Clinical presentation of chronic traumatic encephalopathy

and Department of Neurosurgery (R.C.C.), Emerson Hospital, Concord, MA.
Neurology (Impact Factor: 8.29). 08/2013; 81(13). DOI: 10.1212/WNL.0b013e3182a55f7f
Source: PubMed


The goal of this study was to examine the clinical presentation of chronic traumatic encephalopathy (CTE) in neuropathologically confirmed cases.
Thirty-six adult male subjects were selected from all cases of neuropathologically confirmed CTE at the Boston University Center for the Study of Traumatic Encephalopathy brain bank. Subjects were all athletes, had no comorbid neurodegenerative or motor neuron disease, and had next-of-kin informants to provide retrospective reports of the subjects' histories and clinical presentations. These interviews were conducted blind to the subjects' neuropathologic findings.
A triad of cognitive, behavioral, and mood impairments was common overall, with cognitive deficits reported for almost all subjects. Three subjects were asymptomatic at the time of death. Consistent with earlier case reports of boxers, 2 relatively distinct clinical presentations emerged, with one group whose initial features developed at a younger age and involved behavioral and/or mood disturbance (n = 22), and another group whose initial presentation developed at an older age and involved cognitive impairment (n = 11).
This suggests there are 2 major clinical presentations of CTE, one a behavior/mood variant and the other a cognitive variant.

Download full-text


Available from: Christine Baugh, Aug 25, 2014
  • Source
    • "The concomitant CTE-tau pathology in the hippocampus may have contributed to the cognitive decline. Clinical presentations of CTE in older individuals may be indistinguishable from AD with episodic memory impairment and executive dysfunction being more common than behavioural or mood changes [26]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: We report the case of a 75-year-old ex-professional boxer who developed diplopia and eye movement abnormalities in his 60's followed by memory impairment, low mood and recurrent falls. Examination shortly before death revealed hypomimia, dysarthria, vertical supranuclear gaze palsy and impaired postural reflexes. Pathological examination demonstrated 4-repeat tau neuronal and glial lesions, including tufted astrocytes, consistent with a diagnosis of progressive supranuclear palsy. In addition, neurofibrillary tangles composed of mixed 3-repeat and 4-repeat tau and astrocytic tangles in a distribution highly suggestive of chronic traumatic encephalopathy were observed together with limbic TDP-43 pathology. Possible mechanisms for the co-occurrence of these two tau pathologies are discussed.
    02/2014; 2(1):24. DOI:10.1186/2051-5960-2-24
  • Source
    • "Likewise, adolescent mice exposed to 5–10 head impacts display depression-and anxiety-like behaviors 30 days after treatment. These results are consistent with findings of psychiatric conditions, to include affective disorders, in amateur (Kontos et al. 2012) and former professional athletes (Guskiewicz et al. 2007a; Stern et al. 2013) and make our method highly relevant as a model of sports-related rmTBI. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Sports-related head impact and injury has become a very highly contentious public health and medico-legal issue. Near-daily news accounts describe the travails of concussed athletes as they struggle with depression, sleep disorders, mood swings and cognitive problems. Some of these individuals have developed chronic traumatic encephalopathy, a progressive and debilitating neurodegenerative disorder. Animal models have always been an integral part of the study of traumatic brain injury in humans but, historically, they have concentrated on acute, severe brain injuries. This review will describe a small number of new and emerging animal models of sports-related head injury that have the potential to increase our understanding of how multiple mild head impacts, starting in adolescence, can have serious psychiatric, cognitive and histopathological outcomes much later in life. This article is protected by copyright. All rights reserved.
    Journal of Neurochemistry 02/2014; 129(6). DOI:10.1111/jnc.12690 · 4.28 Impact Factor
  • Source
    • "McKee et al. 2009, 2013 and Stern et al. 2013 Angry, verbally aggressive/aggressive outbursts, emotionally labile, alcohol abuse, agitated, paranoid, mood swings, restlessness, apathetic, socially withdrawn, irritable, sometimes violently agitated, anxiety, " downward spiral of depression and substance abuse " , chronic pain, impulsive behavior, explosivity, suicidal/'moderate suicidality', mild depression, PTSD. Cognitive Features Lacks insight, poor memory, demented, slowed thinking, inability to register, disoriented to time & place, cognitively intact Omalu et al. 2010a, 2011b Impairments in memory, attention, & executive functions, poor judgment McKee et al. 2009, 2013 and Stern et al. 2013 Minor to severe impairments in learning, memory, attention, concentration, organization, planning, problem-solving, judgment, multi-tasking, language, visuospatial abilities Physical and Motor Features Dysarthria, slowed speech, movement difficulties ('unsteady on feet'), resting tremor, intention tremor, akinetic, ataxia, unsteady gait, drag left foot, falls Omalu et al. 2010a, 2011b Parkinsonian symptoms McKee et al. 2009, 2013 and Stern et al. 2013 Unsteady gait, falls, headaches, pain, severe swallowing difficulties, diminished upgaze, masked facies, garbled speech, slow shuffling gait, dysarthric speech All cognitive features of modern CTE were by retrospective study. Select cases presented in these two studies were also presented in the paper by McKee et al. (2009) CTE chronic traumatic encephalopathy; PTSD post-traumatic stress disorder "
    [Show abstract] [Hide abstract]
    ABSTRACT: It has been theorized that a career in contact sports may be associated with long-term neurodegenerative changes. This idea dates as far back as the 1920s, was initially reported in boxers, colloquially termed 'punch drunk,' later more formally termed dementia pugilistica (DP), and now coined chronic traumatic encephalopathy (CTE). Despite considerable ongoing interest on this topic, there is so far only limited evidence showing an association between sport-related concussion (SRC) and increased risk for late-life cognitive and neuropsychiatric impairment, with no causality or risk factors yet determined. The modern CTE description is nevertheless proposed as a unique tauopathy with characteristic pathological stages occurring in retired athletes who have experienced previous repetitive brain trauma. This review highlights the principal issues that so far preclude firm conclusions about the association of athletic head trauma and neurodegenerative diseases of any type. We consider alternative interpretations that may contribute to the clinical progressive neurological findings in some athletes and recommend carefully-controlled epidemiological work to overcome current limitations in this area of research and stimulate future research.
    Neuropsychology Review 11/2013; 23(4). DOI:10.1007/s11065-013-9243-4 · 4.59 Impact Factor
Show more