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September 24, 2013; 81 (13) Article

Clinical presentation of chronic traumatic encephalopathy

Robert A. Stern, Daniel H. Daneshvar, Christine M. Baugh, Daniel R. Seichepine, Philip H. Montenigro, David O. Riley, Nathan G. Fritts, Julie M. Stamm, Clifford A. Robbins, Lisa McHale, Irene Simkin, Thor D. Stein, Victor E. Alvarez, Lee E. Goldstein, Andrew E. Budson, Neil W. Kowall, Christopher J. Nowinski, Robert C. Cantu, Ann C. McKee
First published August 21, 2013, DOI: https://doi.org/10.1212/WNL.0b013e3182a55f7f
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Abstract

Objective: The goal of this study was to examine the clinical presentation of chronic traumatic encephalopathy (CTE) in neuropathologically confirmed cases.

Methods: Thirty-six adult male subjects were selected from all cases of neuropathologically confirmed CTE at the Boston University Center for the Study of Traumatic Encephalopathy brain bank. Subjects were all athletes, had no comorbid neurodegenerative or motor neuron disease, and had next-of-kin informants to provide retrospective reports of the subjects' histories and clinical presentations. These interviews were conducted blind to the subjects' neuropathologic findings.

Results: A triad of cognitive, behavioral, and mood impairments was common overall, with cognitive deficits reported for almost all subjects. Three subjects were asymptomatic at the time of death. Consistent with earlier case reports of boxers, 2 relatively distinct clinical presentations emerged, with one group whose initial features developed at a younger age and involved behavioral and/or mood disturbance (n = 22), and another group whose initial presentation developed at an older age and involved cognitive impairment (n = 11).

Conclusions: This suggests there are 2 major clinical presentations of CTE, one a behavior/mood variant and the other a cognitive variant.

GLOSSARY

AD=
Alzheimer disease;
CSTE=
Center for the Study of Traumatic Encephalopathy;
CTE=
chronic traumatic encephalopathy;
p-tau=
hyperphosphorylated tau;
RBT=
repetitive brain trauma;
TBI=
traumatic brain injury

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • ↵* These authors contributed equally to this work.

  • Received March 16, 2013.
  • Accepted in final form June 18, 2013.
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