Blake and I discuss the symptoms of TES/CTE and what is necessary to meet the criteria used to diagnose a patient with TES or CTE. This condition is a result of multiple mild traumatic brain injuries or one or more moderate/severe TBIs. We discuss the use of biological biomarkers, cognitive, behavioral, and emotional symptoms, and the clinical course necessary to receive the diagnosis and the long term effects of TES/CTE.
The criteria to be diagnosed with Traumatic Encephalopathic Syndrome aka TES includes:
1. History of RHI (Repetitive Head Injury) may or may NOT result in TBI, at least 1 of 5 of the following criteria must be met to qualify as a history of RHI:
A. History of at least 4 concussions OR mild Traumatic Brain Injuries.
B. At Least 2 or More Moderate AND/OR Severe Traumatic Brain Injuries.
C. At Least 6 years of Organized Contact Sports.
D. Military Service WITH combat Exposure.
E. Other Significant Sources of RHI (Domestic Violence/etc.)
Please note: A loss of consciousness or a concussion is NOT necessary for an event to count as a Head Injury. Subconcussive impacts do count towards RHI.
2. Core Clinical Features (At Least ONE symptom in ONE set of core features must be present:
A. Cognitive: Significant impairment in memory, orientation, language, attention, executive function, or visuospatial function.
B. Behavioral: Described as explosive, short fuse, out of control, physically and/or verbally violent, or Intermittent Explosive Disorder.
C. Mood: Feeling overly sad, depressed, or hopeless. Or a diagnosis of Major Depressive Disorder (MDD) or Persistent Depressive Disorder.
3. “Supportive Features” (at least 2 must be present):
Documented Decline and delayed symptom onset after exposure
A. Impulsivity
B. Anxiety
C. Apathy
D. Denial of illness
E. Paranoia
F. Headaches
G. Motor Impairment
4. Clinical Features must be present for at least 12 months.
B. If Patient meets criteria for TES use following diagnostic modifiers and subtypes of TES:
Diagnostic Subtypes of TES: (select only one)
A. Cognitive subtype : cognitive core features are present w/o behavioral or mood features or functional difficulties (ADLs)
B. Behavioral and Mood Subtype: behavioral/mood core features are present w/o cognitive features or functional difficulties (ADLs)
C. Mixed subtype: Both cognitive AND Behavioral/Mood core features are present w/o functional difficulties (ADLs)
D. Dementia subtype: Cognitive AND functional difficulties (problems with ADLs) are present
“With Motor Features” modifier of one of the 4 diagnostic subtypes (at least 1 symptom must be present) :
A. Dysarthria
B. Dysgraphia
C.Bradykinesia
D. Tremor
E. Rigidity
F. Gait Change
G. Falls
H. Parkinson like symptoms
Clinical Course Modifier:
A. Stable: History or Testing indicate little or no change in course of disease
B. Progressive: Clear indication of progression over the last 2 years.
C. Unknown/Inconsistent: Unknown or inconsistent information on course of disease.
Progressive nature of the disease is ruled out by PET scans or spinal tap or imaging MRI for changes to the cortex in a serial set of scans.
Please do not use anything you see here to substitute for the judgement of a physician or other professional in the field of CTE/TES. This video is meant for educational purposes exclusively.
If you or a loved one experiences a TBI or change in cognition, behavior, or emotion go to the nearest emergency room immediately or call 911.
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