There has been increasing recognition of the long term neurological complications that can occur in those exposed to repeated head trauma, not only athletes, but also in the civilian and military population. It has been known for decades that boxers are particularly susceptible to develop “punch drunk” syndrome (now called Chronic Traumatic Encephalopathy - CTE), parkinsonism or dementia.   An important gap in our knowledge of the consequences of cumulative head trauma is how these brain disorders evolve and how early can they be detected. 

Given the numbers of people that participate in sports and the military, this is a far reaching public health issue.

The Cleveland Clinic Lou Ruvo Center for Brain Health is involved in two major research initiatives regarding long term effects of repetitive head trauma.  The Diagnose CTE study (involving retired NFL players) and the Professional Fighters Brain Health study (composed of active and retired professional fighters) are both focused on determining methods to recognize/diagnose individuals who may have CTE and identifying potential risk factors. 

Contact Information

Aaron Ritter, MD



A Systematic Review of Positron Emission Tomography of Tau, Amyloid Beta, and Neuroinflammation in Chronic Traumatic Encephalopathy: The Evidence To Date.  Lee BG, Leavitt MJ, Bernick CB, Leger GC, Rabinovici G, Banks SJ. J Neurotrauma. 2018 Sep 1;35(17):2015-2024. doi: 10.1089/neu.2017.5558. Epub 2018 Jun 12. PMID:29609516

Longitudinal Performance of Plasma Neurofilament Light and Tau in Professional Fighters: The Professional Fighters Brain Health Study.  Bernick C, Zetterberg H, Shan G, Banks S, Blennow K. J Neurotrauma. 2018 Jul 11. doi: 10.1089/neu.2017.5553. PMID:29609512

Investigating structural and perfusion deficits due to repeated head trauma in active professional fighters.  Mishra V, Sreenivasan K, Banks SJ, Zhuang X, Yang Z, Cordes D, Bernick C.Neuroimage Clin. 2017 Nov 21;17:616-627. doi: 10.1016/j.nicl.2017.11.013. eCollection 2018.  PMID:29234598

Multimodal MR Imaging Signatures of Cognitive Impairment in Active Professional Fighters. Mishra VR, Zhuang X, Sreenivasan KR, Banks SJ, Yang Z, Bernick C, Cordes D. Radiology. 2017 Nov;285(2):555-567. doi: 10.1148/radiol.2017162403. Epub 2017 Jul 25. PMID:28741982

Prevalence of Traumatic Findings on Routine MRI in a Large Cohort of Professional Fighters.  Lee JK, Wu J, Banks S, Bernick C, Massand MG, Modic MT, Ruggieri P, Jones SE. AJNR Am J Neuroradiol. 2017 Jul;38(7):1303-1310. doi: 10.3174/ajnr.A5175. Epub 2017 May 4. PMID: 28473342

Fighting to keep a sport safe: toward a structured and sport-specific return to play protocol. Nalepa B, Alexander A, Schodrof S, Bernick C, Pardini J. Phys Sportsmed. 2017 May;45(2):145-150. doi: 10.1080/00913847.2017.1288544. Epub 2017 Feb 15. Review. PMID:28152320

Lack of Influence of Apolipoprotein E Status on Cognition or Brain Structure in Professional Fighters.  Banks SJ, Miller JB, Rissman RA, Bernick CB. J Neurotrauma. 2017 Jan 15;34(2):380-384. doi: 10.1089/neu.2016.4453. Epub 2016 Jun 27.  PMID:27245878

Is phosphorylated tau unique to chronic traumatic encephalopathy? Phosphorylated tau in epileptic brain and chronic traumatic encephalopathy. Puvenna V, Engeler M, Banjara M, Brennan C, Schreiber P, Dadas A, Bahrami A, Solanki J, Bandyopadhyay A, Morris JK, Bernick C, Ghosh C, Rapp E, Bazarian JJ, Janigro D. Brain Res. 2016 Jan 1;1630:225-40. doi: 10.1016/j.brainres.2015.11.007. Epub 2015 Nov 7. PMID:26556772

Determining brain fitness to fight: Has the time come?  Seifert T, Bernick C, Jordan B, Alessi A, Davidson J, Cantu R, Giza C, Goodman M, Benjamin J. Phys Sportsmed. 2015 Nov;43(4):395-402. doi: 10.1080/00913847.2015.1081551. Epub 2015 Aug 21. PMID:26295482

Clinical features of repetitive traumatic brain injury and chronic traumatic encephalopathy.  Montenigro PH, Bernick C, Cantu RC. Brain Pathol. 2015 May;25(3):304-17. doi: 10.1111/bpa.12250. Review. PMID:25904046

Repeated head trauma is associated with smaller thalamic volumes and slower processing speed: the Professional Fighters' Brain Health Study.  Bernick C, Banks SJ, Shin W, Obuchowski N, Butler S, Noback M, Phillips M, Lowe M, Jones S, Modic M.  Br J Sports Med. 2015 Aug;49(15):1007-11. doi: 10.1136/bjsports-2014-093877. Epub 2015 Jan 29.  PMID:25633832

Children and football: a cautionary tale.  Filley CM, Bernick C. Neurology. 2015 Mar 17;84(11):1068-9. doi: 10.1212/WNL.0000000000001357. Epub 2015 Jan 28. No abstract available. PMID:25632092

Impulsiveness in professional fighters.  Banks SJ, Mayer B, Obuchowski N, Shin W, Lowe M, Phillips M, Modic M, Bernick C. J Neuropsychiatry Clin Neurosci. 2014 Winter;26(1):44-50. doi: 10.1176/appi.neuropsych.12070185.  PMID:24515676

The protective effect of education on cognition in professional fighters.  Banks SJ, Obuchowski N, Shin W, Lowe M, Phillips M, Modic M, Bernick C. Arch Clin Neuropsychol. 2014 Feb;29(1):54-9. doi: 10.1093/arclin/act079. Epub 2013 Nov 4. PMID:24191967

Diffusion measures indicate fight exposure-related damage to cerebral white matter in boxers and mixed martial arts fighters. Shin W, Mahmoud SY, Sakaie K, Banks SJ, Lowe MJ, Phillips M, Modic MT, Bernick C. AJNR Am J Neuroradiol. 2014 Feb;35(2):285-90. doi: 10.3174/ajnr.A3676. Epub 2013 Aug 8. PMID:23928146

Professional fighters brain health study: rationale and methods. Bernick C, Banks S, Phillips M, Lowe M, Shin W, Obuchowski N, Jones S, Modic M. Am J Epidemiol. 2013 Jul 15;178(2):280-6. doi: 10.1093/aje/kws456. Epub 2013 Jun 4. PMID:23735309

What boxing tells us about repetitive head trauma and the brain. Bernick C, Banks S.

Alzheimers Res Ther. 2013 Jun 4;5(3):23. doi: 10.1186/alzrt177. eCollection 2013. Review. PMID:23731821

Members & Collaborations

Members & Collaborations

Cleveland Clinic Affiliations

  • Aaron Ritter, MD

External Relationships and Collaborations

  • Boston University
  • University of Minnesota
  • The Sahlgrenska Academy at University of Gothenburg
  • University of New Mexico
  • Banner Alzheimer’s Center
  • University of Washington