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Acute and chronic traumatic encephalopathies: pathogenesis and biomarkers

Nature Reviews Neurology volume 9, pages 192–200 (2013)Cite this article

Subjects

Abstract

Over the past decade, public awareness of the long-term pathological consequences of traumatic brain injury (TBI) has increased. Such awareness has been stimulated mainly by reports of progressive neurological dysfunction in athletes exposed to repetitive concussions in high-impact sports such as boxing and American football, and by the rising number of TBIs in war veterans who are now more likely to survive explosive blasts owing to improved treatment. Moreover, the entity of chronic traumatic encephalopathy (CTE)—which is marked by prominent neuropsychiatric features including dementia, parkinsonism, depression, agitation, psychosis, and aggression—has become increasingly recognized as a potential late outcome of repetitive TBI. Annually, about 1% of the population in developed countries experiences a clinically relevant TBI. The goal of this Review is to provide an overview of the latest understanding of CTE pathophysiology, and to delineate the key issues that are challenging clinical and research communities, such as accurate quantification of the risk of CTE, and development of reliable biomarkers for single-incident TBI and CTE.

Key Points

  • Traumatic brain injury (TBI) can lead to delayed-onset neurodegenerative syndromes that include Alzheimer disease (AD) and chronic traumatic encephalopathy (CTE)

  • CTE has gained attention owing to increasing media coverage of neuropsychiatric dysfunction in players of high-impact sport, such as boxing and American football

  • Brain pathology after single-incident severe TBI is similar to early amyloid pathology in AD, whereas repetitive TBI can produce tauopathy with or without amyloidosis that resembles pathology of boxers' dementia

  • Estimation of the risk and prevalence of CTE remains challenging, and accurate prediction of TBI outcome and CTE risk for soldiers and players of high-impact sports is not yet possible

  • Several genetic risk factors for CTE have been proposed but remain to be established

  • Cerebrospinal fluid and neuroimaging biomarkers of TBI and CTE are emerging and hold promise for antemortem diagnosis of CTE, prediction of CTE risk, and monitoring of neuropathology progression

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Figure 1: Spectrum of pathological features and outcomes of mild and severe TBI.
Figure 2: Histopathology of the temporal cortex in TBI and AD.
Figure 3: Histopathological features of chronic traumatic encephalopathy in a former professional football player.
Figure 4: 18F-THK523 as a tauopathy marker.
Figure 5: CSF neurofilament light polypeptide in Olympic boxers after a bout.

References

  1. Centers for Disease Control and Prevention. Injury prevention and control: traumatic brain injury. Centers for Disease Control and Prevention [online], (2012).

  2. DeKosky, S. T., Ikonomovic, M. D. & Gandy, S. Traumatic brain injury—football, warfare, and long-term effects. N. Engl. J. Med. 363, 1293–1296 (2010).

    Article  CAS  Google Scholar 

  3. US Department of Defense. Traumatic brain injury—Department of Defense special report. US Department of Defense [online], (2012).

  4. Lange, R. T., Brickell, T. A., Ivins, B., Vanderploeg, R. & French, L. M. Variable, not always persistent, postconcussion symptoms following mild TBI in U.S. military service members: a 5-year cross-sectional outcome study. J. Neurotrauma http://dx.doi.org/10.1089/neu.2012.2743.

  5. Wall, P. L. Posttraumatic stress disorder and traumatic brain injury in current military populations: a critical analysis. J. Am. Psychiatr. Nurses Assoc. 18, 278–298 (2012).

    Article  Google Scholar 

  6. Capehart, B. & Bass, D. Review: managing posttraumatic stress disorder in combat veterans with comorbid traumatic brain injury. J. Rehabil. Res. Dev. 49, 789–812 (2012).

    Article  Google Scholar 

  7. Vasterling, J. J. et al. Neuropsychological outcomes of mild traumatic brain injury, post-traumatic stress disorder and depression in Iraq-deployed US Army soldiers. Br. J. Psychiatry 201, 186–192 (2012).

    Article  Google Scholar 

  8. Vanderploeg, R. D. et al. Health outcomes associated with military deployment: mild traumatic brain injury, blast, trauma, and combat associations in the Florida National Guard. Arch. Phys. Med. Rehabil. 93, 1887–1895 (2012).

