Authoritative Text Confirms SPECT Imaging Can Detect CTE-Related Brain Changes

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New neuroimaging textbook confirms tools such as SPECT can identify brain changes related to chronic traumatic encephalopathy (CTE) early.

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Can SPECT Scans Identify CTE-Related Brain Changes?

Some people think that age-related brain changes are an inevitable part of life. But cognitive decline does not need to be part of anyone’s story. There are numerous ways to start protecting your brain health—and these should remain a priority at any age.

Maintaining a healthy brain encompasses more than just avoiding well-known neurodegenerative diseases such as Alzheimer’s and other types of dementia. A healthy brain supports mental health, improves focus and memory, and boosts overall well-being. Simply put, you can’t be healthy if your brain isn’t healthy.

Fortunately, regardless of your age, you can strive for lifelong brain health by taking certain helpful steps. Whether you’re raising small children or have reached your senior years, in this blog, you’ll find age-specific strategies that will help protect the body’s most complex and incredible organ: the brain.

New authoritative textbook—Diagnostic Imaging: Brain, Fifth Edition—establishes that functional neuroimaging tools, including SPECT, can detect telltale patterns of CTE in the brain while the individual is still living.

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The possibility of early SPECT detection marks a major shift in how medical experts can evaluate and treat those with CTE.

In this blog, you will learn more about chronic traumatic encephalopathy, how it affects the brain, and how SPECT scans may help clinicians recognize and address the condition before irreversible damage occurs.

What is Chronic Traumatic Encephalopathy?

Chronic Traumatic Encephalopathy is a progressive brain disease caused by repeated head injuries or repeated blows to the head. This includes concussions and subconcussive impacts. The repeated head injuries that cause CTE are common among certain populations, such as athletes.

Over time, these repeated head injuries damage brain cells and disrupt healthy brain function. Concerningly, CTE is associated with abnormal buildup of tau protein, which impedes communication between brain cells and eventually leads to cell death.

Traumatic brain injuries (TBIs) should always be taken seriously. However, CTE describes an extremely dangerous type of brain damage. Indeed, CTE is different than damage caused by single traumatic brain injury (TBI).

Examining whether CTE affects individuals with other types of TBIs, a study published in 2025 further established the link between CTE and repeated head impacts. The study found that CTE does not typically affect people with a single brain injury.

In this study, researchers examined 47 donated brains from individuals who sustained brain injuries in their lifetimes. Of these, seven people (about 15 percent) had CTE. Five of them had a history of repeated head impacts, including:

  • Playing football
  • Boxing
  • Military combat
  • Interpersonal violence
  • Child abuse

One individual with CTE had not suffered repeated blows to the head, but they had experienced two very serious brain injuries, occurring decades apart, before their death.

On the other hand, subjects without CTE had mixed histories. Some played sports, and some sustained a few head injuries. Others had single brain injuries. These findings support earlier studies that associated CTE with extensive, repetitive head impacts.

What Are the Symptoms of CTE?

There are no specific symptoms that have been directly linked to CTE.  However, in people who were confirmed to have CTE at autopsy, symptoms included changes in behavior, cognition, movement and mood. They may have experienced any of the following:

Behavioral changes

  • Aggression
  • Impulsivity

Issues in Cognition

  • Memory loss
  • Difficulty thinking
  • Problems with planning, organizing and carrying out tasks

Changes to Mood

  • Depression or apathy
  • Substance abuse
  • Emotional instability
  • Suicidal thoughts or behavior

Movement Problems

  • Slowed movement, shaking, and problems with speech
  • Trouble with walking and balance
  • Gradual loss of control of movements, such as walking, swallowing, speaking and breathing (called motor neuron disease)

CTE, Athletes, and Dementia

CTE disproportionately affects certain groups. For example, one study determined that among 202 deceased former American football players, an astounding 177 of them—or 87 percent—had neuropathologically diagnosed CTE.

These repeated brain injuries and CTE are associated with numerous brain health challenges. A 2023 study noted that CTE often coincides with cognitive impairment and progression to dementia.

This study found that, among brain donors with high-stage CTE who died from neurodegenerative disease, approximately 75 percent had late-onset dementia (diagnosed at 65 years or older). They died within 10 years of their dementia diagnosis.

Furthermore, almost three-quarters of these subjects (73.1 percent) had co-occurring neurodegenerative diseases. These include Alzheimer’s disease (45.4 percent), Lewy body disease (31.2 percent), and frontotemporal lobar degeneration (15.1 percent), which affects behavior, personality, and language skills.

At Amen Clinics, football players with repeated brain injuries have reported symptoms such as:

  • Migraines
  • Intense mood swings
  • Anxiety
  • Memory issues

Related: Persistent Post-Concussion Symptoms

What Is Happening Inside the CTE Brain?

The brain is an incredibly complex organ, with 200 billion neurons (brain cells) and trillions of connecting fibers. But it’s also very soft and delicate, like softened butter—and the skull is designed to protect it.

The skull holds the brain in place with many sharp bony ridges. When the head is hit by an external force (or in forceful movements such as whiplash), the brain can get injured as it slams into these ridges and other parts of the skull. The result is a concussion.

