title: What is the evidence for chronic concussion-related changes in retired athletes: behavioural, pathological and clinical outcomes?
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria 3084, Australia. paulmccr@bigpond.net.au
authors.forename: Paul
authors.initials: P
authors.lastname: McCrory
authors.forename: Willem H
authors.initials: WH
authors.lastname: Meeuwisse
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Kutcher
authors.forename: Barry D
authors.initials: BD
authors.lastname: Jordan
authors.forename: Andrew
authors.initials: A
authors.lastname: Gardner
mesh_terms: D000367:Age Factors; D001265:Athletic Injuries / Q000209:etiology / Q000473:pathology* / Q000523:psychology; D020208:Brain Injury, Chronic / Q000473:pathology* / Q000523:psychology; D003072:Cognition Disorders / Q000209:etiology; D003866:Depressive Disorder / Q000209:etiology; D003937:Diagnosis, Differential; D006801:Humans; D019636:Neurodegenerative Diseases / Q000209:etiology; D038223:Post-Concussion Syndrome / Q000209:etiology / Q000473:pathology* / Q000523:psychology; D011379:Prognosis