Chronic traumatic encephalopathy is a common co-morbidity, but less frequent primary dementia in former soccer and rugby players

Lee, E. B., Kinch, K., Johnson, V. E., Trojanowski, J. Q., Smith, D. H. and Stewart, W. (2019) Chronic traumatic encephalopathy is a common co-morbidity, but less frequent primary dementia in former soccer and rugby players. Acta Neuropathologica, 138(3), pp. 389-399. (doi: 10.1007/s00401-019-02030-y) (PMID:31152201) (PMCID:PMC6689293)

Abstract

Chronic traumatic encephalopathy (CTE) is reported at high prevalence in selected autopsy case series of former contact sports athletes. Nevertheless, the contribution of CTE pathology to clinical presentation and its interaction with co-morbid neurodegenerative pathologies remain unclear. To address these issues, we performed comprehensive neuropathology assessments on the brains of former athletes with dementia and considered these findings together with detailed clinical histories to derive an integrated clinicopathological diagnosis for each case. Consecutive, autopsy-acquired brains from former soccer and rugby players with dementia were assessed for neurodegenerative pathologies using established and preliminary consensus protocols. Thereafter, next of kin interviews were conducted to obtain detailed accounts of the patient’s clinical presentation and course of disease to inform a final, integrated clinicopathological diagnosis. Neuropathologic change consistent with CTE (CTE-NC) was confirmed in five of seven former soccer and three of four former rugby players’ brains, invariably in combination with mixed, often multiple neurodegenerative pathologies. However, in just three cases was the integrated dementia diagnosis consistent with CTE, the remainder having alternate diagnoses, with the most frequent integrated diagnosis Alzheimer’s disease (AD) (four cases; one as mixed AD and vascular dementia). This consecutive autopsy series identifies neuropathologic change consistent with preliminary diagnostic criteria for CTE (CTE-NC) in a high proportion of former soccer and rugby players dying with dementia. However, in the majority, CTE-NC appears as a co-morbidity rather than the primary, dementia causing pathology. As such, we suggest that while CTE-NC might be common in former athletes with dementia, in many cases its clinical significance remains uncertain.

• Item Type: Articles
• Additional Information: This work is supported by funding from: the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under award numbers R01NS092398, R01NS094003 and R01NS038104; The Football Association and Professional Footballers Association (WS); and an NHS Research Scotland Career Researcher Fellowship (WS).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Stewart, Dr William and Kinch, Dr Kevin
• Authors: Lee, E. B., Kinch, K., Johnson, V. E., Trojanowski, J. Q., Smith, D. H., and Stewart, W.
• College/School: College of Medical Veterinary and Life Sciences > School of Psychology & Neuroscience
• Journal Name: Acta Neuropathologica
• Publisher: Springer
• ISSN: 0001-6322
• ISSN (Online): 1432-0533
• Published Online: 01 June 2019
• Copyright Holders: Copyright © 2019 The Authors
• First Published: First published in Acta Neuropathologica 138(3):389-399
• Publisher Policy: Reproduced under a Creative Commons License