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Daniel Antonius, PhD

Daniel Antonius, PhD, led a study to critically examine the existing research on behavioral manifestations of chronic traumatic encephalopathy.

Behavioral Symptoms-CTE Link Needs Long-Term Study

Published December 31, 2014

A lack of longitudinal studies on chronic traumatic encephalopathy (CTE) hinders scientists’ ability to understand how the neurodegenerative brain disease is linked to behavioral health symptoms, according to an interdisciplinary study by University at Buffalo researchers.

“According to the research community, there is a need for more empirical evidence.”
Daniel Antonius, PhD
Assistant professor of psychiatry

Relationship Is Complex, Poorly Understood

Media reports link aggression, violence, depression and suicide with CTE in former football players. However, the relationship between CTE and behavioral changes is an extremely complex and poorly understood issue, according to the UB research.

To establish a causal relationship between CTE and behavioral changes, “this phenomenon needs to be systematically studied over a long period in a large sample of contact and non-contact sports athletes, ideally starting early in their careers,” says Daniel Antonius, PhD, lead author and assistant professor of psychiatry

Discussion of these symptoms has evolved as new technologies have helped identify specific brain changes after blows to the head result in forces being transferred to the brain, the researchers say.

However, the absence of “research-accepted diagnostic criteria for identifying individuals considered at risk for CTE” hinders scientists’ understanding of the causal relationship between CTE and behavioral health symptoms, the researchers conclude.

“According to the research community, there is a need for more empirical evidence,” Antonius emphasizes.

Studying Current, Past Literature on CTE

So far, Antonius notes, peer-reviewed literature on CTE consists primarily of individual case review studies and post-mortem research.

“Case studies are illuminating and important, but they cannot be used to properly establish clinical criteria for diagnosing a medical or psychiatric condition,” he says.

The UB paper traces the reporting of neuropsychiatric symptoms now associated with CTE to the 1928 paper, “Punch Drunk,” by H.S. Martland in the Journal of the American Medical Association.

Martland discussed the similarity of these symptoms to other brain disorders involving encephalitis, inflammation of the brain.

Animal Models are Necessary, But Hard to Develop

To better understand CTE and behavioral symptoms, an appropriate animal model also needs to be developed. Yet, this is a challenging task, as experiences with traumatic brain injury (TBI) models suggest, Antonius notes.

“Coming up with an animal model will be difficult and take years,” he says.

For decades, for example, researchers have been using animal models to study TBI, and they still do not have a perfect model, he says.

Like CTE, traumatic brain injury involves multiple factors, including brain deficits and abnormalities affecting different areas of the brain, as well as various behavioral manifestations, Antonius explains.

Project Tracks Mental Health of Aging Athletes

The paper’s co-authors also are involved with UB’s Healthy Aging Mind Project, a comprehensive multidisciplinary research and treatment study. The study assesses how former professional athletes — including football and hockey players — age, while helping them maintain quality of life.

“We wanted to see what happens to their minds, brains and mental health, while helping them and their families identify treatment and counseling opportunities,” says Antonius, who led the project’s behavioral health committee.

The project has a strong service component, providing education, assistance and, where possible, treatment for the athletes.

Developed by two of Antonius’ co-authors — John Leddy, MD, associate professor of clinical orthopaedics, and Barry S. Willer, PhD, professor of psychiatry — the project is based in UB’s Concussion Management Clinic, which Leddy directs. 

It involves researchers —  including UB medical studentsresidents and post-doctoral researchers — from the medical school’s departments of psychiatry and orthopaedics, as well as faculty members from other UB health sciences schools.

Medical Student Among Paper’s Co-Authors

In addition to Antonius, Leddy and Willer, co-authors on the paper are: 

Research leading to the publication was partially supported by grants from:

  • National Football League Charities
  • Buffalo Sabres Foundation
  • Robert Rich Family Foundation
  • Ralph Wilson Foundation
  • Program for Understanding Childhood Concussion and Stroke