Yes CTE Can Be Diagnosed in the Living

Well, sort of. Read on. A definitive diagnosis of CTE (a chronic, degenerative and presently uncurbable disease linked to cumulative brain trauma) is only possible during an autopsy meaning the person with the disease is dead.

But…

If a person is suspected to be living with CTE there are consensus criteria for making the diagnosis. Doctors call it Traumatic Encephalopathy Syndrome (“TES”).

Last year the National Institute For Neurological Disorders and Stroke published ‘consensus criteria’ for the diagnosis of TES. The following 4 part test was laid out:

Diagnosis of TES requires

(1) substantial exposure to repetitive head impacts from contact sports, military service, or other causes;

(2) core clinical features of cognitive impairment (in episodic memory and/or executive functioning) and/or neurobehavioral dysregulation;

(3) a progressive course; and

(4) that the clinical features are not fully accounted for by any other neurologic, psychiatric, or medical conditions

The full Abstract of the paper setting out the consensus criteria reads as follows:

Abstract

Objective: To develop evidence-informed, expert consensus research diagnostic criteria for traumatic encephalopathy syndrome (TES), the clinical disorder associated with neuropathologically diagnosed chronic traumatic encephalopathy (CTE).

Methods: A panel of 20 expert clinician-scientists in neurology, neuropsychology, psychiatry, neurosurgery, and physical medicine and rehabilitation, from 11 academic institutions, participated in a modified Delphi procedure to achieve consensus, initiated at the First National Institute of Neurological Disorders and Stroke Consensus Workshop to Define the Diagnostic Criteria for TES, April, 2019. Before consensus, panelists reviewed evidence from all published cases of CTE with neuropathologic confirmation, and they examined the predictive validity data on clinical features in relation to CTE pathology from a large clinicopathologic study (n = 298).

Results: Consensus was achieved in 4 rounds of the Delphi procedure. Diagnosis of TES requires (1) substantial exposure to repetitive head impacts (RHIs) from contact sports, military service, or other causes; (2) core clinical features of cognitive impairment (in episodic memory and/or executive functioning) and/or neurobehavioral dysregulation; (3) a progressive course; and (4) that the clinical features are not fully accounted for by any other neurologic, psychiatric, or medical conditions. For those meeting criteria for TES, functional dependence is graded on 5 levels, ranging from independent to severe dementia. A provisional level of certainty for CTE pathology is determined based on specific RHI exposure thresholds, core clinical features, functional status, and additional supportive features, including delayed onset, motor signs, and psychiatric features.

Conclusions: New consensus diagnostic criteria for TES were developed with a primary goal of facilitating future CTE research. These criteria will be revised as updated clinical and pathologic information and in vivo biomarkers become available.


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