A Clinical Approach to the Diagnosis of Traumatic Encephalopathy Syndrome

Reams, Nicole; Eckner, James T.; Almeida, Andrea; Aagesen, Andrea; Giordani, Bruno; Paulson, Hank; Lorincz, Matthew T.; Kutcher, Jeffrey S.

doi:10.1001/jamaneurol.2015.5015

Cited by 87 publications

(64 citation statements)

References 38 publications

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“…Memory impairment, executive dysfunction, impaired attention and language abilities, and progressive cognitive decline are all reportedly associated with CTE (McKee et al 2013, Reams et al 2016). These same cognitive difficulties may also be associated with developmental socioeconomic factors, neurodevelopmental disorders, normal aging, adjusting to retirement, drug and alcohol abuse, and sleep disorders.…”

Section: Discussionmentioning

confidence: 99%

“…TES diagnostic criteria initially included five general criteria derived from calculated prevalence of cognitive and emotional deficits across reported cases of CTE, three core clinical features, and nine supportive features (Montenigro et al 2014). Reams et al proposed the most recent iteration of TES, but carefully note their diagnostic criteria are not intended to predict underlying CTE neuropathology and such criteria will likely change as research evolves (Reams et al 2016). The Reams et al criteria require persistence of symptoms for at least two years, a history of head trauma exposure, delayed onset following head trauma, progressive course, and formal neuropsychological testing corroborating self- or observer-report of cognitive dysfunction in the executive, visuospatial, memory, and/or language domain(s).…”

Section: The Nature Of Ctementioning

confidence: 99%

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Factors Influencing Clinical Correlates of Chronic Traumatic Encephalopathy (CTE): a Review

et al. 2016

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Chronic traumatic encephalopathy (CTE) is a neuropathologically defined disease reportedly linked to a history of repetitive brain trauma. As such, retired collision sport athletes are likely at heightened risk for developing CTE. Researchers have described distinct pathological features of CTE as well a wide range of clinical symptom presentations, recently termed traumatic encephalopathy syndrome (TES). These clinical symptoms are highly variable, non-specific to individuals described as having CTE pathology in case reports, and are often associated with many other factors. This review describes the cognitive, emotional, and behavioral changes associated with 1) developmental and demographic factors, 2) neurodevelopmental disorders, 3) normal aging, 4) adjusting to retirement, 5) drug and alcohol abuse, 6) surgeries and anesthesia, and 7) sleep difficulties, as well as the relationship between these factors and risk for developing dementia-related neurodegenerative disease. We discuss why some professional athletes may be particularly susceptible to many of these effects and the importance of choosing appropriate controls groups when designing research protocols. We conclude that these factors should be considered as modifiers predominantly of the clinical outcomes associated with repetitive brain trauma within a broader biopsychosocial framework when interpreting and attributing symptom development, though also note potential effects on neuropathological outcomes. Importantly, this could have significant treatment implications for improving quality of life.

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Section: Discussionmentioning

confidence: 99%

Section: The Nature Of Ctementioning

confidence: 99%

Factors Influencing Clinical Correlates of Chronic Traumatic Encephalopathy (CTE): a Review

et al. 2016

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“…TBI is also linked to a delayed onset progressive neurodegenerative disease, referred to as chronic traumatic encephalopathy (CTE), which is associated with a prolonged history of repetitive head injuries (both concussive and subconcussive) and has been reported in sports athletes as well as soldiers exposed to blasts (Reams et al, 2016). Clinically, CTE is post-mortem diagnosis that associates with behavioral changes, including executive and cognitive impairments (McKee et al, 2013; Reams et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

“…Clinically, CTE is post-mortem diagnosis that associates with behavioral changes, including executive and cognitive impairments (McKee et al, 2013; Reams et al, 2016). Pathologically, CTE is characterized by frontal and temporal lobe atrophy, neuronal and axonal loss, and abnormal deposits of proteins, including phosphorylated tau (pTau) and 43 kDa TAR deoxyribonucleic acid (DNA)-binding protein (TDP-43) (McKee et al, 2014; McKee et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Neuroimmunology of Traumatic Brain Injury: Time for a Paradigm Shift

Jassam

Izzy

Whalen

et al. 2017

Neuron

583

496

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SUMMARY Traumatic brain injury (TBI) is a leading cause of morbidity and disability, with a considerable socioeconomic burden. Heterogeneity of pathoanatomical subtypes and diversity in the pathogenesis and extent of injury contribute to differences in the course and outcome of TBI. Following the primary injury, extensive and lasting damage is sustained through a complex cascade of events referred to as “secondary injury”. Neuroinflammation is proposed as an important manipulable aspect of secondary injury in animal and human studies. Because neuroinflammation can be detrimental or beneficial, before developing immunomodulatory therapies, it is necessary to better understand the timing and complexity of the immune responses that follows TBI. With a rapidly increasing body of literature, there is a need for a clear summary of TBI neuroimmunology. This review presents our current understanding of the immune response to TBI in a chronological and compartment-based manner, highlighting early changes in gene expression and initial signaling pathways that lead to activation of innate and adaptive immunity. Based on recent advances in our understanding of innate immune cell activation, we propose a new paradigm to study innate immune cells following TBI that moves away from the existing M1/M2 classification of activation states towards a stimulus and disease-specific understanding of polarization state based on transcriptomic and proteomic profiling.

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“…Jordan’s classification is based on a clinical evaluation that includes clinical history, physical and neurologic examination, neuroimaging, neuropsychological and laboratory testing. In contrast, Reams et al (48) propose evolving criteria for a clinical diagnosis of TES which are not intended to be used to diagnose underlying CTE. They define CTE as the neuropathological tauopathy disease and TES as the clinical progressive neurodegenerative disease that may occur after repetitive head trauma.…”

Section: Clinical Symptomsmentioning

confidence: 99%

Does a Unique Neuropsychiatric Profile Currently Exist for Chronic Traumatic Encephalopathy?

Hanlon

McGrew

Mayer

2017

Curr Sports Med Rep

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There is evidence that repetitive mild traumatic brain injury leads to specific patterns of neuropathological findings, labeled chronic traumatic encephalopathy (CTE). However, questions remain about whether these neuropathological changes produce changes in behavior, cognition and emotional status that are associated with a unique neuropsychiatric profile that can be assessed using currently available clinical tools. Our review of the literature indicates that insufficient evidence currently exists to suggest a distinct neuropsychiatric profile for CTE. Major limitations to the field presently include the relatively nascent nature of the topic, reliance on retrospective next-of-kin reporting, the lack of prospective studies, and similarities in neuropsychiatric symptoms between CTE, other neurodegenerative disorders and forms of psychopathology. Clinicians and researchers alike have a responsibility to adopt a cautious and balanced approach for ante-mortem assessments to minimize the potential unintended negative consequences of both over- and under-diagnosing a clinical entity that has yet to be clearly established.

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A Clinical Approach to the Diagnosis of Traumatic Encephalopathy Syndrome

Cited by 87 publications

References 38 publications

Factors Influencing Clinical Correlates of Chronic Traumatic Encephalopathy (CTE): a Review

Factors Influencing Clinical Correlates of Chronic Traumatic Encephalopathy (CTE): a Review

Neuroimmunology of Traumatic Brain Injury: Time for a Paradigm Shift

Does a Unique Neuropsychiatric Profile Currently Exist for Chronic Traumatic Encephalopathy?

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