Boston University Alzheimer's Disease Center and Boston University CTE Center, Boston University School of Medicine, Boston, Massachusetts.
Department of Neurology, Boston University School of Medicine, Boston, Massachusetts.
Semin Neurol. 2020 Aug;40(4):370-383. doi: 10.1055/s-0040-1713624. Epub 2020 Aug 2.
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with repetitive head impacts (RHI), such as those received in contact/collision sports, blast injury in military veterans, and domestic violence. Currently, CTE can only be diagnosed following death. Although the clinical features of former boxers have been described for almost a century, and there is increasing evidence of long-term cognitive and neuropsychiatric impairments in living former American football players, the specific clinical presentation associated with underlying CTE neuropathology remains unclear. These features include diverse and nonspecific changes in cognition, mood, behavior, and motor functioning. Currently, there are no validated and widely accepted clinical diagnostic criteria. Proposed criteria are primarily based on retrospective telephonic interviews with the next of kin of individuals who were diagnosed with CTE postmortem. Prospective studies involving individuals presumably at high risk for CTE are underway; these will hopefully clarify the clinical features and course of CTE, allow the diagnostic criteria to be refined, and lead to the development and validation of in vivo biomarkers. This article reviews what is currently known about the clinical presentation of CTE and describes the evolution of this knowledge from early case reports of "punch drunk" boxers through larger case series of neuropathologically confirmed CTE. This article concludes with a discussion of gaps in research and future directions to address these areas.
慢性创伤性脑病（CTE）是一种与反复头部冲击（RHI）相关的神经退行性疾病，例如接触/碰撞性运动、退伍军人的爆炸伤和家庭暴力中所受到的冲击。目前，CTE 只能在死亡后进行诊断。尽管拳击手的临床特征已经被描述了近一个世纪，而且越来越多的证据表明，生前的美式足球运动员存在长期的认知和神经精神损伤，但与潜在的 CTE 神经病理学相关的具体临床表现仍不清楚。这些特征包括认知、情绪、行为和运动功能的多样化和非特异性变化。目前，还没有经过验证和广泛接受的临床诊断标准。提出的标准主要基于对死后被诊断为 CTE 的个体的近亲进行电话访谈。目前正在进行涉及可能患有 CTE 高风险个体的前瞻性研究；这些研究有望阐明 CTE 的临床特征和病程，使诊断标准得到进一步完善，并导致体内生物标志物的开发和验证。本文综述了目前对 CTE 临床表现的了解，并描述了从早期拳击手“拳击醉”的个案报告到经过神经病理学证实的 CTE 更大病例系列的这方面知识的演变。本文最后讨论了研究中的差距和未来的研究方向，以解决这些领域的问题。