The brain also contains tau protein, an essential component that provides the lattice-like structure of brain cells. Think of tau proteins, found inside brain cells, like train tracks, providing structure to help the cells clear any unwanted and toxic proteins.

Brain damage that stems from repeated injuries leads to a breakdown of tau, which then pierces through cell membranes and interferes with cell functioning. The resulting inflammatory response damages the brain. Through repeated head injuries, CTE develops.

Experts identified CTE cases as early as the 1920s. In those days, people labeled boxers as “punch drunk” to describe the effects of the head injuries they sustained throughout their careers. The athletes developed personality changes, psychiatric symptoms, memory issues, and behavior problems.

CTE symptoms affect athletes in other sports too—such as soccer and hockey, as well as military personnel. Victims of ongoing domestic violence or childhood abuse can also develop CTE.

We know that CTE is a progressive, degenerative disease. But the exact underlying mechanisms that lead to abnormal tau proteins are still being researched. (Abnormal tau proteins are also a key marker of Alzheimer’s, but research has found that they differ in their structure.)

In the past, CTE has been conclusively diagnosed only through the examination of autopsied slices of brain tissue. CTE cannot be detected in a blood test or other diagnostic measure. In other words, it could be diagnosed only after an individual dies.

However, the new edition of Diagnostic Imaging: Brain has confirmed that brain neuroimaging tools, including SPECT, can help detect the changes that suggest CTE development—while the patient is still living.

What Is SPECT Imaging?

Here at Amen Clinics, we understand that mental health is brain health. Yet, in the field of psychiatry, medical experts rarely look at the organ being treated: the brain. Instead of simply observing clusters of symptoms, SPECT serves as a functional brain imaging tool that enables clinicians at Amen Clinics to view the underlying brain activity patterns of their patients.

SPECT stands for single photon emission computed tomography. As a nuclear medicine study, SPECT has been proven to reliably evaluate the brain’s regional cerebral perfusion (blood flow) and activity.

SPECT therefore allows clinicians to determine:

  • Areas of the brain that work well
  • Areas of the brain that work too hard
  • Areas of the brain that do not work hard enough

Though it’s a state-of-the-art brain imaging tool, the research using SPECT is vast, and it has been safely used for decades. SPECT has helped study:

  • Strokes
  • Seizures
  • Brain tumors
  • Alzheimer’s disease
  • Head trauma
  • Schizophrenia
  • Depression and other mood disorders
  • ADHD
  • Substance abuse

Amen Clinics has successfully used SPECT to help treat psychiatric patients with complex cases. In many instances, it can change a client’s diagnosis as well as their treatment plan, therefore optimizing results.

SPECT differs from MRI, fMRI, and PET scans. While an MRI shows the physical anatomy or structure of the brain, SPECT shows blood flow patterns, which indicate how an individual’s brain works. SPECT is also more easily accessible, affordable, and comfortable for the client, while being more reliable than other kinds of scans.

Brain SPECT imaging helps clients and clinicians pinpoint the underlying factors behind a wide variety of mental health conditions and cognitive issues. It can help detect problems that play a role in mental health, including:

  • Head injuries
  • Infections (such as Lyme disease)
  • Exposure to toxins (such as mold)
  • Past emotional traumas

Now, experts know that SPECT can also be helpful in detecting the early brain changes that point to cases of chronic traumatic encephalopathy (CTE).

Can SPECT Imaging Help Detect CTE-Related Brain Changes Before Death?

Diagnostic Imaging: Brain, Fifth Edition covers the fast-changing field of brain imaging. As an authoritative neuroradiology reference, it serves as an invaluable resource for neuroradiologists, general radiologists, and trainees in the medical field. The book offers updated information on more than 300 brain and central nervous system conditions.

The textbook confirms that functional neuroimaging tools like SPECT can detect chronic traumatic encephalopathy-associated patterns during life. This marks a major shift in the evaluation of football-related or “punch-drunk” dementia stemming from repetitive blows to the head.

Of course, Amen Clinics has been using SPECT to help identify signs of traumatic brain injuries for years. It holds the world’s largest database of functional brain scans and conducted the first and largest brain imaging studies on active and retired NFL players.

The textbook notes that autopsy confirmation remains the gold standard for definitive CTE diagnosis. But its acknowledgment of imaging markers—particularly tau-binding PET, SPECT, and diffusion MRI tract abnormalities in living patients—signals a significant advancement in clinical capability.

For the first time, frontline psychiatrists, neurologists, sports physicians, and brain injury specialists have authoritative documentation that such imaging tools can help CTE patients. SPECT can identify characteristic changes strongly suggestive of CTE before death—and before severe neurological decline.

Clinical data mirror the textbook’s findings. For example, measurable metabolic, perfusion, and white-matter network changes often emerge decades before individuals show symptoms. This shift transforms CTE from a condition recognized only after a life is over into one that can be monitored and mitigated during life.

Why Are SPECT and Other Neuroimaging Tools Important in Diagnosing CTE?

