Table 4.
Twelve hypothetical examples of psychiatric presentations in former college football, soccer, ice hockey, or rugby athletes that would meet 2014 (35) criteria for traumatic encephalopathy syndrome (TES) but not the 2021 consensus criteria (36) for TES.
| One Core Feature is Required (2014 criteria) | Two or More Supportive Features are Required for Diagnosis (2014 criteria) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Gender Age | Depression | Anger Dyscontrol | Impulsivity | Anxiety | Suicidality | Apathy | Paranoia | Headaches Per Month | Delayed Onset | Progressive (one or more years) | # of Supportive Features |
| Woman 36 | Major Depressive Disorder | -- | Alcohol Abuse | Anxious Mood | Thoughts | -- | -- | -- | ✓ | ✓ | 5 |
| Man 51 | Feeling Hopeless | -- | Excessive Gambling | Agitation | Thoughts/ Attempt | -- | -- | 1–3 | ✓ | -- | 5 |
| Woman 53 | Feeling Overly Sad | -- | Alcohol Abuse | Generalized Anxiety Disorder | Thoughts | -- | -- | 2–5 | ✓ | ✓ | 6 |
| Man 38 | Feeling Overly Sad | -- | Alcohol Abuse | Generalized Anxiety Disorder | -- | -- | -- | 5–10 | ✓ | ✓ | 5 |
| Man 67 | Feeling Depressed | -- | -- | -- | -- | Loss of Interest and Low Motivation | -- | -- | ✓ | -- | 2 |
| Man 42 | Major Depressive Disorder | Intermittent Explosive Disorder | -- | Anxious Mood | Thoughts | -- | -- | 1–3 | ✓ | ✓ | 5 |
| Woman 33 | Feeling Depressed | -- | -- | Obsessive–Compulsive Disorder | -- | -- | -- | -- | ✓ | -- | 2 |
| Man 58 | Major Depressive Disorder | -- | Alcohol Abuse | Agitation | -- | -- | Excessive/ Unwanted Jealousy | -- | ✓ | ✓ | 5 |
| Man 28 | -- | Intermittent Explosive Disorder | Alcohol Abuse | Agitation | Thoughts | -- | -- | -- | -- | -- | 3 |
| Man 31 | Feeling Hopeless | Intermittent Explosive Disorder | -- | Anxious Mood | Thoughts | -- | -- | 5–7 | -- | ✓ | 4 |
| Man 75 | Persistent Depressive Disorder | -- | -- | Agitation | Thoughts | Loss of Interest and Low Motivation | -- | -- | ✓ | -- | 4 |
| Woman 63 | Persistent Depressive Disorder | -- | Excessive Gambling | Anxious Mood | -- | -- | -- | -- | ✓ | -- | 3 |
For former athletes, the exposure criteria in 2014 based on years of play for being at risk for TES is a minimum of 6 years, including at least 2 years at the college level or higher. Any former college athletes who develop depression, for example, anytime during adulthood (after their playing years, such as age 30 through death), meet the criteria for ‘delayed onset.’ Therefore, as written, only one additional supportive feature is required. In fact, as written, if a person developed depression at any point during mid or late adulthood, and that depression progressively worsened over the course of more than a year, than that person would meet 2014 criteria for TES.