    Article  Google Scholar 

  9. Bazarian, J. J. et al. The relation between posttraumatic stress disorder and mild traumatic brain injury acquired during operations enduring freedom and Iraqi freedom. J. Head Trauma Rehabil. 28, 1–12 (2013).

    Article  Google Scholar 

  10. Shively, S. B. & Perl, D. P. Traumatic brain injury, shell shock, and posttraumatic stress disorder in the military—past, present, and future. J. Head Trauma Rehabil. 27, 234–239 (2012).

    Article  Google Scholar 

  11. Ruff, R. L., Riechers, R. G. 2nd, Wang, X. F., Piero, T. & Ruff, S. S. A case–control study examining whether neurological deficits and PTSD in combat veterans are related to episodes of mild TBI. BMJ Open 2, e000312 (2012).

    Article  Google Scholar 

  12. Barnes, S. M., Walter, K. H. & Chard, K. M. Does a history of mild traumatic brain injury increase suicide risk in veterans with PTSD? Rehabil. Psychol. 57, 18–26 (2012).

    Article  Google Scholar 

  13. Bogdanova, Y. & Verfaellie, M. Cognitive sequelae of blast-induced traumatic brain injury: recovery and rehabilitation. Neuropsychol. Rev. 22, 4–20 (2012).

    Article  Google Scholar 

  14. Moretti, L. et al. Cognitive decline in older adults with a history of traumatic brain injury. Lancet Neurol. 11, 1103–1112 (2012).

    Article  Google Scholar 

  15. Shively, S., Scher, A. I., Perl, D. P. & Diaz-Arrastia, R. Dementia resulting from traumatic brain injury: what is the pathology? Arch. Neurol. 9, 1–7 (2012).

    Google Scholar 

  16. Sivanandam, T. M. & Thakur, M. K. Traumatic brain injury: a risk factor for Alzheimer's disease. Neurosci. Biobehav. Rev. 36, 1376–1381 (2012).

    Article  Google Scholar 

  17. Esiri, M. M. & Chance, S. A. Cognitive reserve, cortical plasticity and resistance to Alzheimer's disease. Alzheimers Res. Ther. 4, 7 (2012).

    Article  Google Scholar 

  18. Norton, M. C. et al. Lifestyle behavior pattern is associated with different levels of risk for incident dementia and Alzheimer's disease: the Cache County study. J. Am. Geriatr. Soc. 60, 405–412 (2012).

    Article  Google Scholar 

  19. Johnson, V. E., Stewart, W. & Smith, D. H. Widespread τ and amyloid-β pathology many years after a single traumatic brain injury in humans. Brain Pathol. 22, 142–149 (2012).

    Article  CAS  Google Scholar 

  20. Lehman, E. J., Hein, M. J., Baron, S. L. & Gersic, C. M. Neurodegenerative causes of death among retired National Football League players. Neurology 79, 1970–1974 (2012).

    Article  Google Scholar 

  21. Klunk, W. E. et al. Imaging brain amyloid in Alzheimer's disease with Pittsburgh Compound-B. Ann. Neurol. 55, 306–319 (2004).

    Article  CAS  Google Scholar 

  22. Clark, C. M. et al. Use of florbetapir-PET for imaging β-amyloid pathology. JAMA 305, 275–283 (2011).

    Article  CAS  Google Scholar 

  23. Zhang, W. et al. A highly selective and specific PET tracer for imaging of tau pathologies. J. Alzheimers Dis. 31, 601–612 (2012).

    Article  CAS  Google Scholar 

  24. Chien, D. T. et al. Early clinical PET imaging results with the novel PHF-tau radioligand [F-18]-T807. J. Alzheimers Dis. http://dx.doi.org/10.3233/JAD-122059.

  25. Ciallella, J. R. et al. Changes in expression of amyloid precursor protein and interleukin-1β after experimental traumatic brain injury in rats. J. Neurotrauma 19, 1555–1567 (2002).

    Article  Google Scholar 

  26. Ikonomovic, M. D. et al. Alzheimer's pathology in human temporal cortex surgically excised after severe brain injury. Exp. Neurol. 190, 192–203 (2004).

