Performance of traumatic encephalopathy syndrome criteria in identifying individuals with chronic traumatic encephalopathy.

The discovery of chronic traumatic encephalopathy neuropathologic change (CTE-NC) in the brains of former athletes has generated an explosion in public and scientific interest. As CTE-NC can only be diagnosed postmortem, consensus diagnostic criteria have been developed for the proposed clinical correlate, that is, traumatic encephalopathy syndrome (TES). However, the diagnostic accuracy of TES criteria in predicting CTE-NC remains unproven and considerable concerns exist regarding the specificity of proposed clinical features. Here we reviewed antemortem clinical records for 1,038 cases in a neurodegenerative brain bank. Neuropathological evaluation for CTE-NC was then conducted in all cases. In total, 25 (2.4%) cases fulfilled the criteria for a diagnosis of TES, of which six demonstrated CTE-NC (positive predictive value = 24.0%, 95% confidence interval 9.4-45.1%). Of the remaining 1,013 cases, CTE-NC was present in seven (0.69%). The diagnostic accuracy of TES for CTE-NC was driven by exposure to repetitive head impacts rather than proposed clinical features. There was no difference in the prevalence of core or supportive clinical features of TES among cases with CTE-NC compared to a matched sample. The poor performance of TES criteria raises substantial concern for its potential negative psychological impact on current and former contact sport athletes, who may be incorrectly diagnosed with a progressive neurodegenerative pathology.