A model for intervening with veterans and service members who are concerned about developing Chronic Traumatic Encephalopathy (CTE)

Abstract

Objective

This paper briefly reviews what is unknown about chronic traumatic encephalopathy (CTE), highlights understandable concerns by individuals with a history of mild traumatic brain injuries who present to neuropsychologists with fears about a deteriorating course and eventual dementia due to CTE, and proposes a three-phased model for intervening with such individuals.

Method

The proposed model includes three phases – (1) assessment and education, (2) targeted interventions for specific symptoms and comorbidities (e.g., sleep disturbance, headache, depression), and (3) psychotherapy to address mental health issues. While this is generally the order in which they will occur, the approach is not necessarily linear but rather provides a recommended schema.

Conclusion

Media attention on concussion has greatly increased in the last several years, as interest in the possible contribution of concussion(s) to CTE grows. This media attention has some adverse effects in that it creates a false perception about the current state of the science and may engender iatrogenic effects. The proposed model is offered as one approach to engage patients within this context.

Keywords:

• Concussion
• CTE
• neuropsychological
• postconcussive
• mild TBI
• intervention

Acknowledgements

The views expressed herein are those of the authors and do not necessarily reflect the views or the official policy of the Department of Veterans Affairs, Department of Defense, or U.S. Government. The research reported here was supported by the Department of Veterans Affairs, Veterans Health Administration (VHA), the Department of Defense (DoD), and 9 Line LLC. Further support was provided by the Defense and Veterans Brain Injury Center, Grant number MDA 905-03-2-0003, and the James A. Haley Veterans’ Hospital. Drs. Belanger, Cooper, and Vanderploeg earn part of their income from independent practice, which includes work for the National Football League and the NFL Concussion Settlement. Dr. Wortzel maintains a private practice in forensic neuropsychiatry.

Disclosure statement

No potential conflict of interest was reported by the authors.