Chronic Traumatic Encephalopathy (CTE) made international headlines in 2002 when Dr Bennet Omalu identified the disease in the brain of former NFL Hall of Famer Mike Webster. Webster, once the celebrated centre for the Pittsburgh Steelers, died at just 50 years old. In the years before his death, he had experienced severe depression, dementia, memory loss, and behavioural changes.

For many, this discovery appeared to mark the beginning of CTE research.

But the truth is far more sobering.

The link between repeated head trauma and long-term neurological damage has been recognised for nearly a century.

The Early Warnings: 1920s–1930s

In 1928, Dr Harrison Martland, a forensic pathologist, published a landmark paper titled “Punch Drunk.” After examining hundreds of traumatic brain injury cases, he identified microscopic brain damage in boxers who had suffered repeated blows to the head.

Martland described symptoms including:

• Tremors
• Parkinsonism
• Vertigo
• Cognitive decline
• “Mental deterioration”

He proposed that repetitive head impacts were causing cumulative brain damage — a revolutionary idea at the time.

In 1934, H.L. Parker published “Traumatic Encephalopathy (Punch Drunk) of Professional Pugilists,” describing a progressive neurological syndrome in boxers that could lead to severe mental and physical impairment.

By 1937, J.A. Millspaugh coined the term “dementia pugilistica”, calling for rule changes and mandatory medical oversight in boxing to protect athletes.

The warnings were clear — and they were early.

The Emergence of “Chronic Traumatic Encephalopathy”

In 1957, British neurologist Dr Macdonald Critchley was the first to use the term Chronic Traumatic Encephalopathy (CTE) in a study published in the British Medical Journal.

He described:

• Gradual mental decline
• Emotional instability
• Slowed speech and thinking
• Severe memory deterioration

Critchley noted that individuals often had little insight into their own decline.

In 1969, British neurologist Dr A.H. Roberts published “Brain Damage in Boxers,” based on a study of 250 retired professional fighters. He stated that the condition could no longer be ignored by the medical profession or the public.

Pathologist John Corsellis further advanced understanding in 1973 with “The Aftermath of Boxing,” detailing the neuropathological changes seen in retired boxers. His work laid important foundations for modern CTE research.

By the 1970s, the connection between repeated head trauma and neurodegeneration had been documented extensively.

Yet public awareness remained limited.

Dr Bennet Omalu & the Turning Point (2002–2010)

In 2002, Dr Bennet Omalu, a forensic pathologist working in the United States, conducted the autopsy of Mike Webster.

Webster had suffered from severe cognitive and psychiatric symptoms before his death. Although he died from a heart attack, Dr Omalu chose to examine his brain tissue more closely — funding the analysis himself.

Under the microscope, Omalu discovered abnormally high concentrations of tau protein, a hallmark of neurodegenerative diseases such as Alzheimer’s. While similar pathology had been described in boxers decades earlier, this was the first time it had been identified in an American football player.

In 2005, Omalu published his findings in the journal Neurosurgery, formally describing CTE outside of the boxing world.

The NFL initially denied any link between football and neurodegenerative disease. However, Omalu continued his research, examining additional brains of former players. His work later gained global attention with the release of the film Concussion in 2015.

In 2016, the NFL publicly acknowledged the link between playing football and CTE.

Dr Ann McKee & Modern Research

In 2005, neuropathologist Dr Ann McKee identified CTE in the brain of former boxer Paul Pender. In 2008, she confirmed the disease in a former NFL player.

Dr McKee and her team at Boston University’s CTE Centre have since become leaders in CTE research, working closely with brain banks to study donated brains from athletes and veterans.

In 2013, McKee and colleagues proposed a staging system for CTE, outlining four stages based on severity.

In 2017, a landmark study published in JAMA examined 202 donated brains from former American football players. CTE was identified in:

• 86% of all cases studied
• 110 out of 111 former NFL players

While brain bank studies reflect donated samples rather than the general population, the findings intensified global debate about player safety.

Beyond Sport

CTE is not limited to athletes.

Research has identified CTE pathology in:

• Military personnel exposed to blast injuries
• Victims of domestic violence
• Individuals with repetitive head-banging behaviours
• Poorly controlled epilepsy cases

This expanded understanding highlights that CTE is linked to repetitive brain trauma — not a specific sport.

Why CTE Cannot Yet Be Diagnosed in Life

Despite over 100 years of scientific documentation, CTE still cannot be definitively diagnosed in a living person.

The damage caused by CTE is microscopic. It can only be confirmed through post-mortem examination of brain tissue.

Today, researchers use criteria for Traumatic Encephalopathy Syndrome (TES) to identify individuals who may have CTE during life.

In 2014, McKee and colleagues proposed TES criteria. In 2021, the National Institute of Neurological Disorders and Stroke (NINDS) published research-based diagnostic criteria for TES, focusing on:

• History of repetitive head impacts
• Progressive cognitive decline
• Behavioural dysfunction
• Exclusion of other causes

However, TES remains a research tool and is not yet a formal clinical diagnosis.

A Century of Knowledge

It would be easy to believe that CTE is a “new” disease discovered in the 21st century.

In reality, the scientific community has documented the link between repetitive head trauma and neurological decline since 1928.

From “Punch Drunk” to “Dementia Pugilistica” to Chronic Traumatic Encephalopathy, the condition has been described, renamed, debated, and rediscovered — but never truly unknown.

The challenge today is not awareness within science. It is translating that knowledge into prevention, policy, and protection.

Moving Forward

CTE research continues to evolve. Scientists are working toward:

• Biomarkers for diagnosis in life
• Improved imaging techniques
• Better understanding of risk factors
• Stronger prevention strategies

At Marshalling Brain Injuries Alliance, we believe understanding the history of CTE is essential.

Because when we realise this is not a new issue — but one documented for a century — it strengthens the call for better education, safer sport, and stronger protections for future generations.

Protecting brain health today protects lives tomorrow.