Clinical subtypes of chronic traumatic encephalopathy: literature review and proposed research diagnostic criteria for traumatic encephalopathy syndrome

Montenigro, Philip H; Baugh, Christine M; Daneshvar, Daniel H; Mez, Jesse; Budson, Andrew E; Au, Rhoda; Katz, Douglas I; Cantu, Robert C; Stern, Robert A

doi:10.1186/s13195-014-0068-z

Alzheimer's Research & Therapy

Table 1 Summary of published cases describing the clinical features of chronic traumatic encephalopathy

From: Clinical subtypes of chronic traumatic encephalopathy: literature review and proposed research diagnostic criteria for traumatic encephalopathy syndrome

		Clinical features
Study	Sample	Behavioral	Mood	Cognition	Motor
Study	(total n = 202)	Behavioral	Mood	Cognition	Motor
Parker [16] (1934)	Boxers (n = 3)	Social	Anxiety	Reduced intelligence	Ataxia
		inappropriateness	Labile emotions	Memory impairment	Clonus
		Childish behavior	Fatigue	Impaired attention	Dragging gait
				Visuospatial difficulties	Dysarthria
					Muscle weakness
					Spasticity
					Tremor
Herzog [42] (1938)	Boxers (n = 7)	Boastfulness	Apathy	General cognitive impairment	Dysarthria
		Personality changes	Flat affect	Memory difficulties	Masked facies
		Impulsiveness		Perseveration	Shuffling gait
		Loss of control		Language difficulties	Truncal ataxia
				Alogia
				Dementia
Knoll et al. [43] (1938)	Boxers (n = 3)	Personality changes	Apathy	General cognitive impairment	Ataxia
			Flat affect	Memory impairment	Dysarthria
			Loss of interest	Visuospatial difficulties	Masked facies
			Prolix	Alogia
			Prolix	Dementia
Jokl [31] (1941) and Jokl and Guttmann [32] (1933)	Boxers (n = 3)	Boastfulness	Apathy	Reduced intelligence	Ataxia
		Childish behavior	Depression	Executive dysfunction	Dysarthria
		Paranoid delusions	Euphoria	Memory impairment	Masked facies
		Personality changes	Fatigue	Impaired attention	Muscle weakness
		Physical violence	Flat affect	Altered concentration	Shuffling gait
		Psychosis	Insomnia	Language difficulties	Tremor
		Short fuse	Irritability	Dysgraphia	Unsteady gait
		Explosivity	Labile emotions	Visuospatial difficulties
		Social inappropriateness	Loss of interest
		Verbal violence	Mania
			Mood swings
Schwarz [44] (1953)	Boxers (n = 3)	Personality changes	Fearfulness	Memory impairment	Ataxia
		Short fuse	Irritability	Altered concentration	Dysarthria
		Explosivity	Labile emotions	Language difficulties	Masked facies
					Muscle weakness
					Stamping gait
					Tremor
					Unsteady Gait
Soeder and Arndt [45] (1954)	Boxers (n = 5)	Boastfulness	Apathy	General cognitive impairment	Clonus
		Disinhibited behavior	Depressed mood	Executive dysfunction	Dysarthria
		Inappropriate speech	Euphoria	Memory impairment	Masked facies
		Paranoia	Fatigue	Impaired attention	Rolling gait
		Personality changes	Flat affect	Altered concentration	Tremor
		Physical violence	Insomnia	Language difficulties	Truncal ataxia
		Psychosis	Mania	Alogia	Unsteady gait
		Short fuse	Mood swings
		Explosivity	Prolix
		Social inappropriateness
Grahmann and Ule [33] (1957)	Boxers (n = 4)	Childish behavior	Apathy	General cognitive impairment	Dysarthria
	Confirmed CTE (1)	Disinhibited behavior	Depressed	Executive dysfunction	Swaying gait
		Disinhibited speech	Euphoria	Memory impairment	Masked facies
		Impulsivity	Labile emotions	Impaired attention
		Loss of control	Fatigue	Altered concentration
		Physical violence	Flat affect	Dementia
		Personality changes	Irritable
		Short fuse	Mood swings
		Explosivity	Prolix
		Social inappropriateness
Muller [46] (1958)	Boxers (n = 3)	Social isolation	Fatigue	General cognitive impairment	Dysarthria
		Personality changes	Irritability	Executive dysfunction	Unsteady gait
		Lack of insight		Impaired attention	Spastic gait
				Memory impairment
				Altered concentration
				Dementia
Spillane [47] (1962)	Boxers (n = 5)	Childish behavior	Anxiety	General cognitive impairment	Ataxia
		Disinhibited behavior	Depressed mood	Reduced intelligence	Dysarthria
		Impulsivity	Euphoria	Memory impairment	Dragging gait
