The long-term consequences of repetitive head impacts have been described since the early 20th century. Terms\nsuch as punch drunk and dementia pugilistica were first used to describe the clinical syndromes experienced by\nboxers. A more generic designation, chronic traumatic encephalopathy (CTE), has been employed since the mid-1900s\nand has been used in recent years to describe a neurodegenerative disease found not just in boxers but in American\nfootball players, other contact sport athletes, military veterans, and others with histories of repetitive brain trauma,\nincluding concussions and subconcussive trauma. This article reviews the literature of the clinical manifestations\nof CTE from 202 published cases. The clinical features include impairments in mood (for example, depression\nand hopelessness), behavior (for example, explosivity and violence), cognition (for example, impaired memory,\nexecutive functioning, attention, and dementia), and, less commonly, motor functioning (for example, parkinsonism,\nataxia, and dysarthria). We present proposed research criteria for traumatic encephalopathy syndrome (TES) which\nconsist of four variants or subtypes (TES behavioral/mood variant, TES cognitive variant, TES mixed variant, and TES\ndementia) as well as classifications of ââ?¬Ë?probable CTEââ?¬â?¢ and ââ?¬Ë?possible CTEââ?¬â?¢. These proposed criteria are expected to be\nmodified and updated as new research findings become available. They are not meant to be used for a clinical\ndiagnosis. Rather, they should be viewed as research criteria that can be employed in studies of the underlying\ncauses, risk factors, differential diagnosis, prevention, and treatment of CTE and related disorders.
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