Abstract
Traumatic encephalopathy syndrome (TES) is proposed to represent the long-term impact of repetitive head-injury exposure and the clinical manifestation of chronic traumatic encephalopathy (CTE). This study aimed to evaluate the frequency of TES in a cohort of retired professional contact sport athletes, compare the frequency of TES to clinical consensus diagnoses, and identify predictors that increase the likelihood of TES diagnosis. Participants were 85 retired professional contact sport athletes from a prospective cohort at the University of Texas Southwestern Medical Center and the University of Texas at Dallas. Participants ranged in age from 23 to 79 (M = 55.95, SD = 13.82) and obtained 7 to 19 years of education (M = 16.08, SD = 1.03). Retirees were either non-Hispanic white (n = 62) or African-American (n = 23). Retired athletes underwent a standard clinical evaluation, which included a clinical interview, neurological exam, neuroimaging, neuropsychological testing, and consensus diagnosis of normal, mild cognitive impairment, or dementia. TES criteria were applied to all 85 athletes, and frequencies of diagnoses were compared. Fourteen predictors of TES diagnosis were evaluated using binary logistic regressions, and included demographic, neuropsychological, depression symptoms, and head-injury exposure variables. A high frequency (56%) of TES was observed among this cohort of retired athletes, but 54% of those meeting criteria for TES were diagnosed as cognitively normal via consensus diagnosis. Games played in the National Football League (OR = 0.993, p = 0.087), number of concussions (OR = 1.020, p = 0.532), number of concussions with loss of consciousness (OR = 1.141 p = 0.188), and years playing professionally (OR = 0.976, p = 0.627) were not associated with TES diagnosis. Degree of depressive symptomatology, as measured by the total score on the Beck Depression Inventory-II, was the only predictor of TES diagnosis (OR = 1.297, p < 0.001). Our results add to previous findings underscoring the risk for false positive diagnosis, highlight the limitations of the TES criteria in clinical and research settings, and question the relationship between TES and head-injury exposure. Future research is needed to examine depression in retired professional athletes.
Highlights
In recent years, the long-term impact of sports-related concussion has gathered a great deal of scientific and publichealth interest, in part due to the identification of chronic traumatic encephalopathy (CTE) among former National Football League (NFL) players and other professional athletes
In 2014, Montenigro et al proposed research diagnostic criteria for Traumatic Encephalopathy Syndrome (TES), which aimed to represent the clinical manifestation of CTE and chronic post-concussive deficits [6]
This study aimed to evaluate the frequency of TES diagnoses and TES symptoms collected prospectively in a cohort of retired professional athletes with head-injury exposure, compared the frequency of TES diagnoses to clinical consensus diagnoses, and evaluated predictors of TES diagnosis
Summary
The long-term impact of sports-related concussion has gathered a great deal of scientific and publichealth interest, in part due to the identification of chronic traumatic encephalopathy (CTE) among former National Football League (NFL) players and other professional athletes. In 2014, Montenigro et al proposed research diagnostic criteria for Traumatic Encephalopathy Syndrome (TES), which aimed to represent the clinical manifestation of CTE and chronic post-concussive deficits [6]. These criteria were derived from a comprehensive literature review of available case series among athletes with possible CTE using Jordan’s et al criteria [8]. Supportive features were selected from a literature review which identified in total 56 possible clinical features of CTE, but a more specific quantification and justification for the inclusion of these nine supportive features in the TES diagnostic criteria was not reported [6]. The authors noted the selection of TES criteria was meant to favor sensitivity of the clinical features of CTE rather than specificity, and would be refined in further study
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