Chronic traumatic encephalopathy, or CTE, is a brain disease linked to repeated hits to the head, often seen in military veterans and athletes.

“CTE is linked to repetitive brain trauma and has a distinct pathology that can only be diagnosed at autopsy,” says Dr. Ross Zafonte, a principal investigator of the Football Players Health Study at Harvard University and executive vice dean at the University of Missouri.

The man who killed at least four people in a N.Y.C. office building shooting claimed in his suicide note to have chronic traumatic encephalopathy (CTE). Here’s what to know about the degenerative brain disease.