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. 2023 Jan 3;15(1):1.
doi: 10.1186/s13195-022-01147-9.

Neuropsychological test performance of former American football players

Michael L Alosco  1 , William B Barr  2 , Sarah J Banks  3   4 , Jennifer V Wethe  5 , Justin B Miller  6 , Surya Vamsi Pulukuri  7 , Julia Culhane  7 , Yorghos Tripodis  8   9 , Charles H Adler  10 , Laura J Balcer  2   11   12 , Charles Bernick  6   13 , Megan L Mariani  7 , Robert C Cantu  7 , David W Dodick  5 , Michael D McClean  14 , Rhoda Au  7   15   16   17   18 , Jesse Mez  7   15 , Robert W Turner 2nd  19 , Joseph N Palmisano  20 , Brett Martin  20 , Kaitlin Hartlage  20 , Jeffrey L Cummings  21 , Eric M Reiman  22 , Martha E Shenton  23   24 , Robert A Stern  7   17   25 ; DIAGNOSE CTE Research Project
Collaborators, Affiliations

Neuropsychological test performance of former American football players

Michael L Alosco et al. Alzheimers Res Ther. .

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.

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

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Conflict of interest statement

CHA consulted for Avion, CND Life Sciences, Jazz, and Precon Health. LJB is Editor-in-Chief of the Journal of Neuro-Ophthalmology and is a paid consultant to Biogen (Cambridge, MA, USA). CB receives research support from the Ultimate Fighting Championship, Top Rank promotions, Haymon Boxing, Las Vegas Raiders, and Professional Bull Riders. He is a paid consultant for Aurora Concussion Therapy Systems, Inc. (St. Paul, MN). RA is a paid consultant to Biogen (Cambridge, MA, USA) and serves on the Scientific Advisory Board of Signant Health (Blue Bell, PA). WBB provides expert witness testimony in legal cases involving concussion and CTE. DWD reports the following conflicts: consulting: Amgen, CapiThera, Cerecin, Ceruvia Lifesciences, Cooltech, Ctrl M, Allergan, Abbvie, Biohaven, GSK, Lundbeck, Eli Lilly, Novartis, Impel, Satsuma, Theranica, WL Gore, Genentech, Nocira, Perfood, Praxis, Pfizer, AYYA Biosciences, and Revance; honoraria/expense reimbursement/royalties: American Academy of Neurology, Headache Cooperative of the Pacific, MF Med Ed Research, Biopharm Communications, CEA Group Holding Company (Clinical Education Alliance LLC), Teva (speaking), Amgen (speaking), Eli Lilly (speaking), Lundbeck (speaking), Vector psychometric Group, Clinical Care Solutions, CME Outfitters, Curry Rockefeller Group, DeepBench, Global Access Meetings, KLJ Associates, Academy for Continued Healthcare Learning, Majallin LLC, Medlogix Communications, Medica Communications LLC, MJH Lifesciences, Miller Medical Communications, Synapse, WebMD Health/Medscape, Wolters Kluwer, Oxford University Press, and Cambridge University Press; non-profit board membership: American Brain Foundation, American Migraine Foundation, ONE Neurology, Precon Health Foundation, International Headache Society Global Patient Advocacy Coalition, Atria Health Collaborative, Domestic Violence HOPE Foundation/Panfila, CSF Leak Foundation. Research Support: Department of Defense, National Institutes of Health, Henry Jackson Foundation, Sperling Foundation, American Migraine Foundation, and Patient Centered Outcomes Research Institute (PCORI); stock options/shareholder/patents/board of directors: Ctrl M (options), Aural analytics (options), ExSano (options), Palion (options), Healint (options), Theranica (options), Second Opinion/Mobile Health (options), Epien (options/board), Nocira (options), Matterhorn (shares/board), Ontologics (shares/board), King-Devick Technologies (options/board), Precon Health (options/board), AYYA Biosciences (options), Axon Therapeutics (options/board), Cephalgia Group (options/board), and Atria Health (options/salary). Patent 17189376.1-1466:vTitle: Botulinum Toxin Dosage Regimen for Chronic Migraine Prophylaxis (No fee/compensation/royalty). RCC is a Senior Advisor to the NFL Head Neck & Spine Committee; Vice President, National Operating Committee on Standards for Athletic Equipment; and Chair, Scientific Advisory Committee, Co-Founder, and Medical Director, Concussion Legacy Foundation. He is a member of the Medical Science Committee for the National Collegiate Athletic Association Student-Athlete Concussion Injury Litigation, and he receives royalties for published books from Houghton Mifflin Harcourt. JLC has provided consultation to Acadia, Alkahest, AriBio, Avanir, Axsome, Behren Therapeutics, Biogen, Cassava, Cerecin, Cerevel, Cortexyme, EIP Pharma, Eisai, GemVax, Genentech, Green Valley, Grifols, Janssen, Jazz, Karuna, Merck, Novo Nordisk, Otsuka, ReMYND, Resverlogix, Roche, Samumed, Samus, Signant Health, Sunovion, Suven, United Neuroscience, and Unlearn AI pharmaceutical and assessment companies. He owns the copyright of the Neuropsychiatric Inventory. EMR is a compensated scientific advisor for Alkahest, Alzheon, Aural Analytics, Denali, Green Valley, Retromer Therapeutics, and Vaxxinity and a co-founder of ALZPath. RAS is a paid consultant to Biogen (Cambridge, MA, USA). He is a member of the Board of Directors of King-Devick Technologies, Inc. (Chicago, IL, USA), and he receives royalties for published neuropsychological tests from Psychological Assessment Resources, Inc. (Lutz, FL, USA). He is a member of the Medical Science Committee for the National Collegiate Athletic Association Student-Athlete Concussion Injury Litigation. The remaining authors have no conflicts of interest to disclose.