    Article  CAS  Google Scholar 

  27. DeKosky, S. T. et al. Association of increased cortical soluble Aβ42 levels with diffuse plaques after severe brain injury in humans. Arch. Neurol. 64, 541–544 (2007).

    Article  Google Scholar 

  28. Nicoll, J. A., Roberts, G. W. & Graham, D. I. Apolipoprotein E ɛ4 allele is associated with deposition of amyloid β-protein following head injury. Nat. Med. 1, 135–137 (1995).

    Article  CAS  Google Scholar 

  29. Jordan, B. D. et al. Apolipoprotein E ɛ4 associated with chronic traumatic brain injury in boxing. JAMA 278, 136–140 (1997).

    Article  CAS  Google Scholar 

  30. Jordan, B. D. Clinical spectrum of sports-related traumatic brain injury. Nat. Rev. Neurol. http://dx.doi.org/10.1038/nrneurol.2013.33.

  31. Horsburgh, K. et al. β-amyloid (Aβ)42(43), aβ42, aβ40 and apoE immunostaining of plaques in fatal head injury. Neuropathol. Appl. Neurobiol. 26, 124–132 (2000).

    Article  CAS  Google Scholar 

  32. Johnson, V. E. et al. A neprilysin polymorphism and amyloid-β plaques after traumatic brain injury. J. Neurotrauma 26, 1197–1202 (2009).

    Article  Google Scholar 

  33. Factor, S. A. & Weiner, W. J. Prior history of head trauma in Parkinson's disease. Mov. Disord. 6, 225–229 (1991).

    Article  CAS  Google Scholar 

  34. Rugbjerg, K., Ritz, B., Korbo, L., Martinussen, N. & Olsen, J. H. Risk of Parkinson's disease after hospital contact for head injury: population based case–control study. BMJ 337, a2494 (2008).

    Article  Google Scholar 

  35. Corsellis, J. A. & Brierley, J. B. Observations on the pathology of insidious dementia following head injury. J. Ment. Sci. 105, 714–720 (1959).

    Article  CAS  Google Scholar 

  36. Corsellis, J. A. Boxing and the brain. BMJ 298, 105–109 (1989).

    Article  CAS  Google Scholar 

  37. Roberts, G. W., Allsop, D. & Bruton, C. The occult aftermath of boxing. J. Neurol. Neurosurg. Psychiatry 53, 373–378 (1990).

    Article  CAS  Google Scholar 

  38. Tokuda, T., Ikeda, S., Yanagisawa, N., Ihara, Y. & Glenner, G. G. Re-examination of ex-boxers' brains using immunohistochemistry with antibodies to amyloid β-protein and tau protein. Acta Neuropathol. 82, 280–285 (1991).

    Article  CAS  Google Scholar 

  39. McKee, A. C. et al. Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury. J. Neuropathol. Exp. Neurol. 68, 709–735 (2009).

    Article  Google Scholar 

  40. Gandy, S. & DeKosky, S. T. APOE ɛ4 status and traumatic brain injury on the gridiron or the battlefield. Sci. Transl. Med. 4, 134ed4 (2012).

    Article  Google Scholar 

  41. Gandy, S. The role of cerebral amyloid β accumulation in common forms of Alzheimer disease. J. Clin. Invest. 115, 1121–1129 (2005).

    CAS  PubMed  PubMed Central  Google Scholar 

  42. Gandy, S. & DeKosky, S. T. Toward the treatment and prevention of Alzheimer's disease: rational strategies and recent progress. Annu. Rev. Med. 64, 367–383 (2013).

    Article  CAS  Google Scholar 

  43. Guskiewicz, K. M. et al. Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery 57, 719–726 (2005).

    Article  Google Scholar 

  44. Omalu, B. I. et al. Chronic traumatic encephalopathy in a National Football League player. Neurosurgery 57, 128–134 (2005).

    Article  Google Scholar 

  45. Yi, J., Padalino, D. J., Chin, L. S., Montenegro, P. & Cantu, R. C. Chronic traumatic encephalopathy. Curr. Sports Med. Rep. 12, 28–32 (2013).

    Article  Google Scholar 

  46. Clark, E. C. & Harper, E. O. Electroencephalographic findings in 186 cases of chronic post traumatic encephalopathy. Electroencephalogr. Clin. Neurophysiol. 3, 9–14 (1951).

