Can CTE Be Diagnosed in Life?

At present, CTE cannot be definitively diagnosed during life. A confirmed diagnosis can only be made through post-mortem examination of brain tissue.

However, clinicians may diagnose Traumatic Encephalopathy Syndrome (TES) — a clinical condition based on:

• A history of repeated head impacts
• Progressive cognitive decline
• Mood and behavioural changes
• Exclusion of other neurological conditions

TES is currently the closest clinical diagnosis available for suspected CTE in living patients.

Recognising Possible Symptoms

Symptoms typically develop years — sometimes decades — after repeated brain trauma.

They may include:

Behaviour and Mental Health Symptoms: Depression, anxiety, suicidal ideation, mood swings, impulsive behaviour, agitation, aggressive behaviour, addiction problems, low self-esteem, paranoia, lack of empathy, inappropriate behaviour, quick to temper, poor judgement, reclusive, apathy, disinhibition.

Cognitive Problems Symptoms: Short term memory problems, long term memory problems, difficulties with multitasking, decision making problems, confusion, brain fog, difficulties with word finding, confabulation, difficulties in keeping track of conversations, easily becoming lost, anosognosia, time loss, dysgraphia, 

Other Symptoms: Headaches, migraines, communication problems, balance issues, dizziness, problems with coordination, tremors, insomnia, sleep disturbances, ringing in ears, sensory overload, neck pain/tension, sound sensitivity, light sensitivity, unexplained localised pain, muscle spasms, spaced out look, tapping fingers, bouncing legs.

Symptoms often overlap with other conditions such as Alzheimer’s disease, frontotemporal dementia, PTSD, or major depressive disorder — which makes diagnosis complex.

The NHS Diagnostic Pathway in the UK

If CTE or TES is suspected, the pathway usually begins with your GP.

Step 1: GP Assessment

Your GP may:

• Review your symptom history
• Take a detailed history of head injuries or repeated impacts
• Conduct basic cognitive screening
• Rule out other medical causes (e.g., thyroid issues, vitamin deficiencies)
• Refer you to a specialist

Being open about your history of sport, military service, domestic abuse, or repeated concussions is important during this stage.

Step 2: Specialist Referral

You may be referred to:

• A Neurologist
• A Neuropsychiatrist
• A Memory Clinic
• A specialist brain injury service
• At this stage, further assessments may include:
• MRI brain scans
• Neuropsychological testing (detailed cognitive assessments)
• Mental health evaluations
• Blood tests to exclude other conditions

Importantly, scans may appear normal in early or moderate stages. Diagnosis is largely clinical and based on symptom progression and history.

Challenges in Diagnosis

In the UK, there is currently:

• No single standardised NHS pathway specifically for CTE
• Limited clinician awareness in some areas
• No definitive diagnostic biomarker during life

Because symptoms overlap with other neurodegenerative and psychiatric conditions, some individuals may initially receive alternative diagnoses such as:

• Depression
• PTSD
• Early-onset dementia
• Frontotemporal dementia

Advocacy and informed conversations with healthcare professionals can be crucial.

Treatment and Management in the UK

There is currently no cure for CTE, and no treatment that can reverse the underlying brain changes. However, supportive care can significantly improve quality of life. Treatment focuses on symptom management and support.

1. Cognitive Support

• Cognitive rehabilitation
• Memory strategies
• Occupational therapy
• Structured routines

Memory clinics and neuropsychology services may provide this support.

2. Mental Health Support

Mood and behavioural symptoms are often the most distressing.

Treatment may include:

• Psychological therapy (CBT, counselling)
• Medication for depression or anxiety
• Support for anger or impulsivity
• Community mental health services

3. Physical Symptom Management

• Headache management
• Sleep interventions
• Physiotherapy for balance issues

4. Social & Practical Support

Individuals may also need:

• Benefits advice
• Occupational adjustments
• Carer support
• Social services involvement

Support for families is especially important, as behavioural changes can be extremely challenging.

Private vs NHS Options

Some individuals choose to seek private neurological consultations or advanced imaging. However:

• There is currently no scan that can definitively diagnose CTE in life.
• Private testing does not guarantee clearer answers.

Research and the Future

Research into CTE is ongoing in the UK and internationally. Scientists are exploring:

• Blood biomarkers
• Advanced imaging techniques
• Improved clinical criteria
• Prevention strategies

Awareness is increasing, but there is still work to be done to improve pathways and professional education.

Prevention and Advocacy

Because there is no cure, prevention is critical.

This includes:

• Proper concussion protocols
• Education around sub-concussive impacts
• Safe return-to-play guidelines
• Early reporting of symptoms
• Long-term monitoring of those with repeated head trauma
• Raising awareness protects future generations.

Moving Forward

If you or a loved one are experiencing symptoms and have a history of repeated head impacts:

Book a GP appointment.

• Document your symptom history.
• Be clear about your concussion or impact history.
• Ask about referral to neurology or a memory clinic.

A diagnosis may not be straightforward — but support is available.

And most importantly: you are not alone.