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Abstract
Background and Objectives Due to current limitations in diagnosing chronic traumatic encephalopathy (CTE) clinically, traumatic encephalopathy syndrome (TES) has been proposed as the clinical presentation of suspected CTE. This study aimed to determine whether there was an association between a clinical diagnosis of TES and subsequent temporal decline in cognitive or MRI volumetric measures.
Methods This was a secondary analysis of the Professional Athletes Brain Health Study (PABHS), inclusive of active and retired professional fighters older than 34 years. All athletes were adjudicated as TES positive (TES+) or TES negative (TES−) based on the 2021 clinical criteria. General linear mixed models were used to compare MRI regional brain volumes and cognitive performance between groups.
Results A total of 130 fighters met inclusion criteria for consensus conference. Of them, 52 fighters (40%) were adjudicated as TES+. Athletes with a TES+ diagnosis were older and had significantly lower education. Statistically significant interactions and between-group total mean differences were found in all MRI volumetric measurements among the TES+ group compared with those among the TES− group. The rate of volumetric change indicated a significantly greater increase for lateral (estimate = 5,196.65; 95% CI = 2642.65, 7750.66) and inferior lateral ventricles (estimate = 354.28; 95% CI = 159.90, 548.66) and a decrease for the hippocampus (estimate = −385.04, 95% CI = −580.47, −189.62), subcortical gray matter (estimate = −4,641.08; 95% CI = −6783.98, −2498.18), total gray matter (estimate = −26492.00; 95% CI = −50402.00, −2582.32), and posterior corpus callosum (estimate = −147.98; 95% CI = −222.33, −73.62). Likewise, the rate of cognitive decline was significantly greater for reaction time (estimate = 56.31; 95% CI = 26.17, 86.45) and other standardized cognitive scores in the TES+ group.
Discussion The 2021 TES criteria clearly distinguishes group differences in the longitudinal presentation of volumetric loss in select brain regions and cognitive decline among professional fighters 35 years and older. This study suggests that a TES diagnosis may be useful in professional sports beyond football, such as boxing and mixed martial arts. These findings further suggest that the application of TES criteria may be valuable clinically in predicting cognitive decline.
Glossary
- ccTES=
- clinical criteria for traumatic encephalopathy syndrome;
- CTE=
- chronic traumatic encephalopathy;
- MMA=
- mixed martial arts;
- OR=
- odds ratio;
- PABHS=
- Professional Athletes Brain Health Study;
- PHQ-9=
- patient health questionnaire–9;
- RHI=
- repetitive head impacts;
- ROI=
- regions of interest;
- TES=
- traumatic encephalopathy syndrome
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was Associate Editor Linda Hershey, MD, PhD, FAAN.
Editorial, page 461
- Received January 3, 2023.
- Accepted in final form May 12, 2023.
- © 2023 American Academy of Neurology
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