References

    1. Montenigro PH, Alosco ML, Martin BM, Daneshvar DH, Mez J, Chaisson CE, Nowinski CJ, Au R, McKee AC, Cantu RC, et al. Cumulative head impact exposure predicts later-life depression, apathy, executive dysfunction, and cognitive impairment in former high school and college football players. J Neurotrauma. 2017;34(2):328–340. doi: 10.1089/neu.2016.4413. - DOI - PMC - PubMed
    1. Roberts AL, Pascual-Leone A, Speizer FE, Zafonte RD, Baggish AL, Taylor H, Jr, Nadler LM, Courtney TK, Connor A, Grashow R, et al. Exposure to American football and neuropsychiatric health in former national football league players: findings from the football players health study. Am J Sports Med. 2019;47(12):2871–2880. doi: 10.1177/0363546519868989. - DOI - PMC - PubMed
    1. Schaffert J, LoBue C, Fields L, Wilmoth K, Didehbani N, Hart J, Jr, Cullum CM. Neuropsychological functioning in ageing retired NFL players: a critical review. Int Rev Psychiatry. 2020;32(1):71–88. doi: 10.1080/09540261.2019.1658572. - DOI - PubMed
    1. Wright MJ, Woo E, Birath JB, Siders CA, Kelly DF, Wang C, Swerdloff R, Romero E, Kernan C, Cantu RC, et al. An index predictive of cognitive outcome in retired professional American Football players with a history of sports concussion. J Clin Exp Neuropsychol. 2016;38(5):561–571. doi: 10.1080/13803395.2016.1139057. - DOI - PubMed
    1. Mez J, Alosco ML, Daneshvar DH, Saltiel N, Baucom Z, Abdolmohammadi B, Uretsky M, Nicks R, Martin BM, Palmisano JN, et al. Validity of the 2014 traumatic encephalopathy syndrome criteria for CTE pathology. Alzheimers Dement. 2021;17(10):1709–1724. doi: 10.1002/alz.12338. - DOI - PMC - PubMed

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