Traumatic Encephalopathy Syndrome Criteria Feature High Sensitivity for CTE Pathology in Life

The following article is part of coverage from the American Academy of Neurology’s Annual Meeting (AAN 2020). Due to the global COVID-19 pandemic, the Academy made the necessary decision to cancel the meeting originally scheduled for April 25–May 1, 2020, in Toronto. While live events will not proceed as planned, readers can click here catch up on the latest research intended to be presented at the meeting.

Previously proposed traumatic encephalopathy syndrome (TES) criteria, especially when augmented to require cognitive symptoms, feature a high sensitivity for the diagnosis of chronic traumatic encephalopathy (CTE) during life in patients with repetitive head impact exposure, according to research from the UNITE (Understanding Neurologic Injury and Traumatic Encephalopathy) study intended to be presented at the annual meeting of the American Academy of Neurology (AAN 2020).

The study included brain donors (age range 14-89 years; mean age, 61.5 years) with repetitive head injuries associated with contact sport play (n=286) or military service (n=85). Published criteria were used to diagnose CTE. Blinded investigators also conducted comprehensive gross and microscopic brain examinations.

Neurologists and neuropsychologists blinded to neuropathological information also performed family interviews and reviewed medical records of donors to collect clinical information. An expert clinical panel reviewed each donor’s clinical history during bi-monthly clinicopathological conferences. The panel then reached consensus diagnoses per TES criteria.

In the cohort, a total of 249 donors (87.4%)  sustained ≥4 concussions. Using TES criteria, the consensus panel diagnosed 284 donors (91.9%) with probable or possible CTE. Approximately 74.3% (n=228) of donors exhibited CTE pathology. For this cohort, the TES criteria had a sensitivity, specificity, and accuracy of 0.97, 0.23, and 0.78, respectively.

A total of 37 out of 61 false positive cases had other neurodegenerative or vascular pathology. In contrast, the 6 false negatives in the sample had mild CTE pathology, including 5 in stage 1 and 1 in stage 2. The specificity of the TES criteria improved to 0.37 after the investigators augmented the criteria to require cognitive symptoms.

While CTE is most commonly diagnosed post-mortem, the researchers wrote that diagnosing “CTE in life is necessary for counseling patients and developing therapeutics.” Based on their findings, they suggest their “results will inform revised TES criteria.”

Reference

Mez J, Alosco M, Daneshvar D, et al. Validity of traumatic encephalopathy syndrome clinical research criteria for chronic traumatic encephalopathy pathology: The understanding neurologic injury and traumatic encephalopathy (UNITE) study. Intended to be presented at the 2020 annual meeting of the American Academy of Neurology. 

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