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Does the difficulty in diagnosis stem from the fact that it is hard to differentiate CTE from other degenerative brain diseases, or is it just hard to diagnose

Does the difficulty in diagnosis stem from the fact that it is hard to differentiate CTE from other degenerative brain diseases, or is it just hard to diagnose in the living altogether? I mean, is the presence of Alzheimer's-like symptoms a necessary but not sufficient condition? Being able to rule out the condition would be very valuable to former contact sport athletes worrying about the disease.

tmh79 9y ago
from what I understand, it is currently a chemical test that requires a biopsy or tissue sample, which is difficult to get from the brain because well, you remove part of the brain, which is bad.
- ulrikrasmussen 9y ago
  Right, that is to diagnose CTE post-mortem. But does CTE also cause other phyiscal symptoms which are just indistinguishable from regular Alzheimer's? For instance, would a person with CTE also have visible plaques on an MRI, or is the disease really invisible in the living? The fact that they found CTE in 110 out of 111 NFL players post-mortem should indicate that they had a pretty good idea about which players to pick for autopsy. Was those picks based on their history of psychological issues alone, or were there other indicators such as definite signs of Alzheimer's?
  - ddorian43 9y ago
    Many brain disease don't show on MRI (schizophrenia, depression, bipolar etc).
- ekianjo 9y ago
  brain biopsies are routinely performed for brain tumors so its not that uncommon.
  - throwanem 9y ago
    But that's to characterize a known lesion, which may require aggressive treatment depending upon its type, and will likely require excision in any case because its simple presence is likely causing some degree of pathological effect. This is a rather different situation, and while I'm not myself a neurosurgeon or indeed anything at all in the medical field except possibly an occasional annoyance, I tend to think that "hey, let's see if we'll find anything this time!" is probably not considered a sufficient reason to perform brain surgery. I could totally be wrong about that, though!
robbiep 9y ago
All brain diseases are really difficult to diagnose - almost all of them remain pathological diagnoses - that is, even if we say ‘alzheimers’ we mean ‘likely Alzheimer’s until we can biopsy or autopsy to determine completely’. Also, just diagnosing (at present, and aside from the aims of the article) doesn’t help as we can’t really treat. We know that, for example, being knocked out more than twice in your life doubles your risk of ‘brain disease’, and having a second concussion within a week or so of the first also is a massive risk multiplier. So we need to have appropriate management and identification strategies in place to ensure we don’t allow that to happen, restrict play after concussive injuries etc

tmh79 9y ago

from what I understand, it is currently a chemical test that requires a biopsy or tissue sample, which is difficult to get from the brain because well, you remove part of the brain, which is bad.

ulrikrasmussen 9y ago
Right, that is to diagnose CTE post-mortem. But does CTE also cause other phyiscal symptoms which are just indistinguishable from regular Alzheimer's? For instance, would a person with CTE also have visible plaques on an MRI, or is the disease really invisible in the living? The fact that they found CTE in 110 out of 111 NFL players post-mortem should indicate that they had a pretty good idea about which players to pick for autopsy. Was those picks based on their history of psychological issues alone, or were there other indicators such as definite signs of Alzheimer's?
- ddorian43 9y ago
  Many brain disease don't show on MRI (schizophrenia, depression, bipolar etc).
ekianjo 9y ago
brain biopsies are routinely performed for brain tumors so its not that uncommon.
- throwanem 9y ago
  But that's to characterize a known lesion, which may require aggressive treatment depending upon its type, and will likely require excision in any case because its simple presence is likely causing some degree of pathological effect. This is a rather different situation, and while I'm not myself a neurosurgeon or indeed anything at all in the medical field except possibly an occasional annoyance, I tend to think that "hey, let's see if we'll find anything this time!" is probably not considered a sufficient reason to perform brain surgery. I could totally be wrong about that, though!

robbiep 9y ago

All brain diseases are really difficult to diagnose - almost all of them remain pathological diagnoses - that is, even if we say ‘alzheimers’ we mean ‘likely Alzheimer’s until we can biopsy or autopsy to determine completely’. Also, just diagnosing (at present, and aside from the aims of the article) doesn’t help as we can’t really treat. We know that, for example, being knocked out more than twice in your life doubles your risk of ‘brain disease’, and having a second concussion within a week or so of the first also is a massive risk multiplier. So we need to have appropriate management and identification strategies in place to ensure we don’t allow that to happen, restrict play after concussive injuries etc