Clinical subtypes of chronic traumatic encephalopathy: literature review and proposed research diagnostic criteria for traumatic encephalopathy syndrome

doi:10.1186/s13195-014-0068-z

Review

. 2014 Sep 24;6(5):68.

doi: 10.1186/s13195-014-0068-z. eCollection 2014.

Clinical subtypes of chronic traumatic encephalopathy: literature review and proposed research diagnostic criteria for traumatic encephalopathy syndrome

Philip H Montenigro¹, Christine M Baugh², Daniel H Daneshvar³, Jesse Mez⁴, Andrew E Budson⁵, Rhoda Au⁶, Douglas I Katz⁷, Robert C Cantu⁸, Robert A Stern⁹

Affiliations

¹ Department of Anatomy and Neurobiology, Boston University School of Medicine, 72 East Concord Street, Boston 02118, MA, USA.
² Department of Neurology, Boston University School of Medicine, 72 East Concord Street, Boston 02118, MA, USA.
³ Behavioral Neurosciences Program, Boston University School of Medicine, 72 East Concord Street, Boston 02118, MA, USA.
⁴ BU Alzheimer's Disease Center, Boston University School of Medicine, 72 East Concord Street, Boston 02118, MA, USA.
⁵ BU Alzheimer's Disease Center, Boston University School of Medicine, 72 East Concord Street, Boston 02118, MA, USA ; VA Boston Healthcare System, 150 S Huntington Avenue, Boston 02130, MA, USA.
⁶ Department of Neurology, Boston University School of Medicine, 72 East Concord Street, Boston 02118, MA, USA ; Framingham Heart Study, National Heart, Lung and Blood Institute, 72 East Concord Street, Boston 02118, MA, USA.
⁷ Department of Neurology, Boston University School of Medicine, 72 East Concord Street, Boston 02118, MA, USA ; Braintree Rehabilitation Hospital, 250 Pond Street, Braintree 02184, MA, USA.
⁸ Department of Neurosurgery, Boston University School of Medicine, 73 East Concord Street, Boston 02118, MA, USA ; Department of Neurosurgery, Emerson Hospital, 131 Old Road, Suite 820, Concord 01742, MA, USA.
⁹ Department of Anatomy and Neurobiology, Boston University School of Medicine, 72 East Concord Street, Boston 02118, MA, USA ; BU Alzheimer's Disease Center, Boston University School of Medicine, 72 East Concord Street, Boston 02118, MA, USA ; Department of Neurology, Boston University School of Medicine, 72 East Concord Street, Boston 02118, MA, USA ; Department of Neurosurgery, Boston University School of Medicine, 73 East Concord Street, Boston 02118, MA, USA.

PMID: 25580160
PMCID: PMC4288217
DOI: 10.1186/s13195-014-0068-z

Review

Clinical subtypes of chronic traumatic encephalopathy: literature review and proposed research diagnostic criteria for traumatic encephalopathy syndrome

Philip H Montenigro et al. Alzheimers Res Ther. 2014.

. 2014 Sep 24;6(5):68.

doi: 10.1186/s13195-014-0068-z. eCollection 2014.

Authors

Philip H Montenigro¹, Christine M Baugh², Daniel H Daneshvar³, Jesse Mez⁴, Andrew E Budson⁵, Rhoda Au⁶, Douglas I Katz⁷, Robert C Cantu⁸, Robert A Stern⁹

Affiliations

¹ Department of Anatomy and Neurobiology, Boston University School of Medicine, 72 East Concord Street, Boston 02118, MA, USA.
² Department of Neurology, Boston University School of Medicine, 72 East Concord Street, Boston 02118, MA, USA.
³ Behavioral Neurosciences Program, Boston University School of Medicine, 72 East Concord Street, Boston 02118, MA, USA.
⁴ BU Alzheimer's Disease Center, Boston University School of Medicine, 72 East Concord Street, Boston 02118, MA, USA.
⁵ BU Alzheimer's Disease Center, Boston University School of Medicine, 72 East Concord Street, Boston 02118, MA, USA ; VA Boston Healthcare System, 150 S Huntington Avenue, Boston 02130, MA, USA.
⁶ Department of Neurology, Boston University School of Medicine, 72 East Concord Street, Boston 02118, MA, USA ; Framingham Heart Study, National Heart, Lung and Blood Institute, 72 East Concord Street, Boston 02118, MA, USA.
⁷ Department of Neurology, Boston University School of Medicine, 72 East Concord Street, Boston 02118, MA, USA ; Braintree Rehabilitation Hospital, 250 Pond Street, Braintree 02184, MA, USA.
⁸ Department of Neurosurgery, Boston University School of Medicine, 73 East Concord Street, Boston 02118, MA, USA ; Department of Neurosurgery, Emerson Hospital, 131 Old Road, Suite 820, Concord 01742, MA, USA.
⁹ Department of Anatomy and Neurobiology, Boston University School of Medicine, 72 East Concord Street, Boston 02118, MA, USA ; BU Alzheimer's Disease Center, Boston University School of Medicine, 72 East Concord Street, Boston 02118, MA, USA ; Department of Neurology, Boston University School of Medicine, 72 East Concord Street, Boston 02118, MA, USA ; Department of Neurosurgery, Boston University School of Medicine, 73 East Concord Street, Boston 02118, MA, USA.

