Proposed criteria for diagnosing CTE-related clinical syndromes

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

New arrival Diagnostic criteria for traumatic encephalopathy syndrome The National Institute of Neurological Disorders and Stroke (NINDS) (TES) is the first research standard developed for clinical disorders associated with CTE, Dr. Robert Stern and co-authors of Boston University report. Neurology.

“The publication of these criteria opens up a knowledge gap for scientists, including the clinical characteristics and natural history of CTE, incidence and prevalence, and a better understanding of the causes and risk factors for developing this neurodegenerative disease. It’s another important step that makes it possible to fill in, “NINDS director Walter Colossets, doctor of medicine, said in a statement.

CTEs are associated with a history of repetitive head impact (RHI), including those that persist in contact or collision sports such as American football and boxing.maybe Diagnosed neuropathologically Due to the presence of hyperphosphorylated tau (p-tau) in a unique pattern.

Part of the ongoing NINDS expert panel CTE diagnosis The project aims to provide researchers with detailed criteria for diagnosing TES research participants, with a “provisional level of certainty” that individuals have CTE brain lesions.

Under the new criteria, a person diagnosed with TES for research purposes must have both substantial exposure to RHI and core clinical features that are not well explained in other conditions. There is. If these criteria are met, the individual’s functional level is assessed, including the assessment of dementia.

Substantial exposure to RHI can be due to contact sports, repeated military blasts, or other causes such as domestic violence, headbanging, or occupational activity. These head effects can occur with or without clinical symptoms or signs of concussion or traumatic brain injury. Football thresholds, where most CTE studies are conducted, include organized American football for a minimum of five years, of which more than two years are played at high school level and above.

Core clinical features include progressive cognitive impairment with episodic memory or executive function, or neurobehavioral dysregulation, including explosive, impulsive, angry, violent explosives, and emotional instability, or both. It will be.

These changes in cognition or behavior should not be fully explained by existing, established, or acquired neurodegenerative or non-degenerative nervous system, medical, or psychiatric disorders and conditions. “Diagnosis of another neurodegenerative disorder, substance use disorder, post-traumatic stress disorder (PTSD), or comorbidity of mood or anxiety disorders does not exclude TES,” Stern and co-authors write. “Determining whether other conditions more fully explain the core clinical features may often require extensive evaluation.”

It is important to note that these symptoms of TES are non-specific. Dr. Lili Naz Hazrati, MD, a hospital for sick children in Toronto and Master Nicole Schwab, University of Toronto, Ancillary editorial..

“RHI is a risk factor for several neurodegenerative diseases, such as Alzheimer’s disease, Parkinson’s disease, and ALS, whose clinical manifestations largely overlap with TES,” writes Hazrati and Schwab. “The symptoms of TES are also common in the general population, reflecting patients with chronic pain, suicidal tendencies, and mood disorders.” Moreover, the neuropathology of CTE is not completely clear and universal. They said it was not agreed upon.

Importantly, the editors emphasized that the TES diagnostic criteria are for researchers, not clinicians. “Due to the uncertainties surrounding CTE pathology and TES, the clinician’s priority should be to treat clinical symptoms to improve the patient’s quality of life,” they wrote.

“Currently, there are no biomarkers or disease-modifying treatments for CTE, but there are treatments for many symptoms of CTE,” Hazrati and Schwab pointed out. “It is important that clinicians do not make a prenatal diagnosis of CTE because it can cause harm and lead to worsening symptoms, mental health and even suicide.”

In a statement, Stern said the TES diagnostic criteria will be updated as new research information becomes available. “Biomarkers such as PET scans and blood tests currently being studied in the DIAGNOSE CTE research project are expected to be integrated into the criteria. Over the next few years, we will improve the accuracy of diagnosis and diagnose patients in the clinic. To properly use the criteria for. “