Asken Breton M, Brett Benjamin L, Barr William B, Banks Sarah, Wethe Jennifer V, Dams-O'Connor Kristen, Stern Robert A, Alosco Michael L
Department of Clinical and Health Psychology, University of Florida, 1Florida Alzheimer's Disease Research Center, Gainesville, FL, USA.
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WS, USA.
Clin Neuropsychol. 2025 Jan 20:1-25. doi: 10.1080/13854046.2025.2454047.
The long-recognized association of brain injury with increased risk of dementia has undergone significant refinement and more detailed study in recent decades. Chronic traumatic encephalopathy (CTE) is a specific neurodegenerative tauopathy related to prior exposure to repetitive head impacts (RHI). We aim to contextualize CTE within a historical perspective and among emerging data which highlights the scientific and conceptual evolution of CTE-related research in parallel with the broader field of neurodegenerative disease and dementia.
We provide a narrative state-of-the-science update on CTE neuropathology, clinical manifestations, biomarkers, different types and patterns of head impact exposure relevant for CTE, and the complicated influence of neurodegenerative co-pathology on symptoms.
Now almost 20 years since the initial case report of CTE in a former American football player, the field of CTE continues evolving with increasing clarity but also several ongoing controversies. Our understanding of CTE neuropathology outpaces that of disease-specific clinical correlates or the development of in-vivo biomarkers. Diagnostic criteria for symptoms attributable to CTE are still being validated, but leveraging increasingly available biomarkers for other conditions like Alzheimer's disease may be helpful for informing the CTE differential diagnosis. As diagnostic refinement efforts advance, clinicians should provide care and/or referrals to providers best suited to treat an individual patient's clinical symptoms, many of which have evidence-based behavioral treatment options that are etiologically agnostic. Several ongoing research initiatives and the gradual accrual of gold standard clinico-pathological data will pay dividends for advancing the many existing gaps in the field of CTE.
脑损伤与痴呆风险增加之间长期以来被认可的关联在近几十年经历了显著的细化和更深入的研究。慢性创伤性脑病（CTE）是一种与先前反复头部撞击（RHI）暴露相关的特定神经退行性tau蛋白病。我们旨在将CTE置于历史背景以及新出现的数据之中，这些数据凸显了CTE相关研究在神经退行性疾病和痴呆这一更广泛领域中的科学和概念演变。
我们提供了关于CTE神经病理学、临床表现、生物标志物、与CTE相关的不同类型和模式的头部撞击暴露以及神经退行性共病对症状的复杂影响的叙述性科学现状更新。
自最初报道一名前美国橄榄球运动员患有CTE至今已近20年，CTE领域仍在不断发展，越来越清晰，但也存在一些持续的争议。我们对CTE神经病理学的理解超过了对疾病特异性临床关联或体内生物标志物的发展。归因于CTE的症状的诊断标准仍在验证中，但利用越来越多可用于阿尔茨海默病等其他病症的生物标志物可能有助于CTE的鉴别诊断。随着诊断细化工作的推进，临床医生应提供护理和/或转诊给最适合治疗个体患者临床症状的医疗服务提供者，其中许多症状有基于证据的行为治疗选择，且病因不明。一些正在进行的研究计划以及金标准临床病理数据的逐步积累将为弥合CTE领域中许多现有的差距带来益处。
