Memory and executive function symptoms more accurate for predicting CTE than mood, behavior

Apr 07, 2021

Diagnosing chronic traumatic encephalopathy during life is crucial for developing therapies and for determining how common the disease is among individuals exposed to repetitive head impacts from contact sports, military service, and physical violence.

While the ability to diagnose chronic traumatic encephalopathy prior to death has remained elusive, researchers from Boston University School of Medicine (BUSM) for the first time have shown that progressive memory loss and issues with executive function, the ability to focus, follow directions, and problem-solve, are more useful for predicting chronic traumatic encephalopathy pathology than mood and behavior symptoms.

Chronic traumatic encephalopathy is a progressive brain disease. Clinically, impulsivity, explosivity, depression, memory impairment, and executive dysfunction have been reported to occur in the disease.

"This study significantly advances our understanding of how to diagnose chronic traumatic encephalopathy in life, suggesting progressive memory and executive function symptoms are particularly valuable for predicting chronic traumatic encephalopathy pathology," explained corresponding author Jesse Mez MD MS, director of the Boston University (BU) Alzheimer's Disease Center Clinical Core and a BU Chronic Traumatic Encephalopathy Center Investigator.

In 2014, criteria for traumatic encephalopathy syndrome were proposed for use in clinical research settings to diagnose chronic traumatic encephalopathy in life. In an effort to assess the reliability and diagnostic validity of traumatic encephalopathy syndrome criteria, a team of clinicians interviewed family members of 336 brain donors exposed to repetitive head impacts from contact sports, military service, or physical violence who were at risk for chronic traumatic encephalopathy. Neuropathologists then evaluated the brains for chronic traumatic encephalopathy pathology. An expert panel of clinicians then determined whether (traumatic encephalopathy syndrome) criteria (ie, proposed criteria to diagnose chronic traumatic encephalopathy in life) were met. They found when individual traumatic encephalopathy syndrome criteria components were assessed, cognitive symptoms but not mood/behavior or motor symptoms were significantly associated with chronic traumatic encephalopathy pathology.

According to Mez, this study moves the field closer to being able to diagnose chronic traumatic encephalopathy in life rather than exclusively after death, as is currently the case. "Our study provides doctors with information about which symptoms are most predictive of chronic traumatic encephalopathy pathology," he adds.

While having reliable and valid criteria to diagnose chronic traumatic encephalopathy in life will improve patient care and accelerate the development of effective therapies, Mez points out that the criteria did not perform well enough to be immediately moved to the clinic. However, these findings were used by an international team of experts to develop improved traumatic encephalopathy syndrome criteria.

Source: News Release
Boston University School of Medicine
April 7, 2021