At the 2019 in Philadelphia, rehabilitation specialist , of The Mount Sinai Hospital in New York City, had a conversation with Ƶ about the challenging dilemma neurologists face as to whether a patient's cognitive or behavioral symptoms may be related to a remote head trauma.
Following is a transcript of her remarks:
We anticipated audience questions about chronic traumatic encephalopathy, which is a neuropathological disease believed to be associated with repetitive sub-concussive head trauma. We, of course, got some questions. One of the things that has happened with the research in this area is that it has resulted in a lot of media attention and that has made it so that people living in the community with a history of head trauma have begun to question whether symptoms that they're experiencing may be related to a remote history of brain injury.
What that means for a lot of practicing neurologists is that they get patients in their practice who come with questions relating to symptoms like headaches, sometimes cognitive symptoms that seem to be getting worse over time, behavioral changes that seem concerning either to them or to their families. This question is a really challenging one clinically as to whether these apparently newly emerging or worsening symptoms may be related to a remote head trauma.
One of the pieces of advice we gave is to almost treat these patients as though they're being evaluated for a neurodegenerative disease irrespective of the potential initiating event, which may or may not be that remote brain injury, to do a full workup, to characterize as best as possible the spectrum of symptoms. While we do a lot of research that is ongoing to try to better diagnose posttraumatic neurodegeneration during life, the best approach at this time is really to treat the symptoms. Many of the symptoms that are believed to be associated with this neurodegenerative pathology are symptoms for which individual treatments exist, and so as we await more empirical evidence, to treat the symptoms in the short term is really the best approach.
These PET tracers are definitely not yet ready for clinical use. At this time, they don't provide the level of resolution that would be required to distinguish a tau pathology that may be associated with normal aging -- that may have no clinical symptoms associated with it -- from the pathognomonic lesion that is believed to be representative of CTE according to the provisional diagnostic criteria that exist.
The other really important thing for practicing clinicians to recognize is that we don't yet know whether there is a real association between that pathological substrate and clinical symptoms. So, since we cannot diagnose CTE during life, just like we can't really yet diagnose a unique posttraumatic neurodegeneration during life, at this time, I'm not sure how useful that would be to have that additional information.