			Mania	Visuospatial difficulties	Muscle weakness
			Payne mood swings	Dysgraphia	Tremor
				Lack of insight	Unsteady gait
				Dementia
Mawdsley and Ferguson [22] (1963)	Boxers (n = 10)	Impulsivity	Apathy	General cognitive impairment	Ataxia
		Loss of control	Depression	Reduced intelligence	Dysarthria
		Physical violence	Insomnia	Memory impairment	Dragging gait
		Psychosis	Irritability	Language difficulties	Masked facies
		Paranoid delusions		Dysgraphia	Muscle weakness
		Personality changes		Dementia	Tremor
		Short fuse			Unsteady gait
		Explosivity
		Social inappropriateness
		Verbal violence
Critchley [23-25] (1949, 1957, 1964)	Boxers (n = 17)	Disinhibited speech	Depressed	General cognitive impairment	Ataxia
		Disinhibited behavior	Labile emotions	Reduced intelligence	Clumsy
		Impulsivity	Euphoria	Memory impairment	Dysarthria
		Lack of insight	Insomnia	Impaired attention	Masked facies
		Physical violence	Irritable	Altered concentration	Muscle weakness
		Personality changes	Loss of interest	Visuospatial difficulties	Tremor
		Social inappropriateness	Fatigue	Dementia	Unsteady gait
		Short fuse	Fatigue	Dementia	Unsteady gait
Payne [48] (1968)	Boxers (n = 6)	Disinhibited behavior	Depressed mood	General cognitive impairment	Ataxia
		Impulsivity	Labile emotions	Reduced intelligence	Dysarthria
		Paranoid delusions	Insomnia	Altered concentration	Unsteady gait
		Physical violence	Mania	Visuospatial difficulties
		Psychotic	Mood swings	Memory impairment
		Verbal violence	Suicidal ideation
Johnson [26] (1969)	Boxers (n = 17)	Loss of control	Anxiety	General cognitive impairment	Ataxia
		Paranoid delusions	Labile emotions	Reduced intelligence	Dysarthria
		Personality changes	Irritability	Memory impairment	Tremor
		Psychotic		Dementia	Dragging gait
		Short fuse			Masked facies
		Explosivity			Muscle weakness
		Verbal violence
Roberts [49] (1969)	Boxers (n = 11)	Lack of insight	Apathy	Reduced intelligence	Ataxia
		Paranoid delusions	Depression	Executive dysfunction	Dysarthria
		Psychosis	Euphoria	Memory impairment	Dragging gait
		Short fuse	Flat affect	Perseveration	Masked facies
		Explosivity	Labile emotions	Impaired attention	Muscle weakness
				Altered concentration	Shuffling gait
				Language difficulties	Spasticity
				Dysgraphia	Tremor
				Visuospatial difficulties	Unsteady gait
				Dementia
Corsellis et al. [50] (1973)	Boxers (n = 13) Confirmed CTE (13)	Childish behavior	Anxiety	General cognitive impairment	Ataxia
		Paranoid delusions	Labile emotions	Reduced intelligence	Dysarthria
		Personality changes	Irritability	Memory impairment	Masked facies
		Short fuse		Dementia	Muscle weakness
		Explosivity			Tremor
		Social inappropriateness			Staggering gait
		Social isolation			Shuffling gait
		Verbal violence			Unsteady gait
Sabharwal et al. [51] (1987)	Boxers (n = 4)	Inappropriate speech	Depression	Reduced intelligence	Ataxia
			Irritability	Memory impairment	Spasticity
			Labile emotions		Dysarthria
			Mood swings
Jordan et al. [52] (1997)	Boxers (n = 19)	Disinhibited speech	Depression	Impaired attention	Ataxia
		Disinhibited behavior	Irritability	Altered concentration	Clonus
			Flat affect	Memory impairment	Dysarthria
			Mania		Spasticity
					Tremor
					Unsteady gait
Omalu et al. [29,53,54] (2005, 2006, 2010)	Football and wrestling (n = 5)	Paranoid delusions	Suicidality	General cognitive impairment	-
		Social isolation	Anxiety	Memory impairment
		Physical violence	Labile emotions	Language difficulties
	Confirmed CTE (5)		Irritability	Executive dysfunction
			Insomnia	Impaired attention
			Depression
Mckee et al. [2] (2013)	Boxing, American football, ice hockey, wrestling (n = 64)	Explosivity	Depression	Memory impairment	Dysarthria
		Aggression	Hopelessness	Executive dysfunction	Gait disturbance
		Impulsivity	Suicidality	Impaired attention	Parkinsonism
		Paranoia	Mood swings	Language difficulties
				Visuospatial difficulties
				Dementia
	Confirmed CTE (64)			Dementia

CTE, chronic traumatic encephalopathy.

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