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Comment & Response
December 19, 2017

Chronic Traumatic Encephalopathy in Football Players

Author Affiliations
  • 1Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tennessee
  • 2Department of Psychology, Veterans Affairs Connecticut Healthcare System, West Haven
JAMA. 2017;318(23):2352. doi:10.1001/jama.2017.16667

To the Editor The study of former professional football players diagnosed posthumously as having chronic traumatic encephalopathy (CTE) is the largest such study to date.1 The criterion used to diagnose CTE is a crucial limitation that necessitates further discussion.

According to 2016 guidelines, the only criterion necessary to diagnose CTE is identification of “at least one perivascular ptau [phosphorylated tau] lesion consisting of ptau aggregates … around a small blood vessel.”1,2 Would a neuropathologist diagnose Alzheimer disease with a solitary area of amyloid-β, or conclude that a patient had Lewy body disease when detecting a single Lewy body? These neurodegenerative diagnoses require specific pathologic criteria tied to well-defined clinical presentations.3 The diagnosis of CTE requires neither. The proposed CTE diagnostic criterion maximizes sensitivity, identifying cases in which the condition may be present, at the cost of specificity.