Examining the Research Criteria for Traumatic Encephalopathy Syndrome in Middle-Aged Men From the General Population Who Played Contact Sports in High School.

Grant L Iverson,Douglas P Terry,Zachary C Merz

doi:10.3389/fneur.2021.632618

Abstract

Objective: There are no validated or agreed upon diagnostic clinical criteria for chronic traumatic encephalopathy or traumatic encephalopathy syndrome. This study examines the leading research criteria for traumatic encephalopathy syndrome (TES) in middle-aged men in the general population.Method: Participants were 409 men between the ages of 35 and 55 recruited through an online crowdsourcing platform. Participants provided demographic information, medication history, concussion history, contact sport history, current medication use, and current symptoms. Research criteria for TES were applied to the sample.Results: Over half of the total sample met TES symptom criteria (56.2%), without applying the neurotrauma exposure criteria. Those with 4+ prior concussions had higher rates of meeting TES criteria compared to those with 0–3 prior concussions, but the results were not statistically significant (69.8 vs. 54.6%; χ2 = 3.58, p = 0.06). Exposure to contact sports was not related to higher rates of TES (ps ≥ 0.55). In a binary logistic regression predicting the presence of mild or greater TES, significant predictors were sleep difficulties [Odds ratio (OR) = 6.68], chronic pain (OR = 3.29), and age (OR = 1.04). Neurotrauma exposure was not a significant predictor (p = 0.66). When analyzing those with no prior concussions or contact sport histories (n = 126), 45.2% met symptom criteria for mild or greater TES; chronic pain and sleep difficulties were associated with a higher prevalence of meeting criteria for TES in this subgroup (ps < 0.001).Conclusions: Men who participated in contact sports in high school or college were not more likely to meet criteria for TES than men who participated in non-contact sports or no sports. In a multivariable model, sleep problems and chronic pain were predictive of meeting the symptom criteria for TES, but the repetitive neurotrauma exposure criterion was not a significant predictor of meeting the TES symptom criteria.

Highlights

Chronic traumatic encephalopathy (CTE) was conceptualized as a neurological syndrome associated with cumulative brain damage from a long career in boxing [1, 2]
These research criteria are being used in studies included in a $15.8M multicenter grant entitled “Diagnostics, Imaging, And Genetics Network for the Objective Study and Evaluation of Chronic Traumatic Encephalopathy”
Ten participants were excluded from all analyses because they reported experiencing a concussion within the past 1 year

Summary

Introduction

Chronic traumatic encephalopathy (CTE) was conceptualized as a neurological syndrome associated with cumulative brain damage from a long career in boxing [1, 2]. Throughout the century, it was referred to as dementia pugilistica [3,4,5,6,7] It was typically described as Parkinsonianlike in nature, with dysarthric speech, gait and coordination difficulties, and cognitive deficits [1, 2, 5]. Some authors conceptualized it as a progressive dementia and others noted that it could have a static or progressive course [1, 2, 4, 7,8,9,10,11,12,13]. These research criteria are being used in studies included in a $15.8M multicenter grant entitled “Diagnostics, Imaging, And Genetics Network for the Objective Study and Evaluation of Chronic Traumatic Encephalopathy”

Results

Discussion

Conclusion