TY - JOUR
T1 - National Institute of Neurological Disorders and Stroke Consensus Diagnostic Criteria for Traumatic Encephalopathy Syndrome
AU - Katz, Douglas I.
AU - Bernick, Charles
AU - Dodick, David W.
AU - Mez, Jesse
AU - Mariani, Megan L.
AU - Adler, Charles H.
AU - Alosco, Michael L.
AU - Balcer, Laura J.
AU - Banks, Sarah J.
AU - Barr, William B.
AU - Brody, David L.
AU - Cantu, Robert C.
AU - Dams-O'connor, Kristen
AU - Geda, Yonas E.
AU - Jordan, Barry D.
AU - Mcallister, Thomas W.
AU - Peskind, Elaine R.
AU - Petersen, Ronald C.
AU - Wethe, Jennifer V.
AU - Zafonte, Ross D.
AU - Foley, Éimear M.
AU - Babcock, Debra J.
AU - Koroshetz, Walter J.
AU - Tripodis, Yorghos
AU - Mckee, Ann C.
AU - Shenton, Martha E.
AU - Cummings, Jeffrey L.
AU - Reiman, Eric M.
AU - Stern, Robert A.
N1 - Funding Information:
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with exposure to repetitive head impacts (RHIs), including those sustained in contact and collision sports. The diagnosis of CTE is confirmed only by neuropathologic examination demonstrating a unique pattern of hyperphosphorylated tau (p-tau) deposition. Descriptions of the clinical features of CTE are based on retrospective reports about deceased individuals with neuropathologically diagnosed CTE and include nonspecific cognitive, neuropsychiatric, and motor impairments, progressing to functional dependence and dementia. Preliminary diagnostic schemas for the clinical syndrome associated with CTE neuropathology have recognized deficiencies. These include the 2014 research diagnostic criteria, termed traumatic encephalopathy syndrome (TES). There is a need for evidence-informed, expert consensus diagnostic criteria to facilitate research and help close important knowledge gaps on the epidemiology, risk factors, and course of CTE, as well as to enable clinical trials for treatment and prevention. The development of consensus diagnostic criteria for the clinical features of CTE is one of the aims of the Diagnostics, Imaging, and Genetics Network for the Objective Study and Evaluation of CTE (DIAGNOSE CTE) Research Project, funded by the National Institute of Neurological Disorders and Stroke (NINDS; U01NS093334). In April 2019, the First NINDS Consensus Workshop to Define the Diagnostic Criteria for TES was held in Phoenix, AZ, for a multidisciplinary panel of 20 clinician-scientists and 7 observers, initiating a modified Delphi process to achieve consensus. This article describes the methodology used and the resulting NINDS Consensus Diagnostic Criteria for TES. , ,
Publisher Copyright:
© 2021 American Academy of Neurology.
PY - 2021/5/4
Y1 - 2021/5/4
N2 - Objective: To develop evidence-informed, expert consensus research diagnostic criteria for traumatic encephalopathy syndrome (TES), the clinical disorder associated with neuropathologically diagnosed chronic traumatic encephalopathy (CTE). Methods: A panel of 20 expert clinician-scientists in neurology, neuropsychology, psychiatry, neurosurgery, and physical medicine and rehabilitation, from 11 academic institutions, participated in a modified Delphi procedure to achieve consensus, initiated at the First National Institute of Neurological Disorders and Stroke Consensus Workshop to Define the Diagnostic Criteria for TES, April, 2019. Before consensus, panelists reviewed evidence from all published cases of CTE with neuropathologic confirmation, and they examined the predictive validity data on clinical features in relation to CTE pathology from a large clinicopathologic study (n = 298). Results: Consensus was achieved in 4 rounds of the Delphi procedure. Diagnosis of TES requires (1) substantial exposure to repetitive head impacts (RHIs) from contact sports, military service, or other causes; (2) core clinical features of cognitive impairment (in episodic memory and/or executive functioning) and/or neurobehavioral dysregulation; (3) a progressive course; and (4) that the clinical features are not fully accounted for by any other neurologic, psychiatric, or medical conditions. For those meeting criteria for TES, functional dependence is graded on 5 levels, ranging from independent to severe dementia. A provisional level of certainty for CTE pathology is determined based on specific RHI exposure thresholds, core clinical features, functional status, and additional supportive features, including delayed onset, motor signs, and psychiatric features. Conclusions: New consensus diagnostic criteria for TES were developed with a primary goal of facilitating future CTE research. These criteria will be revised as updated clinical and pathologic information and in vivo biomarkers become available.
AB - Objective: To develop evidence-informed, expert consensus research diagnostic criteria for traumatic encephalopathy syndrome (TES), the clinical disorder associated with neuropathologically diagnosed chronic traumatic encephalopathy (CTE). Methods: A panel of 20 expert clinician-scientists in neurology, neuropsychology, psychiatry, neurosurgery, and physical medicine and rehabilitation, from 11 academic institutions, participated in a modified Delphi procedure to achieve consensus, initiated at the First National Institute of Neurological Disorders and Stroke Consensus Workshop to Define the Diagnostic Criteria for TES, April, 2019. Before consensus, panelists reviewed evidence from all published cases of CTE with neuropathologic confirmation, and they examined the predictive validity data on clinical features in relation to CTE pathology from a large clinicopathologic study (n = 298). Results: Consensus was achieved in 4 rounds of the Delphi procedure. Diagnosis of TES requires (1) substantial exposure to repetitive head impacts (RHIs) from contact sports, military service, or other causes; (2) core clinical features of cognitive impairment (in episodic memory and/or executive functioning) and/or neurobehavioral dysregulation; (3) a progressive course; and (4) that the clinical features are not fully accounted for by any other neurologic, psychiatric, or medical conditions. For those meeting criteria for TES, functional dependence is graded on 5 levels, ranging from independent to severe dementia. A provisional level of certainty for CTE pathology is determined based on specific RHI exposure thresholds, core clinical features, functional status, and additional supportive features, including delayed onset, motor signs, and psychiatric features. Conclusions: New consensus diagnostic criteria for TES were developed with a primary goal of facilitating future CTE research. These criteria will be revised as updated clinical and pathologic information and in vivo biomarkers become available.
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U2 - 10.1212/WNL.0000000000011850
DO - 10.1212/WNL.0000000000011850
M3 - Review article
C2 - 33722990
AN - SCOPUS:85103621481
SN - 0028-3878
VL - 96
SP - 848
EP - 863
JO - Neurology
JF - Neurology
IS - 18
ER -