PMID: 25580160
PMCID: PMC4288217
DOI: 10.1186/s13195-014-0068-z

Abstract

The long-term consequences of repetitive head impacts have been described since the early 20th century. Terms such as punch drunk and dementia pugilistica were first used to describe the clinical syndromes experienced by boxers. A more generic designation, chronic traumatic encephalopathy (CTE), has been employed since the mid-1900s and has been used in recent years to describe a neurodegenerative disease found not just in boxers but in American football players, other contact sport athletes, military veterans, and others with histories of repetitive brain trauma, including concussions and subconcussive trauma. This article reviews the literature of the clinical manifestations of CTE from 202 published cases. The clinical features include impairments in mood (for example, depression and hopelessness), behavior (for example, explosivity and violence), cognition (for example, impaired memory, executive functioning, attention, and dementia), and, less commonly, motor functioning (for example, parkinsonism, ataxia, and dysarthria). We present proposed research criteria for traumatic encephalopathy syndrome (TES) which consist of four variants or subtypes (TES behavioral/mood variant, TES cognitive variant, TES mixed variant, and TES dementia) as well as classifications of 'probable CTE' and 'possible CTE'. These proposed criteria are expected to be modified and updated as new research findings become available. They are not meant to be used for a clinical diagnosis. Rather, they should be viewed as research criteria that can be employed in studies of the underlying causes, risk factors, differential diagnosis, prevention, and treatment of CTE and related disorders.

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References

1. McKee AC, Cantu RC, Nowinski CJ, Hedley-Whyte ET, Gavett BE, Budson AE, Santini VE, Lee HS, Kubilus CA, Stern RA. Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury. J Neuropathol Exp Neurol. 2009;68:709–735. doi: 10.1097/NEN.0b013e3181a9d503. - DOI - PMC - PubMed
1. McKee AC, Stern RA, Nowinski CJ, Stein TD, Alvarez VE, Daneshvar DH, Lee HS, Hall G, Wojtowicz SM, Baugh CM, Riley DO, Kubilus CA, Cormier KA, Jacobs MA, Martin BR, Abraham CR, Ikezu T, Reichard RR, Wolozin BL, Budson AE, Goldstein LE, Kowall NW, Cantu RC. The spectrum of disease in chronic traumatic encephalopathy. Brain. 2013;136:43–64. doi: 10.1093/brain/aws307. - DOI - PMC - PubMed
1. Bailes JE, Petraglia AL, Omalu BI, Nauman E, Talavage T. Role of subconcussion in repetitive mild traumatic brain injury: a review. J Neurosurg. 2013;119:1235–1245. doi: 10.3171/2013.7.JNS121822. - DOI - PubMed
1. Baugh CM, Stamm JM, Riley DO, Gavett BE, Shenton ME, Lin A, Nowinski CJ, Cantu RC, McKee AC, Stern RA. Chronic traumatic encephalopathy: neurodegeneration following repetitive concussive and subconcussive brain trauma. Brain Imaging Behav. 2012;6:244–254. doi: 10.1007/s11682-012-9164-5. - DOI - PubMed
1. Goldstein LE, Fisher AM, Tagge CA, Zhang X-L, Velisek L, Sullivan JA, Upreti C, Kracht JM, Ericsson M, Wojnarowicz MW, Goletiani CJ, Maglakelidze GM, Casey N, Moncaster JA, Minaeva O, Moir RD, Nowinski CJ, Stern RA, Cantu RC, Geiling J, Blusztajn JK, Wolozin BL, Ikezu T, Stein TD, Budson AE, Kowall NW, Chargin D, Sharon A, Saman S, Hall GF. et al.Chronic traumatic encephalopathy in blast-exposed military veterans and a blast neurotrauma mouse model. Sci Transl Med. 2012;4:134. - PMC - PubMed

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[1] McKee AC, Cantu RC, Nowinski CJ, Hedley-Whyte ET, Gavett BE, Budson AE, Santini VE, Lee HS, Kubilus CA, Stern RA. Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury. J Neuropathol Exp Neurol. 2009;68:709–735. doi: 10.1097/NEN.0b013e3181a9d503. - DOI - PMC - PubMed

