Evaluating and treating neurobehavioral symptoms in professional American football players: Lessons from a case series.
In the aftermath of multiple high-profile cases of chronic traumatic encephalopathy (CTE) in professional American football players, physicians in clinical practice are likely to face an increasing number of retired football players seeking evaluation for chronic neurobehavioral symptoms. Guidelines for the evaluation and treatment of these patients are sparse. Clinical criteria for a diagnosis of CTE are under development. The contribution of CTE vs other neuropathologies to neurobehavioral symptoms in these players remains unclear. Here we describe the experience of our academic memory clinic in evaluating and treating a series of 14 self-referred symptomatic players. Our aim is to raise awareness in the neurology community regarding the different clinical phenotypes, idiosyncratic but potentially treatable symptoms, and the spectrum of underlying neuropathologies in these players.
Memory and Aging Center (RCG, KLP, LTG, BIC-S, PMG, SL, JM, JHK, BLM, KY, GDR), Department of Neurology, Department of Radiology & Biomedical Imaging (CPH), Department of Pathology (EJH, ALN), Department of Neurosurgery (MSB), and Departments of Psychiatry and Epidemiology and Biostatistics (KY), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (RCG, KY), San Francisco, CA.
Raquel C
RC
Gardner
Memory and Aging Center (RCG, KLP, LTG, BIC-S, PMG, SL, JM, JHK, BLM, KY, GDR), Department of Neurology, Department of Radiology & Biomedical Imaging (CPH), Department of Pathology (EJH, ALN), Department of Neurosurgery (MSB), and Departments of Psychiatry and Epidemiology and Biostatistics (KY), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (RCG, KY), San Francisco, CA.
Katherine L
KL
Possin
Memory and Aging Center (RCG, KLP, LTG, BIC-S, PMG, SL, JM, JHK, BLM, KY, GDR), Department of Neurology, Department of Radiology & Biomedical Imaging (CPH), Department of Pathology (EJH, ALN), Department of Neurosurgery (MSB), and Departments of Psychiatry and Epidemiology and Biostatistics (KY), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (RCG, KY), San Francisco, CA.
Christopher P
CP
Hess
Memory and Aging Center (RCG, KLP, LTG, BIC-S, PMG, SL, JM, JHK, BLM, KY, GDR), Department of Neurology, Department of Radiology & Biomedical Imaging (CPH), Department of Pathology (EJH, ALN), Department of Neurosurgery (MSB), and Departments of Psychiatry and Epidemiology and Biostatistics (KY), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (RCG, KY), San Francisco, CA.
Eric J
EJ
Huang
Memory and Aging Center (RCG, KLP, LTG, BIC-S, PMG, SL, JM, JHK, BLM, KY, GDR), Department of Neurology, Department of Radiology & Biomedical Imaging (CPH), Department of Pathology (EJH, ALN), Department of Neurosurgery (MSB), and Departments of Psychiatry and Epidemiology and Biostatistics (KY), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (RCG, KY), San Francisco, CA.
Lea T
LT
Grinberg
Memory and Aging Center (RCG, KLP, LTG, BIC-S, PMG, SL, JM, JHK, BLM, KY, GDR), Department of Neurology, Department of Radiology & Biomedical Imaging (CPH), Department of Pathology (EJH, ALN), Department of Neurosurgery (MSB), and Departments of Psychiatry and Epidemiology and Biostatistics (KY), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (RCG, KY), San Francisco, CA.
Amber L
AL
Nolan
Memory and Aging Center (RCG, KLP, LTG, BIC-S, PMG, SL, JM, JHK, BLM, KY, GDR), Department of Neurology, Department of Radiology & Biomedical Imaging (CPH), Department of Pathology (EJH, ALN), Department of Neurosurgery (MSB), and Departments of Psychiatry and Epidemiology and Biostatistics (KY), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (RCG, KY), San Francisco, CA.
Brendan I
BI
Cohn-Sheehy
Memory and Aging Center (RCG, KLP, LTG, BIC-S, PMG, SL, JM, JHK, BLM, KY, GDR), Department of Neurology, Department of Radiology & Biomedical Imaging (CPH), Department of Pathology (EJH, ALN), Department of Neurosurgery (MSB), and Departments of Psychiatry and Epidemiology and Biostatistics (KY), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (RCG, KY), San Francisco, CA.
Pia M
PM
Ghosh
Memory and Aging Center (RCG, KLP, LTG, BIC-S, PMG, SL, JM, JHK, BLM, KY, GDR), Department of Neurology, Department of Radiology & Biomedical Imaging (CPH), Department of Pathology (EJH, ALN), Department of Neurosurgery (MSB), and Departments of Psychiatry and Epidemiology and Biostatistics (KY), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (RCG, KY), San Francisco, CA.
Serggio
S
Lanata
Memory and Aging Center (RCG, KLP, LTG, BIC-S, PMG, SL, JM, JHK, BLM, KY, GDR), Department of Neurology, Department of Radiology & Biomedical Imaging (CPH), Department of Pathology (EJH, ALN), Department of Neurosurgery (MSB), and Departments of Psychiatry and Epidemiology and Biostatistics (KY), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (RCG, KY), San Francisco, CA.
Jennifer
J
Merrilees
Memory and Aging Center (RCG, KLP, LTG, BIC-S, PMG, SL, JM, JHK, BLM, KY, GDR), Department of Neurology, Department of Radiology & Biomedical Imaging (CPH), Department of Pathology (EJH, ALN), Department of Neurosurgery (MSB), and Departments of Psychiatry and Epidemiology and Biostatistics (KY), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (RCG, KY), San Francisco, CA.
Joel H
JH
Kramer
Memory and Aging Center (RCG, KLP, LTG, BIC-S, PMG, SL, JM, JHK, BLM, KY, GDR), Department of Neurology, Department of Radiology & Biomedical Imaging (CPH), Department of Pathology (EJH, ALN), Department of Neurosurgery (MSB), and Departments of Psychiatry and Epidemiology and Biostatistics (KY), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (RCG, KY), San Francisco, CA.
Mitchel S
MS
Berger
Memory and Aging Center (RCG, KLP, LTG, BIC-S, PMG, SL, JM, JHK, BLM, KY, GDR), Department of Neurology, Department of Radiology & Biomedical Imaging (CPH), Department of Pathology (EJH, ALN), Department of Neurosurgery (MSB), and Departments of Psychiatry and Epidemiology and Biostatistics (KY), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (RCG, KY), San Francisco, CA.
Bruce L
BL
Miller
Memory and Aging Center (RCG, KLP, LTG, BIC-S, PMG, SL, JM, JHK, BLM, KY, GDR), Department of Neurology, Department of Radiology & Biomedical Imaging (CPH), Department of Pathology (EJH, ALN), Department of Neurosurgery (MSB), and Departments of Psychiatry and Epidemiology and Biostatistics (KY), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (RCG, KY), San Francisco, CA.
Kristine
K
Yaffe
Memory and Aging Center (RCG, KLP, LTG, BIC-S, PMG, SL, JM, JHK, BLM, KY, GDR), Department of Neurology, Department of Radiology & Biomedical Imaging (CPH), Department of Pathology (EJH, ALN), Department of Neurosurgery (MSB), and Departments of Psychiatry and Epidemiology and Biostatistics (KY), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (RCG, KY), San Francisco, CA.
Gil D
GD
Rabinovici