347Keywords
chronic traumatic encephalopathy, repetitive brain trauma, traumatic brain injury, neuropathology, contact sportsAbstract
Background: Repetitive brain trauma has become a significant problem in modern sport, particularly in athletes exposed to repeated head impacts. Such injuries have been associated with chronic traumatic encephalopathy (CTE), a progressive neurodegenerative disease characterized by abnormal accumulation of hyperphosphorylated tau protein and other neuropathological changes.
Aim: The aim of this study was to review current scientific knowledge on the neuropathological consequences of repetitive brain trauma in athletes, with particular emphasis on chronic traumatic encephalopathy.
Material and methods: This study was conducted as a literature review. Relevant research articles related to repetitive brain injury and chronic traumatic encephalopathy (CTE) were identified through a PubMed database search using the following keywords: chronic traumatic encephalopathy, repetitive brain trauma, traumatic brain injury, neuropathology, and contact sports. The selected publications were analyzed to summarize the current state of knowledge on the neuropathology of CTE.
Results: The reviewed studies indicate that repetitive head impacts can lead to progressive neurodegenerative changes, including abnormal tau protein deposition, neuroinflammation, neuronal loss, and axonal damage. These neuropathological alterations are considered key features of chronic traumatic encephalopathy.
Conclusions: Repetitive brain trauma may significantly contribute to the development of chronic traumatic encephalopathy. Further research is needed to improve early diagnosis, prevention strategies, and clinical treatment of athletes exposed to repeated head impacts.
References
Affleck, A. J., Suter, C. M., Cropley, J. E., Pearce, A. J., & Buckland, M. E. (2025). The neuropathology of chronic traumatic encephalopathy. Pathology, 57(2), 248–252. https://doi.org/10.1016/j.pathol.2024.12.387
Arena, J. D., et al. (2020). Tau immunophenotypes in chronic traumatic encephalopathy recapitulate those of ageing and Alzheimer’s disease. Brain, 143(5), 1572–1587. https://doi.org/10.1093/brain/awaa071
Asken, B. M., Sullan, M. J., Snyder, A. R., et al. (2016). Factors influencing clinical correlates of chronic traumatic encephalopathy (CTE): A review. Neuropsychology Review, 26(4), 340–363. https://doi.org/10.1007/s11065-016-9327-z
Babcock, K. J., Abdolmohammadi, B., & McKee, A. C. (2025). Recent advances in chronic traumatic encephalopathy. The American Journal of Pathology, 195(11), 2048–2058. https://doi.org/10.1016/j.ajpath.2025.07.008
Bieniek, K. F., Ross, O. A., Cormier, K. A., et al. (2015). Chronic traumatic encephalopathy pathology in a neurodegenerative disorders brain bank. Acta Neuropathologica, 130(6), 877–889. https://doi.org/10.1007/s00401-015-1502-4
Bindra, G. S., Asad, S., Shanaa, J., Lui, F., Budson, A. E., Turk, K. W., & Cherry, J. D. (2025). Neuroinflammatory mechanisms may help identify candidate biomarkers in chronic traumatic encephalopathy (CTE). Free Neuropathology, 6, 15. https://doi.org/10.17879/freeneuropathology-2025-6382
Butler, M. L., et al. (2025). Repeated head trauma causes neuron loss and inflammation in young athletes. Nature, 647(8088), 228–237. https://doi.org/10.1038/s41586-025-09534-6
Cherry, J. D., et al. (2020). Evolution of neuronal and glial tau isoforms in chronic traumatic encephalopathy. Brain Pathology, 30(5), 913–925. https://doi.org/10.1111/bpa.12867
Layden, R. M., Groh, J. R., Miner, A. E., et al. (2026). CTE neuropathology alone associated with dementia and cognitive symptoms. Alzheimer’s & Dementia, 22(1), e71032. https://doi.org/10.1002/alz.71032
McKee, A. C. (2009). Chronic traumatic encephalopathy in athletes: Progressive tauopathy following repetitive head injury. Journal of Neuropathology & Experimental Neurology, 68(7), 709–735. https://doi.org/10.1097/NEN.0b013e3181a9d503
McKee, A. C., Daneshvar, D. H., Alvarez, V. E., & Stein, T. D. (2014). The neuropathology of sport. Acta Neuropathologica, 127(1), 29–51. https://doi.org/10.1007/s00401-013-1230-6
McKee, A. C., Daneshvar, D. H. (2015). The neuropathology of traumatic brain injury. Handbook of Clinical Neurology, 127, 45–66. https://doi.org/10.1016/B978-0-444-52892-6.00004-0
McKee, A. C., Stein, T. D., Kiernan, P. T., & Alvarez, V. E. (2015). The neuropathology of chronic traumatic encephalopathy. Brain Pathology, 25(3), 350–364. https://doi.org/10.1111/bpa.12248
McKee, A. C., Stein, T. D., Huber, B. R., Crary, J. F., Bieniek, K., Dickson, D., Alvarez, V. E., Cherry, J. D., Farrell, K., Butler, M., Uretsky, M., Abdolmohammadi, B., Alosco, M. L., Tripodis, Y., Mez, J., & Daneshvar, D. H. (2023). Chronic traumatic encephalopathy (CTE): criteria for neuropathological diagnosis and relationship to repetitive head impacts. Acta Neuropathologica, 145(4), 371–394. https://doi.org/10.1007/s00401-023-02540-w
McKee, A. C., Abdolmohammadi, B., & Stein, T. D. (2018). The neuropathology of chronic traumatic encephalopathy. In B. Hainline & R. A. Stern (Eds.), Handbook of Clinical Neurology (Vol. 158, pp. 297–307). Elsevier. https://doi.org/10.1016/B978-0-444-63954-7.00028-8
McKee, A. C., et al. (2023). Neuropathologic and clinical findings in young contact sport athletes exposed to repetitive head impacts. JAMA Neurology, 80(10), 1037–1050. https://doi.org/10.1001/jamaneurol.2023.2907
Mez, J., Daneshvar, D. H., Kiernan, P. T., et al. (2017). Clinicopathological evaluation of chronic traumatic encephalopathy in players of American football. JAMA, 318(4), 360–370. https://doi.org/10.1001/jama.2017.8334
Stein, T. D., Alvarez, V. E., & McKee, A. C. (2015). Concussion in chronic traumatic encephalopathy. Current Pain and Headache Reports, 19(10), 47. https://doi.org/10.1007/s11916-015-0522-z
Stein, T. D., Montenigro, P. H., Alvarez, V. E., et al. (2015). Beta-amyloid deposition in chronic traumatic encephalopathy. Acta Neuropathologica, 130(1), 21–34. https://doi.org/10.1007/s00401-015-1435-y
van Amerongen, S., et al. (2023). Severe CTE and TDP-43 pathology in a former professional soccer player with dementia: A clinicopathological case report and review of the literature. Acta Neuropathologica Communications, 11(1), 77. https://doi.org/10.1186/s40478-023-01572-3
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Agnieszka Przepióra, Anna Żmigrodzka, Agnieszka Kamińska, Maria Orłowska, Klaudia Czernic-Goławska, Jana Kozłowska, Maria Sanocka, Joanna Falana, Aleksandra Wielogórska, Anna Kwiatkowska, Karolina Trojnar
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 48
Number of citations: 0