    Article  CAS  Google Scholar 

  47. McKee, A. C. et al. The spectrum of disease in chronic traumatic encephalopathy. Brain 136, 43–64 (2013).

    Article  Google Scholar 

  48. Omalu, B. I., Hamilton, R. L., Kamboh, M. I., DeKosky, S. T. & Bailes, J. Chronic traumatic encephalopathy (CTE) in a National Football League Player: case report and emerging medicolegal practice questions. J. Forensic Nurs. 6, 40–46 (2010).

    Article  Google Scholar 

  49. Omalu, B. I., Bailes, J., Hammers, J. L. & Fitzsimmons, R. P. Chronic traumatic encephalopathy, suicides and parasuicides in professional American athletes: the role of the forensic pathologist. Am. J. Forensic Med. Pathol. 31, 130–132 (2010).

    Article  Google Scholar 

  50. Omalu, B. I., Fitzsimmons, R. P., Hammers, J. & Bailes, J. Chronic traumatic encephalopathy in a professional American wrestler. J. Forensic. Nurs. 6, 130–136 (2010).

    Article  Google Scholar 

  51. Omalu, B. et al. Emerging histomorphologic phenotypes of chronic traumatic encephalopathy in American athletes. Neurosurgery 69, 173–183 (2011).

    Article  Google Scholar 

  52. Dwyre, B. Dave Duerson's suicide could be a turning point for the NFL. Los Angeles Times http://articles.latimes.com/2011/feb/21/sports/la-sp-dwyre-20110222 (21 Feb 2011).

  53. Nelson, E. & Sherwood, R. Chris Benoit's murder, suicide: was brain damage to blame? ABC News http://abcnews.go.com/Nightline/chris-benoits-dad-son-suffered-severe-brain-damage/story?id=11471875 (26 Aug 2010).

  54. Tierny, M. Football player who killed himself had brain disease. New York Times B16 (27 Jul 2012).

  55. Kounang, N. & Smith, S. Seau had brain disease that comes from hits to head, NIH finds. CNN http://www.cnn.com/2013/01/10/health/seau-brain-disease/index.html (11 Jan 2013).

  56. Omalu, B. et al. Chronic traumatic encephalopathy in an Iraqi war veteran with posttraumatic stress disorder who committed suicide. Neurosurg. Focus 31, E3 (2011).

    Article  Google Scholar 

  57. Goldstein, L. E. et al. Chronic traumatic encephalopathy in blast-exposed military veterans and a blast neurotrauma mouse model. Sci. Transl. Med. 14, 134ra60 (2012).

    Google Scholar 

  58. Fagan, A. M. et al. Cerebrospinal fluid tau/β-amyloid42 ratio as a prediction of cognitive decline in nondemented older adults. Arch. Neurol. 64, 343–349 (2007).

    Article  Google Scholar 

  59. Cairns, N. J. et al. Absence of Pittsburgh compound B detection of cerebral amyloid β in a patient with clinical, cognitive, and cerebrospinal fluid markers of Alzheimer disease: a case report. Arch. Neurol. 66, 1557–1562 (2009).

    Article  Google Scholar 

  60. Zetterberg, H., Smith, D. H. & Blennow, K. Biomarkers of mild traumatic brain Injury in cerebrospinal fluid and blood. Nat. Rev. Neurol. http://dx.doi.org/10.1038/nrneurol.2013.9.

  61. Ikonomovic, M. D. et al. Post-mortem correlates of in vivo PiB-PET amyloid imaging in a typical case of Alzheimer's disease. Brain 131, 1630–1645 (2008).

    Article  Google Scholar 

  62. Povlishock, J. T., Becker, D. P., Cheng, C. L. & Vaughan, G. W. Axonal change in minor head injury. J. Neuropathol. Exp. Neurol. 42, 225–242 (1983).

    Article  CAS  Google Scholar 

  63. Franz, G. et al. Amyloid beta 1–42 and tau in cerebrospinal fluid after severe traumatic brain injury. Neurology 60, 1457–1461 (2003).

    Article  CAS  Google Scholar 

  64. Öst, M. et al. Initial CSF total tau correlates with 1-year outcome in patients with traumatic brain injury. Neurology 67, 1600–1604 (2006).

