Validity of the 2014 Traumatic Encephalopathy Syndrome Criteria for CTE Pathology

Overview

Journal Alzheimers Dement

Specialties Neurology
Psychiatry

Date 2021 Apr 7

PMID 33826224

Citations 38

Authors

Jesse Mez

Michael L Alosco

Daniel H Daneshvar

Nicole Saltiel

Zachary Baucom

Bobak Abdolmohammadi

Madeline Uretsky

Raymond Nicks

Brett M Martin

Joseph N Palmisano

Christopher J Nowinski

Philip Montenigro

Todd M Solomon

Ian Mahar

Jonathan D Cherry

Victor E Alvarez

Brigid Dwyer

Lee E Goldstein

Douglas I Katz

Robert C Cantu

Neil W Kowall

Yorghos Tripodis

Bertrand R Huber

Thor D Stein

Robert A Stern

Ann C McKee

Affiliations

Soon will be listed here.

Abstract

Introduction: Validity of the 2014 traumatic encephalopathy syndrome (TES) criteria, proposed to diagnose chronic traumatic encephalopathy (CTE) in life, has not been assessed.

Methods: A total of 336 consecutive brain donors exposed to repetitive head impacts from contact sports, military service, and/or physical violence were included. Blinded to clinical information, neuropathologists applied National Institute on Neurological Disorders and Stroke/National Institute of Biomedical Imaging and Bioengineering CTE criteria. Blinded to neuropathological information, clinicians interviewed informants and reviewed medical records. An expert panel adjudicated TES diagnoses.

Results: A total of 309 donors were diagnosed with TES; 244 donors had CTE pathology. TES criteria demonstrated sensitivity and specificity of 0.97 and 0.21, respectively. Cognitive (odds ratio [OR] = 3.6; 95% confidence interval [CI]: 1.2-5.1), but not mood/behavior or motor symptoms, were significantly associated with CTE pathology. Having Alzheimer's disease (AD) pathology was significantly associated with reduced TES accuracy (OR = 0.27; 95% CI: 0.12-0.59).

Discussion: TES criteria provided good evidence to rule out, but limited evidence to rule in, CTE pathology. Requiring cognitive symptoms in revised criteria and using AD biomarkers may improve CTE pathology prediction.

Citing Articles

Characterizing white matter and vascular pathologies in brain donors exposed to repetitive head impacts.

Emrani S, Koutures A, Tripodis Y, Uretsky M, Abdolmohammadi B, Nowinski C Acta Neuropathol. 2025; 149(1):24.

PMID: 40047953 PMC: 11885321. DOI: 10.1007/s00401-025-02860-z.

F-MK-6240 tau PET in patients at-risk for chronic traumatic encephalopathy.

Alosco M, Mejia Perez J, Culhane J, Shankar R, Nowinski C, Bureau S Mol Neurodegener. 2025; 20(1):23.

PMID: 39994806 PMC: 11852567. DOI: 10.1186/s13024-025-00808-1.

Traumatic Brain Injury and Risk of Incident Comorbidities.

Halabi C, Izzy S, DiGiorgio A, Mills H, Radmanesh F, Yue J JAMA Netw Open. 2024; 7(12):e2450499.

PMID: 39666337 PMC: 11638795. DOI: 10.1001/jamanetworkopen.2024.50499.

Chronic Traumatic Encephalopathy, Family History of Mental Illness, and Aggression in Brain Donors With Repetitive Head Impact Exposure.

Uretsky M, Nair E, Burton R, Cronin S, Rousseau D, Tuz-Zahra F Neurology. 2024; 103(12):e210056.

PMID: 39602665 PMC: 11604107. DOI: 10.1212/WNL.0000000000210056.

Perceived Chronic Traumatic Encephalopathy and Suicidality in Former Professional Football Players.

Grashow R, Terry D, Iverson G, DiGregorio H, Dairi I, Brown C JAMA Neurol. 2024; .

PMID: 39312218 PMC: 11420824. DOI: 10.1001/jamaneurol.2024.3083.

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