TRAUMATIC encephalopathy syndrome features were common after traumatic brain injury, even without repetitive head impacts.
Traumatic Encephalopathy Syndrome in TBI Survivors
Traumatic encephalopathy syndrome (TES), proposed as the clinical manifestation of chronic traumatic encephalopathy neuropathologic change, is currently tied to substantial repetitive head impact exposure. However, new findings from the Late Effects of TBI (LETBI) study suggest that core TES clinical features may also be frequent among people with complicated mild, moderate, or severe traumatic brain injury, regardless of repetitive head impact history.
The secondary analysis included 295 community based participants with traumatic brain injury. Mean age was 52.6 years, and 35.6% of participants were female. Investigators grouped participants by injury severity and repetitive head impact exposure, creating six categories across isolated mild, moderate, and severe traumatic brain injury, with and without repetitive head impacts.
Clinical Features Were Frequent Across Groups
Among all participants, 56.9% met the TES core criterion for cognitive impairment, 32.9% met the criterion for neurobehavioral dysregulation, and 45.8% showed a progressive course of clinical features. Overall, 14.9% of the LETBI cohort had substantial repetitive head impact exposure and met all three clinical criteria, fulfilling consensus based TES criteria.
When the repetitive head impact exposure requirement was removed, 33.5% of participants with isolated traumatic brain injury met all core clinical criteria. This finding is clinically important because it suggests that chronic and sometimes progressive symptoms after traumatic brain injury may resemble traumatic encephalopathy syndrome, even when the exposure profile does not align with current TES criteria.
Repetitive Head Impact Exposure Remains Central
No demographic or injury related variables predicted the likelihood of meeting TES core criteria. Notably, the presence of TES core clinical features was greatest among participants without repetitive head impact exposure, raising the possibility that late clinical sequelae of traumatic brain injury may reflect a distinct pathobiological process rather than TES itself.
The findings reinforce the importance of repetitive head impact exposure in TES diagnosis, while highlighting the need for careful clinical interpretation when cognitive impairment, neurobehavioral dysregulation, and progressive symptoms appear after traumatic brain injury. The authors noted that selection of participants with chronic symptoms may have influenced the results, but the study underscores the complexity of distinguishing TES from broader late effects of traumatic brain injury.
Reference
Dams-O’Connor K et al. Traumatic encephalopathy syndrome in the Late Effects of Traumatic Brain Injury (LETBI) study cohort. Neurol Open Access. 2025;1(2).
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