Chronic traumatic encephalopathy neuropathologic change in former Australian rugby players

Aims We applied the 2021 consensus criteria for both chronic traumatic encephalopathy neuropathological change and traumatic encephalopathy syndrome in a small case series of six former elite‐level Australian rugby code players. Methods Neuropathological assessment of these cases was carried out at the Sydney and Victorian Brain Banks. Clinical data were collected via clinical interviews and health questionnaires completed by the participants and/or their next of kin, and neuropsychological testing was conducted with participants who were capable of completing this testing. Results All cases exhibited progressive cognitive impairment during life. Chronic traumatic encephalopathy neuropathological change was identified in four out of the six cases. However, coexisting neuropathologies were common, with limbic‐predominant age‐related TDP‐43 encephalopathy and ageing‐related tau astrogliopathy seen in all cases, intermediate or high Alzheimer's disease neuropathological change seen in four cases and hippocampal sclerosis seen in two of the six cases. Conclusion The presence of multiple neuropathologies in these cases complicates clinical diagnostic efforts for traumatic encephalopathy syndrome. It will be important for further clinicopathological studies on larger groups to report all neuropathological comorbidities found in cases diagnosed with either chronic traumatic encephalopathy neuropathological change and/or traumatic encephalopathy syndrome. In this clinicopathological case series of former Australian rugby code players, four of six had post mortem CTE‐NC. All met current diagnostic criteria for TES and had multiple pathologies at post mortem. Future studies are needed to improve the specificity of the TES consensus diagnostic criteria for predicting the presence of CTE‐NC, and we encourage future researchers to report all neuropathological comorbidities clearly in their clinicopathological studies.