Traumatic Encephalopathy: Review and Provisional Research Diagnostic Criteria

Symptoms of traumatic encephalopathy syndrome are common in the US general population

“…This is the largest study, to date, examining the psychiatric symptoms criteria for TES ( Montenigro et al , 2014 ) in the general population, and the first study to examine these criteria in women. There have been four proposed sets of clinical criteria for TES ( Jordan, 2013 ; Victoroff, 2013 ; Montenigro et al , 2014 ; Reams et al , 2016 ; Laffey et al , 2018 ); we selected the proposed criteria by Montenigro et al (2014 , 2015) because they are the most explicitly characterized, least ambiguous, they are being used in ongoing studies and they were the foundation for a consensus conference designed to establish future, agreed upon, criteria for TES. This study focussed on the psychiatric symptoms criteria only because we did not have access to information that would allow us to examine the neurotrauma exposure criteria, cognitive impairment or neurological signs.…”

“…Moreover, every former college athlete, who participated for 4 years in sports like football, hockey, lacrosse, rugby, wrestling and soccer, automatically meets the exposure criteria (assuming that they played any contact sport for at least 2 years during high school). All of the diagnostic systems are rather generic in their neurotrauma exposure criteria ( Jordan, 2013 ; Victoroff, 2013 ; Montenigro et al , 2014 ; Reams et al , 2016 ; Laffey et al , 2018 ), for example by just requiring ‘repetitive’ head trauma exposure, with the exception of the system by Montenigro et al (2014 , 2015) which is clearly the most specific in this regard, and the only system to provide an operational definition for neurotrauma exposure. Second, including ‘delayed onset’ as one of the two ‘supportive features’ for diagnosing TES is problematic.…”

“…The condition was believed to be caused by repetitive neurotrauma to the brain sustained in boxing, but possibly worsened in some people by other factors including substance abuse, ageing and other neurological diseases ( Spillane, 1962 ; Payne, 1968 ; Roberts, 1969 ). The neurological disorder was conceptualized to be a progressive Parkinsonian-like dementia in many cases, although some authors noted that the neurological problems were not Parkinsonian or progressive in some people ( Martland, 1928 ; Parker, 1934 ; Carrol, 1936 ; Critchley, 1949 ; Grahmann and Ule, 1957 ; Courville, 1962 ; Johnson, 1969 ; Roberts, 1969 ; Mendez, 1995 ; Victoroff, 2013 ). Authors who reviewed and summarized the literature on traumatic encephalopathy that was published during the 20th century discussed behavioural changes in the boxers, such as dis-inhibition, emotional lability, euphoria, suspiciousness to the point of paranoia, aggression and violence ( Roberts, 1969 ; Mendez, 1995 ; Jordan, 2000 )—but these behavioural changes, as described, occurred in the context of a neurological disorder not in isolation and not arising in the context of a mood or anxiety disorder.…”

“…As of 2020, there are no agreed upon or validated clinical criteria for diagnosing CTE, or TES, in a living person, although several sets of clinical diagnostic criteria have been proposed in the past few years ( Jordan, 2013 ; Victoroff, 2013 ; Montenigro et al , 2014 ; Reams et al , 2016 ; Laffey et al , 2018 ). Preliminary research criteria for TES were published in 2014 ( Montenigro et al , 2014 ) and are being used in studies relating to a large multicenter grant entitled ‘Diagnostics, Imaging, And Genetics Network for the Objective Study and Evaluation of Chronic Traumatic Encephalopathy’ (DIAGNOSE CTE; NIH/NINDS Grant No.…”

Pathological Assessment of Chronic Traumatic Encephalopathy

“…A subset of individuals with pathologically confirmed CTE have also been found to present with amyotrophic lateral sclerosis (ALS)-like progressive motor neuron disease with severe muscular atrophy, spasticity, and fasciculations (sometimes termed chronic traumatic myelo-encephalopathy) (9). Several sets of clinical criteria have been proposed, all of which sub-classify suspected CTE on gradients of certainty, similar to diagnostic criteria currently used for Alzheimer disease (AD) dementia (7, 10 –12). In vivo or antemortem modalities for diagnosis of CTE remain under investigation and are not yet routinely used in the clinical setting.…”