    Article  Google Scholar 

  65. Zetterberg, H. et al. Neurochemical aftermath of amateur boxing. Arch. Neurol. 63, 1277–1280 (2006).

    Article  Google Scholar 

  66. Neselius, S. et al. CSF-biomarkers in Olympic boxing: diagnosis and effects of repetitive head trauma. PLoS ONE 7, e33606 (2012).

    Article  CAS  Google Scholar 

  67. Kövesdi, E. et al. Update on protein biomarkers in traumatic brain injury with emphasis on clinical use in adults and pediatrics. Acta Neurochir. (Wien) 152, 1–17 (2010).

    Article  Google Scholar 

  68. Naeimi, Z. S., Weinhofer, A., Sarahrudi, K., Heinz, T. & Vecsei, V. Predictive value of S-100B protein and neuron specific-enolase as markers of traumatic brain damage in clinical use. Brain Inj. 20, 463–468 (2006).

    Article  Google Scholar 

  69. Anderson, R. E., Hansson, L. O., Nilsson, O., Dijlai-Merzoug, R. & Settergren, G. High serum S100B levels for trauma patients without head injuries. Neurosurgery 48, 1255–1258 (2001).

    CAS  PubMed  Google Scholar 

  70. Neselius, S. et al. Olympic boxing is associated with elevated levels of the neuronal protein tau in plasma. Brain Inj. (in press).

  71. Randall, J. et al. Tau proteins in serum predict neurological outcome after hypoxic brain injury from cardiac arrest: results of a pilot study. Resuscitation http://dx.doi.org/10.1016/j.resuscitation.2012.07.027.

  72. Weiner, M. W. et al. The Alzheimer's Disease Neuroimaging Initiative: a review of papers published since its inception. Alzheimers Dement. 8 (Suppl. 1), S1–S68 (2012).

    Article  Google Scholar 

  73. Mitsis, E. et al. Florbetapir scanning excludes Alzheimer's disease in a retired NFL played with delayed cognitive impairment. Presented at the 7th Human Amyloid Imaging Conference http://www.scribd.com/doc/117537451/HAI-2013-ConferenceBook#outer_page_83.

  74. Fodero-Tavoletti, M. T. et al. 18F-THK523: a novel in vivo tau imaging ligand for Alzheimer's disease. Brain 134, 1089–1100 (2011).

    Article  Google Scholar 

  75. World Medical Association. WMA statement on boxing. WMA [online], (2013).

  76. Baird, L. C. et al. Mortality resulting from head injury in professional boxing. Neurosurgery 67, 1444–1450 (2010).

    Article  Google Scholar 

  77. Atha, J., Yeadon, M. R., Sandover, J. & Parsons, K. C. The damaging punch. Br. Med. J. 291, 1756–1757 (1985).

    Article  CAS  Google Scholar 

  78. Bartsch, A. J., Benzel, E. C., Miele, V. J., Morr, D. R. & Prakash, V. Boxing and mixed martial arts: preliminary traumatic neuromechanical injury risk analyses from laboratory impact dosage data. J. Neurosurg. 116, 1070–1080 (2012).

    Article  Google Scholar 

  79. Jako, P. Safety measures in amateur boxing. Br. J. Sports Med. 36, 394–395 (2002).

    Article  CAS  Google Scholar 

  80. McCrory, P. et al. Consensus statement on concussion in sport—the Third International Conference on Concussion in Sport held in Zurich, November 2008. Phys. Sportsmed. 37, 141–159 (2009).

    Article  Google Scholar 

  81. Svinth, J. R. Death Under the Spotlight: The Manuel Velazquez Boxing Fatality Collection. Electronic Journals of Martial Arts and Sciences [online], (2007).

  82. Miele, V. J. & Bailes, J. E. Objectifying when to halt a boxing match: a video analysis of fatalities. Neurosurgery 60, 307–315 (2007).

    Article  Google Scholar 

  83. Cantu, R. C. Return to play guidelines after a head injury. Clin. Sports Med. 17, 45–60 (1998).

    Article  CAS  Google Scholar 

  84. Epstein, D. Conclusions? Too early. Sports Illustrated http://sportsillustrated.cnn.com/vault/article/magazine/MAG1206738/index.htm (21 Jan 2013).