[2] McKee AC, Cantu RC, Nowinski CJ, Hedley-Whyte ET, Gavett BE, Budson AE, Santini VE, Lee HS, Kubilus CA, Stern RA. Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury. J Neuropathol Exp Neurol. 2009;68:709–735. doi: 10.1097/NEN.0b013e3181a9d503. - DOI - PMC - PubMed

[3] McKee AC, Stern RA, Nowinski CJ, Stein TD, Alvarez VE, Daneshvar DH, Lee HS, Hall G, Wojtowicz SM, Baugh CM, Riley DO, Kubilus CA, Cormier KA, Jacobs MA, Martin BR, Abraham CR, Ikezu T, Reichard RR, Wolozin BL, Budson AE, Goldstein LE, Kowall NW, Cantu RC. The spectrum of disease in chronic traumatic encephalopathy. Brain. 2013;136:43–64. doi: 10.1093/brain/aws307. - DOI - PMC - PubMed

[4] McKee AC, Stern RA, Nowinski CJ, Stein TD, Alvarez VE, Daneshvar DH, Lee HS, Hall G, Wojtowicz SM, Baugh CM, Riley DO, Kubilus CA, Cormier KA, Jacobs MA, Martin BR, Abraham CR, Ikezu T, Reichard RR, Wolozin BL, Budson AE, Goldstein LE, Kowall NW, Cantu RC. The spectrum of disease in chronic traumatic encephalopathy. Brain. 2013;136:43–64. doi: 10.1093/brain/aws307. - DOI - PMC - PubMed

[5] Bailes JE, Petraglia AL, Omalu BI, Nauman E, Talavage T. Role of subconcussion in repetitive mild traumatic brain injury: a review. J Neurosurg. 2013;119:1235–1245. doi: 10.3171/2013.7.JNS121822. - DOI - PubMed

[6] Bailes JE, Petraglia AL, Omalu BI, Nauman E, Talavage T. Role of subconcussion in repetitive mild traumatic brain injury: a review. J Neurosurg. 2013;119:1235–1245. doi: 10.3171/2013.7.JNS121822. - DOI - PubMed

[7] Baugh CM, Stamm JM, Riley DO, Gavett BE, Shenton ME, Lin A, Nowinski CJ, Cantu RC, McKee AC, Stern RA. Chronic traumatic encephalopathy: neurodegeneration following repetitive concussive and subconcussive brain trauma. Brain Imaging Behav. 2012;6:244–254. doi: 10.1007/s11682-012-9164-5. - DOI - PubMed

[8] Baugh CM, Stamm JM, Riley DO, Gavett BE, Shenton ME, Lin A, Nowinski CJ, Cantu RC, McKee AC, Stern RA. Chronic traumatic encephalopathy: neurodegeneration following repetitive concussive and subconcussive brain trauma. Brain Imaging Behav. 2012;6:244–254. doi: 10.1007/s11682-012-9164-5. - DOI - PubMed

[9] Goldstein LE, Fisher AM, Tagge CA, Zhang X-L, Velisek L, Sullivan JA, Upreti C, Kracht JM, Ericsson M, Wojnarowicz MW, Goletiani CJ, Maglakelidze GM, Casey N, Moncaster JA, Minaeva O, Moir RD, Nowinski CJ, Stern RA, Cantu RC, Geiling J, Blusztajn JK, Wolozin BL, Ikezu T, Stein TD, Budson AE, Kowall NW, Chargin D, Sharon A, Saman S, Hall GF. et al.Chronic traumatic encephalopathy in blast-exposed military veterans and a blast neurotrauma mouse model. Sci Transl Med. 2012;4:134. - PMC - PubMed

[10] Goldstein LE, Fisher AM, Tagge CA, Zhang X-L, Velisek L, Sullivan JA, Upreti C, Kracht JM, Ericsson M, Wojnarowicz MW, Goletiani CJ, Maglakelidze GM, Casey N, Moncaster JA, Minaeva O, Moir RD, Nowinski CJ, Stern RA, Cantu RC, Geiling J, Blusztajn JK, Wolozin BL, Ikezu T, Stein TD, Budson AE, Kowall NW, Chargin D, Sharon A, Saman S, Hall GF. et al.Chronic traumatic encephalopathy in blast-exposed military veterans and a blast neurotrauma mouse model. Sci Transl Med. 2012;4:134. - PMC - PubMed

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Clinical subtypes of chronic traumatic encephalopathy: literature review and proposed research diagnostic criteria for traumatic encephalopathy syndrome

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Clinical subtypes of chronic traumatic encephalopathy: literature review and proposed research diagnostic criteria for traumatic encephalopathy syndrome

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