Traditional structural imaging (CT and MRI) frequently appears normal in people with extensive concussion histories. In contrast, the advanced methods outlined in Diagnostic Imaging: Brain, Fifth Edition can reveal:

  • frontal and temporal hypoperfusion (inadequate blood flow) via SPECT
  • microstructural tract injury via diffusion tensor imaging (DTI)
  • tau deposition patterns via PET scans
  • network disruption consistent with cumulative head impact

These imaging signatures represent a critical step forward because they allow for:

  • Earlier identification of neurodegeneration
  • Tracking injury progression over time
  • Intervention before functional collapse
  • Personalized therapeutics rather than late-stage palliative support

How Can the CTE Brain Heal?

Earlier diagnosis is critical for cases of CTE because outcomes can be vastly improved with treatment. Let’s take a look at research conducted at Amen Clinics as an example.

Previously, Amen Clinics joined with scientists from major universities to conduct an extensive study on reversing brain damage (not specifically CTE) in former NFL players.

Subjects underwent cognitive testing and quantitative EEG studies, along with brain SPECT imaging, to assess blood flow patterns in the brain. All tests were completed before the treatment started and again at the study’s end.

Before treatment, the participants’ brain scans showed that more than 90 percent of the players had damage to multiple areas of their brains, especially in:

  • The prefrontal cortex, which affects judgment, planning, forethought, and impulse control
  • The temporal lobes, which play a role in learning, memory, and stable moods
  • The cerebellum, which affects mental agility and processing speed

Participants underwent lifestyle-related treatments, such as weight loss if needed. They also supplemented with omega-3 fatty acids, a high-potency multivitamin, and other aids designed to support the brain.

By the end of the study, four out of five of the former players (80 percent) showed improvements, evident through cognitive testing and brain imaging. Blood flow in certain areas of the brain vastly improved—poor blood flow, like head trauma, is a key factor in brain aging.

The research serves as evidence that individuals with brain damage, and perhaps with CTE, can take steps to boost their brain function now.

The following lifestyle recommendations offer a great place to start:

  • Avoid sustaining further head trauma
  • Stop consuming alcohol, smoking cigarettes (or vaping), and using recreational drugs
  • Address serious health issues such as obesity, diabetes, and high blood pressure
  • Treat insomnia or sleep apnea, if needed, and get seven to eight hours of sleep each night
  • Eat a healthy, nutrient-rich diet, with plenty of fresh produce, clean protein, and healthy fats
  • Avoid excess sugar and processed foods
  • Commit to regular exercise and maintain a healthy weight
  • Reduce chronic stress with relaxing practices such as meditation, mindfulness, journaling, and diaphragmatic breathing
  • Treat any mental health conditions such as depression and ADHD
  • Take daily supplements, including a multivitamin, omega-3s, and vitamin D
  • Reduce automatic negative thoughts
  • Exercise the brain with new learning, puzzles, and social activity 

Related: Fun Ways to Stimulate the Brain

Is There Hope for Individuals Showing Signs of CTE?

Amen Clinics will continue to advance research and clinical applications of neuroimaging for at-risk groups for CTE. These include professional athletes, military service members, and survivors of repetitive head trauma.

Thanks to cutting-edge tools and continued research, there is true hope for individuals concerned about CTE. The encouraging news that SPECT can assist in earlier diagnosis and treatment for CTE equips healthcare experts to change brain health for the better.

“Autopsy remains the gold standard for definitive CTE diagnosis,” says Dr. Daniel Amen, founder of Amen Clinics. “But this is a huge step forward. For the first time, one of the premier medical imaging textbooks acknowledges that we can see CTE-related changes in living patients. If we can see it, we can treat it sooner, and change outcomes.”

FAQ About SPECT and Chronic Traumatic Encephalopathy (CTE)

Chronic traumatic encephalopathy (CTE) happens to individuals who have sustained repeated head trauma. Any person who has increased risk factors for CTE is vulnerable. This includes anyone who plays contact sports, survivors of long-term abuse, or individuals in the military.

SPECT imaging, used at Amen Clinics, can show CTE markers in still-living clients. Clinicians can use imaging tools to evaluate the CTE brain, including tau-binding PET, SPECT, and diffusion MRI tract abnormalities. These characteristic changes strongly suggest CTE before death and before severe cognitive decline.

With SPECT imaging, clinicians can see CTE-related changes in living clients. When these changes are observed, targeted treatments can begin sooner—and potentially change the outcomes for these clients.

Amen Clinics

Founded in 1989 by double-board certified psychiatrist and neuroscientist Daniel G. Amen, MD, Amen Clinics Inc. (ACI) is known as the best brain and mental health company in the world. Our clinical staff includes over 50 healthcare specialists, including adult and child psychiatrists, integrative (functional) medicine physicians, naturopaths, addiction specialists, forensic psychiatrists, geriatric psychiatrists, nutritionists, licensed therapists, and more. Our clinicians have all been hand-selected and personally trained by Dr. Amen, whose mission is to end mental illness by creating a revolution in brain health. Over the last 35-plus years, ACI has built the world’s largest database of functional brain scans—over 250,000 SPECT scans on patients from 155 countries—related to how people think, feel, and behave.
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