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Clinical subtypes of chronic traumatic encephalopathy: literature review and proposed research diagnostic criteria for traumatic encephalopathy syndrome
Open accessAbstract
The long-term consequences of repetitive head impacts have been described since the early 20th century. Terms such as punch drunk and dementia pugilistica were first used to describe the clinical syndromes experienced by boxers. A more generic designation, chronic traumatic encephalopathy (CTE), has been employed since the mid-1900s and has been used in recent years to describe a neurodegenerative disease found not just in boxers but in American football players, other contact sport athletes, military veterans, and others with histories of repetitive brain trauma, including concussions and subconcussive trauma. This article reviews the literature of the clinical manifestations of CTE from 202 published cases. The clinical features include impairments in mood (for example, depression and hopelessness), behavior (for example, explosivity and violence), cognition (for example, impaired memory, executive functioning, attention, and dementia), and, less commonly, motor functioning (for example, parkinsonism, ataxia, and dysarthria). We present proposed research criteria for traumatic encephalopathy syndrome (TES) which consist of four variants or subtypes (TES behavioral/mood variant, TES cognitive variant, TES mixed variant, and TES dementia) as well as classifications of 'probable CTE' and 'possible CTE'. These proposed criteria are expected to be modified and updated as new research findings become available. They are not meant to be used for a clinical diagnosis. Rather, they should be viewed as research criteria that can be employed in studies of the underlying causes, risk factors, differential diagnosis, prevention, and treatment of CTE and related disorders.
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“There are no agreed upon or validated clinical criteria for CTE, although proposed criteria have been published by Jordan [46], Victoroff [47], and Montenigro and colleagues [21].”
From The Need to Separate Chronic Traumatic Encephalopathy Neuropathology from Clinical Features (2017) · cites this paper as [21]
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“There are no agreed upon clinical criteria for diagnosis, although sets of criteria have been proposed for research purposes.”
From The Need to Separate Chronic Traumatic Encephalopathy Neuropathology from Clinical Features (2017) · cites this paper as [21]
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Self-citationMcCrory, P. R., Meeuwisse, W. H., Aubry, M., Cantu, B., Dvořák, J., Echemendía, R. J., Engebretsen, L., Johnston, K., Kutcher, J., Raftery, M., et al. (2013) · Physical Therapy in Sport · doi:10.1016/j.ptsp.2013.03.002 · Cited by 2,141
The spectrum of disease in chronic traumatic encephalopathy
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Blennow, K., Brody, D. L., Kochanek, P. M., Levin, H. S., McKee, A. C., Ribbers, G. M., Yaffe, K. S., & Zetterberg, H. (2016) · Nature Reviews Disease Primers · doi:10.1038/nrdp.2016.84 · Cited by 693
A systematic review of potential long-term effects of sport-related concussion.
Manley, G., Gardner, A. J., Schneider, K. J., Guskiewicz, K. M., Bailes, J., Cantu, R. C., Castellani, R. J., Turner, M., Jordan, B. D., Randolph, C., et al. (2017) · British Journal of Sports Medicine · doi:10.1136/bjsports-2017-097791 · Cited by 663
Self-citationThe Neuropathology of Chronic Traumatic Encephalopathy
McKee, A. C., Stein, T. D., Kiernan, P. T., & Alvarez, V. E. (2015) · Brain Pathology · doi:10.1111/bpa.12248 · Cited by 585
Mental Health Consequences of Traumatic Brain Injury
Howlett, J. R., Nelson, L. D., & Stein, M. B. (2022) · Biological Psychiatry · doi:10.1016/j.biopsych.2021.09.024 · Cited by 389
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Metadata
- Authors
- Montenigro, P. H., Baugh, C. M., Daneshvar, D. H., Mez, J., Budson, A. E., Au, R., Katz, D. I., Cantu, R. C., & Stern, R. A.
- Affiliations
- Boston University (US)
- Corresponding author
- Stern, Robert A
- ORCID
- Venue
- Alzheimer's Research & Therapy
- Published
- 2014-09-24
- Volume
- 6
- Issue
- 5-8
- Pages
- 68-68
- ISSN
- 1758-9193 (ISSN-L)
- PMC
- PMC4288217
- OpenAlex
- W2156511539
- Cited by
- 375
- References
- 68
- Citations by year
- 2026: 15 · 2025: 39 · 2024: 39 · 2023: 32 · 2022: 32 · 2021: 43 · 2020: 30 · 2019: 43 · 2018: 29 · 2017: 30 · 2016: 20 · 2015: 20 · 2014: 3
- FWCI
- 3.25
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Alzheimer s Research & Therapy (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Defense (W81XWH, W81XWH-13-2-, W81XWH1320064, W81XWH-13)
- U.S. Department of Veterans Affairs (AG13846, P30 AG13846)
- National Institutes of Health (W81XWH, AG13846)
- Defense Advanced Research Projects Agency (BAA-11-65)
- National Institute on Aging (P30AG013846, R01AG008122)
- National Cancer Institute (R01CA129769)
- National Institute of Neurological Disorders and Stroke (U01NS086659)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Physical Sciences › Engineering › Biomedical Engineering › Automotive and Human Injury Biomechanics
- Keywords
- chronic traumatic encephalopathy, traumatic encephalopathy syndrome, clinical subtypes, Research Diagnostic Criteria, repetitive head impacts, concussion, boxers, American football players, military veterans, cognitive impairment, parkinsonism, neurodegenerative diseases
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