. 2024 Apr 3;5(1):337–347. doi: 10.1089/neur.2023.0134

Table 2.

Directions for Future Research

1. Determine clear exposure thresholds for repetitive head impacts associated with sports other than football (e.g., hockey, soccer, and rugby) and for repetitive low-level blast exposures during military service. However, any single threshold requirement will likely carry associated risks of over- and underidentification if uniformly applied without other person-specific considerations.

2. Evaluate the inter-rater reliability of the consensus diagnostic criteria for TES.

3. Examine the prevalence of TES clinical features in the general population and in subgroups of persons and patients with clinical conditions, with and without the repetitive head-hits exposure criterion.

4. Conduct specificity studies to determine how often clinical criteria are met in persons who have not had exposure to repetitive neurotrauma.

5. Determine whether neurobehavioral dysregulation believed to be associated with TES in former athletes is different in any way from the neurobehavioral dysregulation that is observed in persons with the mild behavioral impairment^55,56 that is associated with mild cognitive impairment,⁵⁷ Alzheimer's disease,⁵⁸ Parkinson's disease,⁵⁹ or frontotemporal dementia⁶⁰ from the general population.

6. Determine whether neurobehavioral dysregulation associated with TES can be clearly differentiated from worsening of longstanding intermittent explosive disorder⁶¹ or anger attacks that are associated with major depressive disorder^62–64 or anxiety disorders.^65,66

7. Evaluate the reliability and validity of clinician/researcher ratings of levels of functional dependence and dementia.

8. Develop methods and decision rules for examining and applying the criterion “not better accounted for” by another clinical (or neuropathological) diagnosis or condition.

9. Conduct longitudinal case-series, case-control, and cohort studies of those with and without antemortem TES diagnoses and post-mortem CTE-NC diagnoses.

10. Determine whether CTE-NC directly correlates or is causally related to specific symptoms or problems. The literature to date indicates that it does not correlate with features of neurobehavioral dysregulation, depression, suicidality, anxiety, apathy, or paranoia.

TES, traumatic encephalopathy syndrome; CTE-NC, chronic traumatic encephalopathy neuropathological change.