Most who meet proposed CTE criteria do not show disease signs at autopsy
New research from Penn Medicine finds proposed traumatic encephalopathy syndrome criteria often don’t match CTE pathology at autopsy, raising concerns about misdiagnosis and potential mental health impacts for at-risk groups.
2 min. read
CTE, a neurodegenerative disease thought to be caused by repetitive head impacts, can only be identified after death, and therefore linking CTE to specific symptoms in living individuals has proven challenging.
Most people who met proposed clinical criteria meant to identify chronic traumatic encephalopathy (CTE) during life did not show hallmark brain changes of the disease at autopsy. The findings raise concerns that widespread clinical adoption of these criteria could lead to misdiagnosis and unintended mental health consequences for people at higher risk, including athletes and military veterans.
In a new study published in Nature Medicine, researchers from the Perelman School of Medicine have found that 75% of individuals who would be classified as having traumatic encephalopathy syndrome (TES)—a set of symptoms proposed to reflect underlying CTE—do not have the abnormal buildup of hyperphosphorylated tau (p‑tau) protein that defines CTE when their brains were examined after death. These results show that the proposed criteria may miss some people with CTE pathology while incorrectly identifying many others who do not have the disease.
“It is far more likely that someone who meets the current clinical criteria does not have CTE than that they do,” says lead author John D. Arena, chief resident in the Department of Neurosurgery and member of the Center for Brain Injury and Repair at Penn Medicine. “Until we have diagnostic tools that can reliably detect CTE neuropathology in living people, applying these criteria in clinical settings risks doing more harm than good.”
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