  85. Abrahamson, E. E., Ikonomovic, M. D., Dixon, C. E. & DeKosky, S. T. Simvastatin therapy prevents brain trauma-induced increases in β-amyloid peptide levels. Ann. Neurol. 66, 407–414 (2009).

    Article  CAS  Google Scholar 

  86. Loane, D. J. et al. Amyloid precursor protein secretases as therapeutic targets for traumatic brain injury. Nat. Med. 15, 377–379 (2009).

    Article  CAS  Google Scholar 

  87. Tran, H. T., Sanchez, L. & Brody, D. L. Inhibition of JNK by a peptide inhibitor reduces traumatic brain injury-induced tauopathy in transgenic mice. J. Neuropathol. Exp. Neurol. 71, 116–129 (2012).

    Article  CAS  Google Scholar 

  88. Magnoni, S. et al. Tau elevations in the brain extracellular space correlate with reduced amyloid-β levels and predict adverse clinical outcomes after severe traumatic brain injury. Brain 135, 1268–1280 (2012).

    Article  Google Scholar 

  89. Tran, H. T., Sanchez, L., Esparza, T. J. & Brody, D. L. Distinct temporal and anatomical distributions of amyloid-β and tau abnormalities following controlled cortical impact in transgenic mice. PLoS ONE 6, e25475 (2011).

    Article  CAS  Google Scholar 

  90. Tran, H. T., LaFerla, F. M., Holtzman, D. M, & Brody, D. L. Controlled cortical impact traumatic brain injury in 3xTg-AD mice causes acute intra-axonal amyloid-β accumulation and independently accelerates the development of tau abnormalities. J. Neurosci. 29, 9513–9525 (2011).

    Article  Google Scholar 

  91. Garman, R. H. et al. Blast exposure in rats with body shielding is characterized primarily by diffuse axonal injury. J. Neurotrauma 28, 947–959 (2011).

    Article  Google Scholar 

  92. Ojo, J. O. et al. Repetitive mild traumatic brain injury augments tau pathology and glial activation in aged hTau mice. J. Neuropathol. Exp. Neurol. 72, 137–151 (2013).

    Article  CAS  Google Scholar 

  93. Blennow, K., Hardy, J. & Zetterberg, H. The neuropathology and neurobiology of traumatic brain injury. Neuron 76, 886–899 (2012).

    Article  CAS  Google Scholar 

  94. Smith, S. NFL players association, Harvard planning $100 million player study. CNN http://www.cnn.com/2013/01/29/health/nfl-harvard-study/index.html (30 Jan 2013).

  95. Battista, J. NFL joins with GE in effort to detect concussions. New York Times SP6 (3 Feb 2013).

  96. [No authors listed]. NFL expects to soon have neurological consultants on sidelines. National Football League [online], (31 Jan 2013).

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Acknowledgements

The authors gratefully acknowledge the support of NIH grants P01NS30318, P01AG14449 and P50AG05133 (S. T. DeKosky and M. D. Ikonomovic), and VA MERIT review grants 1I01BX000348 (S. Gandy) and 1I01RX000511 (M. D. Ikonomovic). S. Gandy also acknowledges the support of the Cure Alzheimer's Fund and of US NIH P50 AG05138. The authors thank P. Davies (North Shore-Hofstra) for helpful discussions.

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  1. Office of the Dean and Department of Neurology, University of Virginia School of Medicine, P. O. Box 800793, Charlottesville, 22908, VA, USA

    Steven T. DeKosky

  2. Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Mölndal, SE-431 80, Sweden

    Kaj Blennow

  3. and Departments of Neurology and Psychiatry, Geriatric Research Educational and Clinical Center, VA Pittsburgh Healthcare System, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, 15213, PA, USA

    Milos D. Ikonomovic

  4. Departments of Neurology and Psychiatry and Alzheimer's Disease Research Center, Icahn School of Medicine at Mount Sinai, James J. Peters Medical Center, New York, 10029, NY, USA

    Sam Gandy

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DeKosky, S., Blennow, K., Ikonomovic, M. et al. Acute and chronic traumatic encephalopathies: pathogenesis and biomarkers. Nat Rev Neurol 9, 192–200 (2013). https://doi.org/10.1038/nrneurol.2013.36

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