Abstract Details

Title Validity of Traumatic Encephalopathy Syndrome Clinical Research Criteria for Chronic Traumatic Encephalopathy Pathology: The Understanding Neurologic Injury and Traumatic Encephalopathy (UNITE) Study

Topic Aging, Dementia, and Behavioral Neurology

Presentation(s) S33 - Aging and Dementia: Non-Alzheimer Dementia (3:30 PM-3:42 PM)

Poster/Presentation
Number 001

Objective

In 2014, we proposed traumatic encephalopathy syndrome (TES) criteria to diagnose chronic traumatic encephalopathy (CTE) in life. This study’s goal was to assess the validity of TES criteria using CTE pathology as the gold standard.

Background CTE is a neurodegenerative disease associated with repetitive head impact (RHI) exposure. Currently, CTE can only be diagnosed post-mortem.

Design/Methods Brain donors with contact sport play or military service were eligible. Blinded to clinical information, neuropathologists conducted comprehensive gross and microscopic brain examinations, including diagnosing CTE using published criteria. Blinded to neuropathological information, neurologists and neuropsychologists collected clinical information through family interviews and medical record review. In bi-monthly clinicopathological conferences, an expert clinical panel reviewed the clinical history and reached consensus diagnoses based on TES criteria.

Results

The sample included 302 brain donors [age range: 14 to 89 years, mean: 61.5 years (19.9 SD)]. 286 donors (92.6%) were contact sport athletes, 85 donors (29.2%) served in the military and 249 donors (87.4%) sustained 4 or more concussions. 284 donors (91.9%) were diagnosed with probable or possible CTE by the consensus panel using TES criteria. 228 donors (74.3%) had CTE pathology. TES criteria demonstrated a sensitivity of 0.97, specificity of 0.23 and accuracy of 0.78. Of 61 false positives, 37 had other neurodegenerative or vascular pathology. All 6 false negatives had mild CTE pathology (5 stage I, 1 stage II). TES criteria do not require cognitive symptoms. By augmenting the criteria to require cognitive symptoms, specificity improved (0.37) with limited reduction in sensitivity (0.90).

Conclusions Among RHI-exposed brain donors, TES criteria demonstrated high sensitivity, but low specificity for CTE pathology. Inclusion of required cognitive symptoms in TES criteria markedly improved specificity without compromising sensitivity. These results will inform revised TES criteria. Diagnosis of CTE in life is necessary for counseling patients and developing therapeutics.

Authors/Disclosures
Jesse B. Mez, MD (Boston University School of Medicine) PRESENTER	The institution of Dr. Mez has received research support from NIH, DOD.
Michael Alosco, PhD (Boston University)	The institution of Michael Alosco, PhD has received research support from NIH. The institution of Michael Alosco, PhD has received research support from Life Molecular Imaging Inc.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Yorghos Tripodis	Yorghos Tripodis has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Medical Association.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Philip H. Montenigro	No disclosure on file
	No disclosure on file
	No disclosure on file
Brigid Dwyer, MD	Dr. Dwyer has nothing to disclose.
Lee Goldstein (Neruoptix Corp)	No disclosure on file
Douglas I. Katz, MD, FAAN (Boston Medical Center)	Dr. Katz has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Law firms. The institution of Dr. Katz has received research support from NINDS/NIH. Dr. Katz has received publishing royalties from a publication relating to health care.
Neil W. Kowall, MD (Boston University Medical Campus)	Dr. Kowall has received publishing royalties from a publication relating to health care.
Robert Cantu, MD	Dr. Cantu has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Multiple law firms .
Yorghos Tripodis	Yorghos Tripodis has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Medical Association.
	No disclosure on file
Thor D. Stein, MD, PhD (VA Boston Healthcare System)	Dr. Stein has nothing to disclose.
Robert Stern, PhD (Boston University School of Medicine)	Robert Stern, PhD has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen. The institution of Robert Stern, PhD has received research support from Eisai. The institution of Robert Stern, PhD has received research support from Lilly. The institution of Robert Stern, PhD has received research support from ATRI/NIA. Robert Stern, PhD has received publishing royalties from a publication relating to health care. Robert Stern, PhD has a non-compensated relationship as a Member with NFLPA Mackey-White Committee that is relevant to AAN interests or activities.
Ann C. McKee, MD (VA Boston)	Dr. McKee has nothing to disclose.

��ɫ��

��ɫ��