Semin Neurol 2020; 40(04): 384-393
DOI: 10.1055/s-0040-1713628
Review Article

Chronic Traumatic Encephalopathy and Neuropathological Comorbidities

1  Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
2  Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts
3  Departments of Research and Pathology & Laboratory Medicine, VA Boston Healthcare System, Boston, Massachusetts
4  Department of Veterans Affairs Medical Center, Bedford, Massachusetts
John F. Crary
5  Department of Pathology, Neuropathology Brain Bank & Research Core, Ronald M. Loeb Center for Alzheimer's Disease, Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York
› Author Affiliations
Funding This work was supported by the Department of Veterans Affairs, Veterans Health Administration, Clinical Sciences Research and Development Merit Award (I01-CX001038); Veterans Affairs Biorepository (BX002466); Department of Defense (W81XWH-14–1-0399); National Institute of Aging (RF1AG054156, R56AG057768, R01AG057768, R01AG054008, R01NS095252, R01AG062348, RF1AG060961); National Institute of Neurological Disorders and Stroke (U01NS086659); National Institute of Aging Boston University AD Center (P30AG13846; supplement 0572063345–5); Concussion Legacy Foundation, the Tau Consortium (Rainwater Charitable Trust), and the Alzheimer's Association (NIRG-15–363188). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.


With age, the presence of multiple neuropathologies in a single individual becomes increasingly common. Given that traumatic brain injury and the repetitive head impacts (RHIs) that occur in contact sports have been associated with the development of many neurodegenerative diseases, including chronic traumatic encephalopathy (CTE), Alzheimer's disease, Lewy body disease, and amyotrophic lateral sclerosis, it is becoming critical to understand the relationship and interactions between these pathologies. In fact, comorbid pathology is common in CTE and likely influenced by both age and the severity and type of exposure to RHI as well as underlying genetic predisposition. Here, we review the major comorbid pathologies seen with CTE and in former contact sports athletes and discuss what is known about the associations between RHI, age, and the development of neuropathologies. In addition, we examine the distinction between CTE and age-related pathology including primary age-related tauopathy and age-related tau astrogliopathy.

Publication History

Publication Date:
30 June 2020 (online)

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