Jackie Birnbaum

English 3307
Tom Akbari
Unit 1 Final Draft
May 13, 2017

Updating the Medical Field on How to Diagnose Chronic Traumatic Encephalopathy

The review titled, Clinical appraisal of chronic traumatic encephalopathy: current

perspectives and future directions, outlines the current [as of 2011] information and knowledge

that the medical field has regarding chronic traumatic encephalopathy (CTE). This article has

several authors from various institutions, all of whom have a Ph.D. or M.D.: Brandon E. Gavett,

Robert C. Cantu, Martha Shenton, Alexander P. Lin, Christopher J. Nowinski, Ann C. McKee

and Robert A. Stern. It was published in Current Opinion in Neurology in 2011 with the purpose

of providing an overview of existing and upcoming methods for diagnosing CTE. CTE is a

disease characterized by degeneration of neuronal tissue in the patients brain and it is commonly

thought that multiple concussive or subconcussive injuries can lead to the development of the

disease. CTE cannot be confirmed in a living person as there is not an established set of clinical

criteria that allow it to be diagnosed or treated. Based on this notion, I feel that this article is

significant because doctors or researchers who deal with neurodegenerative diseases, traumatic

brain injuries, or CTE specifically can learn about new techniques in their field which may allow

them to evaluate and potentially treat a patient more effectively.

Although researchers and other people may read this review, doctors in particular would

benefit from the information; it is imperative that doctors know the most recent diagnostic tools

available to them so that they can alter, if necessary, how they assess a patient. Doctors, as the
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only ones qualified to examine patients, can use the proposed clinical tests and look for the

symptoms discussed throughout the article. For instance, whole brain atrophy has been

reported as a common feature of CTE at autopsy in addition to cavum septum pellucidum...each

of these features may be detected with MRI1(p.527). Since these neuropathological phenomena

are often seen in the post-mortem examination of confirmed CTE patients, the authors are

suggesting that doctors utilize MRI as a tool to check for these changes within the brains of

living people. The language and terms used within the quoted sentence show, again, that doctors

are meant to read and glean information from this review. Through the use of specific

neuroanatomical terms the authors were able to narrow down the group of people who would be

able to effectively understand and use the information that they present; this lends itself to the

concept of a discourse community as described by Swales. Had this review been intended for

coaches of football players, the authors would not have used such technical language such as

cavum septum pellucidum; but rather everyday language, prevention tips, and signs of a

concussion would have been discussed. Instead, the authors discuss specific pathologies of the

brain and how these can be detected by tools accessible to physicians in order to potentially

diagnose patients with CTE.

There are various means by which diseases and disorders can be diagnosed; the review is

organized into sections based on different detectable effects that CTE is thought to have on a

patients body. The four headings (Neurologic effects, Neuropsychological and neuropsychiatric

effects, Radiologic effects, and Blood and cerebrospinal fluid biomarkers)1(p.526, 527, 529) function

to outline which category a potential diagnostic criterion falls into. The Neurologic effects and

Blood cerebrospinal fluid biomarkers sections are substantially shorter than the other two and

also lack subheadings. Despite having less information, these sections were not omitted because
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the aforementioned areas exude potential in the future of CTE diagnosis as evidenced by this

quote: Blood and CSF biomarkers have yielded promising results for the detection of

neurodegenerative changes caused by Alzheimers disease [56,57],1(p.529). Alzheimers and

CTE share some neuropathological changes which is why the authors chose to mention that

biomarkers may be a diagnostic tool for CTE in the future. The inclusion of these sections

implies that doctors and researchers should expect more upcoming findings about biomarkers

and neurological dysfunction in the context of CTE.

In neuropathologically confirmed CTE, executive dysfunction may be common prior to

death [16]. Poor insight, judgment, and disinhibition have been reported very commonly in

individuals with CTE,1(p.527). The cognitive deficits described in this quote fall under the

subheading of Executive function which is under the umbrella of Neuropsychological and

neuropsychatric effects. Organization of this sort allows the reader to more easily see which of

these CTE pathologies present in a manner that can be tested for and subsequently confirmed.

The quote states specifically how executive function is thought to be impeded in cases of CTE;

the neuropsychological tests that a doctor should administer to patients are not detailed in this

section (or at all in the review). Explanations of neuropsychological exams would be

unnecessary in this case because, as the authors assume, a doctor should already know how

he/she can test for deficits in executive function. This lends itself to a point made earlier: the

review is meant to be read by doctors or researchers with prior knowledge in the field. By only

including which cognitive deficits to test for and how they are related to CTE, the authors made

the paper more focused on the goal of summarizing new and future information for the readers.

A known expectation of every physician is that he/she does not stop learning about

conditions that they encounter and treat after medical school or residency. In this sense, reviews
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similar to this one are what I would expect to encounter in the field of medicine. Particularly

when dealing with a disease such as CTE that is gaining attention from the media, athletes, and

the research community, I would want to ensure that I am administering the proper

neuropsychological tests, neuroimaging tests, and (hopefully in the near future) blood tests to

patients. In order to be able to write a medical document such as this review, one must have

extensively studied patients or cases of the specific disease. This necessitates either going

through medical school or graduate school with a focus on neurodegenerative disease. My

educational path should prepare me to become a member of this specific discourse community;

during medical school it is vital that one learns the medical lexicon used in hospitals and other

clinical settings. I have shadowed a neurologist and can attest to the fact that there are acronyms,

abbreviations, and terms specific not only to medicine, but to the narrower field of neurology.

At this point in my education, I feel that I can read and potentially write a review on the research

of a particular neurodegenerative disease. As a behavioral neuroscience major I am comfortable

with the neural mechanisms discussed in a review such as this one; however I think that if I

needed to write a more medicine-oriented review I would need to learn much more about and

have administered medical evaluations and treatment for the disease as opposed to just

understanding the neuroscience-based concepts.

Reference

1. Gavett BE, Cantu RC, Shenton M, Lin AP, Nowinski CJ, McKee AC, Stern RA. 2011.

Clinical appraisal of chronic traumatic encephalopathy: current perspectives and future

directions. Current Opinion in Neurology. 24:525-531