Neuropsychological test performance of former American football players

Michael L. Alosco, Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Robinson Building, Suite B7800, Boston, MA, 02118, USA. malosco@bu.edu.
William B. Barr, Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA.
Sarah J. Banks, Department of Neuroscience, University of California, San Diego, CA, USA.
Jennifer V. Wethe, Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA.
Justin B. Miller, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA.
Surya Vamsi Pulukuri, Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Robinson Building, Suite B7800, Boston, MA, 02118, USA.
Julia Culhane, Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Robinson Building, Suite B7800, Boston, MA, 02118, USA.
Yorghos Tripodis, Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
Charles H. Adler, Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA.
Laura J. Balcer, Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA.
Charles Bernick, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA.
Megan L. Mariani, Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Robinson Building, Suite B7800, Boston, MA, 02118, USA.
Robert C. Cantu, Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Robinson Building, Suite B7800, Boston, MA, 02118, USA.
David W. Dodick, Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA.
Michael D. McClean, Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA.
Rhoda Au, Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Robinson Building, Suite B7800, Boston, MA, 02118, USA.
Jesse Mez, Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Robinson Building, Suite B7800, Boston, MA, 02118, USA.
Robert W. Turner, Department of Clinical Research & Leadership, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
Joseph N. Palmisano, Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA.
Brett Martin, Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA.
Kaitlin Hartlage, Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA.
Jeffrey L. Cummings, Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA.
Eric M. Reiman, Banner Alzheimer's Institute, University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix, AZ, USA.
Martha E. Shenton, Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
Robert A. Stern, Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Robinson Building, Suite B7800, Boston, MA, 02118, USA.

Document Type

Journal Article

Publication Date

1-3-2023

Journal

Alzheimer's research & therapy

Volume

15

Issue

1

DOI

10.1186/s13195-022-01147-9

Keywords

Alzheimer’s disease; American football; Chronic traumatic encephalopathy; Cognitive function; Neuropsychology; Repetitive head impacts

Abstract

BACKGROUND: Patterns of cognitive impairment in former American football players are uncertain because objective neuropsychological data are lacking. This study characterized the neuropsychological test performance of former college and professional football players. METHODS: One hundred seventy male former football players (n=111 professional, n=59 college; 45-74 years) completed a neuropsychological test battery. Raw scores were converted to T-scores using age, sex, and education-adjusted normative data. A T-score ≤ 35 defined impairment. A domain was impaired if 2+ scores fell in the impaired range except for the language and visuospatial domains due to the limited number of tests. RESULTS: Most football players had subjective cognitive concerns. On testing, rates of impairments were greatest for memory (21.2% two tests impaired), especially for recall of unstructured (44.7%) versus structured verbal stimuli (18.8%); 51.8% had one test impaired. 7.1% evidenced impaired executive functions; however, 20.6% had impaired Trail Making Test B. 12.1% evidenced impairments in the attention, visual scanning, and psychomotor speed domain with frequent impairments on Trail Making Test A (18.8%). Other common impairments were on measures of language (i.e., Multilingual Naming Test [21.2%], Animal Fluency [17.1%]) and working memory (Number Span Backward [14.7%]). Impairments on our tasks of visuospatial functions were infrequent. CONCLUSIONS: In this sample of former football players (most of whom had subjective cognitive concerns), there were diffuse impairments on neuropsychological testing with verbal memory being the most frequently impaired domain.

Department

Clinical Research and Leadership

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