The first known professional female athlete has posthumously been diagnosed with CTE. 

Heather Anderson, who played for the Adelaide Crows, retired in 2017 after suffering on-field injuries including at least one confirmed diagnosed concussion.

Anderson took her own life in November 2022 at age 28.

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Now the Australian Sports Brain Bank, which specialises in researching diseases associated with repeated head injuries, has confirmed she had “low-stage CTE” in her brain.

Let’s unpack what CTE is and why we still have so much to learn about it. 

What does CTE stand for?

Chronic traumatic encephalopathy.

What is CTE?

It’s a degenerative brain disease associated with repeated mild traumatic brain injuries — like suffering a head knock in a footy match. 

When a disease is described as degenerative, that means the structure or function of the affected organ or tissue progressively deteriorates.

Essentially, it gets worse as time goes on.

The disease was first observed in boxers in the 1920s.

In the decades that followed, research focused on American football players and, more recently, Australian contact sports including NRL, AFL and rugby union. 

Does that mean all concussions lead to CTE?

No. 

The Australian Sports Brain Bank website explains that CTE “may or may not be associated with concussion”.

Researchers are looking to learn more about the condition. 

“It is important to know that not everyone who experiences repeated mild traumatic brain injuries will develop CTE,” the research body says. 

“We do not currently understand why this is the case.”

The Concussion Legacy Foundation website emphasises that CTE is caused by repetitive head impacts – not a one-off injuries or “a handful of concussions”.

“Most people diagnosed with CTE suffered hundreds or thousands of head impacts over the course of many years playing contact sports, serving in the military, or, more rarely, as victims of interpersonal violence,” the foundation says.

A US Centers for Disease Control and Prevention (CDC) fact sheet also backs this up. 

“Occasional hits to the head, such as the bumps and tumbles that children experience when learning to walk, do not cause CTE,” the CDC says. 

How is CTE diagnosed?

Currently, there’s no definitive way to diagnose CTE on living patients. 

As with many brain conditions, the only way to determine a case of CTE is by examining the brain tissue after a patient has died.

This specific analysis isn’t usually performed as part of a normal autopsy and it can take months to complete. 

What are the symptoms of CTE?

Severe cases sometimes present as depression or Alzheimer’s disease.

Because CTE cases have only been confirmed after death, researchers rely on people close to the patient to describe the symptoms of their deceased loved one. 

“Researchers are not certain what Symptoms are directly linked to CTE,” the CDC says.

“Family members have reported noticing changes in thinking, feeling, behaviour, and movement among people who are later diagnosed with CTE after death.”

The Concussion Legacy Foundation breaks up the symptoms into mood and behavioural symptoms and cognitive symptoms. They can include:

Mood and behavioural: 

• Impulse control problems
• Aggression
• Mood swings
• Depression
• Paranoia
• Anxiety

Cognitive:

• Executive function problems
• Impaired judgement
• Short-term memory problems
• Dementia

But researchers say these symptoms might not necessarily be caused by CTE.

The foundation also says problems sleeping could be related to CTE, but points out they may also be due to other causes. 

The CDC says the link between CTE and suicide is unclear.

And the Australian Sports Brain Bank says not every person with CTE shows symptoms.

When do symptoms appear?

It depends.

Often symptoms do not appear until well after the repeated head injuries — sometimes years — according to the Concussion Legacy Foundation.

“Progressive cognitive symptoms related to CTE tend to appear later in life, sometimes in midlife, but more frequently in a patient’s 60s or 70s,” the foundation says. 

However, depending on when the repeated head injuries occurred in a patient’s life, mood and behaviour symptoms can present as early as their 20s. 

“In some cases, symptoms worsen with time — even if the patient suffers no additional head impacts,” it says. 

“In other cases, symptoms may be stable for years before worsening.

“If cognitive symptoms appear early or midlife, they could have another, more treatable cause than CTE.”

How is CTE treated?

There’s no specific treatment for the disease itself yet — and it can be difficult since it’s only diagnosed after death.

Many of the symptoms of CTE can be treated, so the foundation says it’s “important to know there is hope”.

“The good news is that there are many therapies available to treat the symptoms associated with CTE so that patients can have a better quality of life,” the foundation says.

“If you suspect you have CTE, it is also important to remember that you may not have the disease.

“Therefore, focusing on treating the symptoms is currently the best approach.”

The foundation advises seeking treatment from a clinician who specialises in brain disorders like Alzheimer’s and frontotemporal dementia.

Look for neurologists, psychologists or psychiatrists who work in treating cognitive, mood, and behavioural difficulties.

The Concussion Legacy Foundation provides free support to patients with concussion or suspected CTE symptoms as well as their families at CLFHelpline.org.

Who has had CTE?

AFL players Danny Frawley, Shane Tuck and Polly Farmer, and NRL player Paul Green have been confirmed to have had CTE.

Farmer died in 2019, aged 84.

Frawley died in 2019, aged 56. 

Tuck died in 2020, aged 38.

Green died in 2022, aged 49.