Search

Background: A 2021 National Institute for Neurological Disorders and Stroke (NINDS) consensus panel proposed a set of clinical diagnostic criteria for traumatic encephalopathy syndrome (TES) and determined provisional levels of certainty for chronic traumatic encephalopathy (CTE) pathology based on neuropathological evidence. The panel suggested the criteria needed to be validated by clinical studies of living populations exposed to repetitive head impacts (RHIs). Hypothesis: As the consensus criteria were developed solely from neuropathologically diagnosed cases of CTE, we hypothesized that they may not be readily applicable to the clinical impressions developed from the histories and examination findings of living patients whose neuropathology was unknown. Study Design: We applied the consensus criteria to 4 groups of living retired contact sports athletes collected from previously published articles in the medical literature. Level of Evidence: Level 4. Methods: Clinical evidence from 4 groups of living retired athletes (boxers and American football players) with extensive RHI exposure was available. We used the NINDS consensus criteria to determine for each athlete whether or not they met the criteria for TES. For those who met the criteria, we determined their provisional level of certainty for CTE pathology. Results: Among all 80 subjects, the prevalence of TES was 21.3% (17 of 80), the prevalence of possible CTE was 12.5% (10 of 80), and the prevalence of probable CTE was 2.5% (2 of 80). Among the 45 retired football players, the prevalence of TES was 24.4% (11 of 45) and the prevalence of possible CTE was 17.7% (8 of 45). None of the retired football players met the criteria for probable CTE. Among the 35 total retired boxers (from all 3 groups), the prevalence of TES was 17.1% (6 of 35), the prevalence of possible CTE was 5.7% (2 of 35), and the prevalence of probable CTE was 5.7% (2 of 35). Conclusion: Applying the NINDS consensus criteria to this historical cohort of living retired athletes with extensive RHI exposure resulted in a relatively low prevalence of TES and possible/probable certainties of CTE pathology, which might suggest limitations on the sensitivity of the NINDS criteria. Clinical Relevance: Physicians are often asked by retired contact sports athletes and their families to determine if their clinical picture is related to TES and/or CTE. Physicians may turn to the NINDS consensus criteria for guidance in making such determinations. The data presented here may assist physicians in evaluating the reliability and validity of using the consensus criteria in living subjects. [ABSTRACT FROM AUTHOR]

Background: Structural brain changes, potentially resulting from repetitive brain trauma (RBT), have been correlated with neurocognitive decline and increased symptom reporting in retired athletes.Hypothesis: In a cohort of retired National Football League (NFL) players, the relationships between 3 neuroimaging parameters, neuropsychological testing, and symptom scores will be significantly correlated.Study Design: Cross-sectional study.Level Of Evidence: Level 3.Methods: Comprehensive magnetic resonance imaging was performed in 45 retired NFL players. Three neuroanatomical parameters were assessed by board-certified radiologists blinded to the purpose of the study: (1) the absence or presence of small or large cavum septum pellucidum, (2) a global mean score of fractional anisotropy (FA), and (3) the presence or absence of microhemorrhages. The subjects underwent a battery of 9 paper-and-pencil neuropsychological tests, a computerized neurocognitive test, and multiple symptom and depression scales. The associations among the neuroimaging results with these outcome measures were assessed utilizing Pearson, Spearman rank, and point-biserial correlations.Results: The 45 subjects (mean age, 46.7 ± 9.1 years) reported a mean 6.9 (±6.2) concussions and 13.0 (±7.9) "dings" in the NFL. Ten (22%) did not have a cavum septum pellucidum, while 32 (71%) had a small and 3 (7%) had a large one. Four (9%) had microhemorrhages. Global FA mean was 0.459 (±0.035). The majority (50.8%) of correlations among the neuroimaging parameters and neurocognitive/symptom scores fell below the threshold of "small" effect size ( r < 0.10). The remaining (49.2%) correlations were between "small" and "medium" effect sizes (0.1 < r < 0.3). However, all correlations were statistically nonsignificant.Conclusion: There were minimal and statistically nonsignificant correlations among the neuroimaging, neurocognitive, and symptom scores examined in this cohort of NFL retirees.Clinical Relevance: Associating the severity of structural brain changes to neurocognitive performance and symptom burden after RBT is complex may involve other moderating variables or biomarkers, and demands further study. [ABSTRACT FROM AUTHOR]