Recommended Criteria for Diagnosis of CTE-Related Clinical Syndrome

Chronic traumatic encephalopathy (CTE) remains a diagnosis that can only be made during autopsy, but consensus criteria for CTE-related clinical syndrome that can be confirmed during life have been established.

New diagnostic criteria for traumatic encephalopathy syndrome (TES) from the National Institute of Neurological Disorders and Stroke (NINDS) are the first research criteria developed for the CTE-related clinical disorder , reported Robert Stern, PhD, of Boston University, and co-authors included Neurology.

“The publication of these criteria is another important step that will enable scientists to fill information gaps, including a better understanding of the clinical features of CTE and natural history, frequency and frequency, as well as the -reasons and risk factors for the development of this neurodegenerative disease, “NINDS director Walter Koroshetz, MD, said in a statement.

CTE is associated with a history of repetitive head effects (RHIs), including those maintained in contact or hit sports such as American football and boxing. It can be diagnosed neuropathologically by the presence of hyperphosphorylated tau (p-tau) in a specific pattern.

The NINDS expert panel, part of the ongoing DIAGNOSE CTE project, aimed to provide researchers with detailed criteria for diagnosing study participants with TES with a “temporary degree of confirmation” that CTE brain pathology would be person.

Under the new criteria, a person diagnosed with TES for research purposes must have both RHIs and key clinical features not fully accounted for by other conditions. If these criteria are met, the person’s level of functioning is graded, including assessment for depression.

Major exposure to RHIs can be from contact sports, repetitive military explosions, or other sources such as domestic violence, headaches, and professional activities. These headache effects may be with or without clinical signs or traumatic brain injury or traumatic brain injury. The thresholds for football, where the majority of CTE study has been conducted, are at least 5 years of American organized football, with 2 or more years those played at high school level or beyond.

Key clinical features include progressive brain impairment including episodic memory or functional activity, or neurobehavioral dysregulation including burst, immobility, rage, violent rebellion, and emotional capacity, or both.

These psychological or behavioral changes need not be fully accounted for by pre-existing, established, or acquired neurodegenerative disorders or non-degenerative nervous system disorders and conditions, medical or psychiatric. “Comorbid diagnosis of other neurodegenerative disease, substance use disorder, post-traumatic stress disorder (PTSD), or mood or anxiety disorder does not exclude TES,” Stern and co-authors wrote. “Determining whether other conditions more fully describe the key clinical features may often require extensive evaluation.”

It is important to note that these symptoms of TES are nonspecific, see Lili-Naz Hazrati, MD, PhD, of the Hospital for Sick Children in Toronto, and Nicole Schwab, MSc, University of Toronto, in accompanying editorial.

“RHIs are a risk factor in several neurodegenerative diseases, including Alzheimer’s disease, Parkinson’s Disease, ALS, and others where the clinical symptoms are significantly exceeded by TES,” Hazrati and Schwab wrote. “TES symptoms are also common in the general population, reflecting patients with chronic pain, self-sufficiency, and mood disorders.” Furthermore, CTE neuropathology is not entirely clear or universally agreed upon. universal, they noted.

Importantly, there are TES diagnostic criteria for researchers, not clinicians, the editors emphasized. “Given the uncertainties regarding CTE and TES pathology, the priority of the clinician should be the management of clinical symptoms to improve patients’ quality of life, ”they wrote.

“Currently there are no biomarkers or disease modifying therapies for CTE, but treatments for many CTE markers do,” Hazrati and Schwab said. “It is critical that clinicians do not make a premortem diagnosis of CTE, as this can cause harm and worsen symptoms, mental health, and even suicide.”

Diagnostic criteria for TES will be updated as new research information becomes available, Stern said in a statement: “Biomarkers, such as PET scans and blood tests currently under investigation are expected to be included in the DIAGNOSE CTE research project , are integrated into the criteria to improve diagnostic accuracy over the next few years, and as a result the criteria will be used to diagnose patients in the clinic. “