title: Cognitive Reserve as a Modifier of Clinical Expression in Chronic Traumatic Encephalopathy: A Preliminary Examination.
abstract: This study conducted a preliminary examination on cognitive reserve (CR) as a modifier of symptom expression in subjects with autopsy-confirmed chronic traumatic encephalopathy (CTE). The sample included 25 former professional football players neuropathologically diagnosed with CTE stage III or IV. Next of kin interviews ascertained age at cognitive and behavioral/mood symptom onset and demographic/athletic characteristics. Years of education and occupational attainment defined CR. High occupational achievement predicted later age at cognitive (p=0.02) and behavioral/mood (p=0.02) onset. Education was not an individual predictor. These preliminary findings suggest that CR may forestall the clinical manifestation of CTE.
authors.affiliation: From Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, RCC, TMS, PTK, LM, BA, DD, PHM, CJN, RAS, ACM); the Department of Neurology, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, DIK, TMS, PTK, LM, BA, DD, PHM, RAS, ACM); Internal Medicine Department, North Shore Medical Center (DD); the VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston (NWK, TDS, ACM); the Departments of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston (NWK, TDS, ACM); the Department of Veterans Affairs Medical Center, Bedford, Mass. (TDS, ACM); the Departments of Psychiatry and Ophthalmology, Boston University School of Medicine, Boston (LEG); the Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston (LEG); the Concussion Legacy Foundation (RCC, CJN); the Department of Neurosurgery, Boston University School of Medicine, Boston (RAS); the Department of Neurosurgery, Emerson Hospital, Concord, Mass. (RCC); Braintree Rehabilitation Hospital, Braintree, Mass. (DIK); and the Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston (PHM, RAS).
authors.forename: Michael L
authors.initials: ML
authors.lastname: Alosco
authors.affiliation: From Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, RCC, TMS, PTK, LM, BA, DD, PHM, CJN, RAS, ACM); the Department of Neurology, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, DIK, TMS, PTK, LM, BA, DD, PHM, RAS, ACM); Internal Medicine Department, North Shore Medical Center (DD); the VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston (NWK, TDS, ACM); the Departments of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston (NWK, TDS, ACM); the Department of Veterans Affairs Medical Center, Bedford, Mass. (TDS, ACM); the Departments of Psychiatry and Ophthalmology, Boston University School of Medicine, Boston (LEG); the Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston (LEG); the Concussion Legacy Foundation (RCC, CJN); the Department of Neurosurgery, Boston University School of Medicine, Boston (RAS); the Department of Neurosurgery, Emerson Hospital, Concord, Mass. (RCC); Braintree Rehabilitation Hospital, Braintree, Mass. (DIK); and the Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston (PHM, RAS).
authors.forename: Jesse
authors.initials: J
authors.lastname: Mez
authors.affiliation: From Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, RCC, TMS, PTK, LM, BA, DD, PHM, CJN, RAS, ACM); the Department of Neurology, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, DIK, TMS, PTK, LM, BA, DD, PHM, RAS, ACM); Internal Medicine Department, North Shore Medical Center (DD); the VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston (NWK, TDS, ACM); the Departments of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston (NWK, TDS, ACM); the Department of Veterans Affairs Medical Center, Bedford, Mass. (TDS, ACM); the Departments of Psychiatry and Ophthalmology, Boston University School of Medicine, Boston (LEG); the Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston (LEG); the Concussion Legacy Foundation (RCC, CJN); the Department of Neurosurgery, Boston University School of Medicine, Boston (RAS); the Department of Neurosurgery, Emerson Hospital, Concord, Mass. (RCC); Braintree Rehabilitation Hospital, Braintree, Mass. (DIK); and the Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston (PHM, RAS).
authors.forename: Neil W
authors.initials: NW
authors.lastname: Kowall
authors.affiliation: From Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, RCC, TMS, PTK, LM, BA, DD, PHM, CJN, RAS, ACM); the Department of Neurology, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, DIK, TMS, PTK, LM, BA, DD, PHM, RAS, ACM); Internal Medicine Department, North Shore Medical Center (DD); the VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston (NWK, TDS, ACM); the Departments of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston (NWK, TDS, ACM); the Department of Veterans Affairs Medical Center, Bedford, Mass. (TDS, ACM); the Departments of Psychiatry and Ophthalmology, Boston University School of Medicine, Boston (LEG); the Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston (LEG); the Concussion Legacy Foundation (RCC, CJN); the Department of Neurosurgery, Boston University School of Medicine, Boston (RAS); the Department of Neurosurgery, Emerson Hospital, Concord, Mass. (RCC); Braintree Rehabilitation Hospital, Braintree, Mass. (DIK); and the Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston (PHM, RAS).
authors.forename: Thor D
authors.initials: TD
authors.lastname: Stein
authors.affiliation: From Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, RCC, TMS, PTK, LM, BA, DD, PHM, CJN, RAS, ACM); the Department of Neurology, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, DIK, TMS, PTK, LM, BA, DD, PHM, RAS, ACM); Internal Medicine Department, North Shore Medical Center (DD); the VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston (NWK, TDS, ACM); the Departments of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston (NWK, TDS, ACM); the Department of Veterans Affairs Medical Center, Bedford, Mass. (TDS, ACM); the Departments of Psychiatry and Ophthalmology, Boston University School of Medicine, Boston (LEG); the Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston (LEG); the Concussion Legacy Foundation (RCC, CJN); the Department of Neurosurgery, Boston University School of Medicine, Boston (RAS); the Department of Neurosurgery, Emerson Hospital, Concord, Mass. (RCC); Braintree Rehabilitation Hospital, Braintree, Mass. (DIK); and the Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston (PHM, RAS).
authors.forename: Lee E
authors.initials: LE
authors.lastname: Goldstein
authors.affiliation: From Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, RCC, TMS, PTK, LM, BA, DD, PHM, CJN, RAS, ACM); the Department of Neurology, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, DIK, TMS, PTK, LM, BA, DD, PHM, RAS, ACM); Internal Medicine Department, North Shore Medical Center (DD); the VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston (NWK, TDS, ACM); the Departments of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston (NWK, TDS, ACM); the Department of Veterans Affairs Medical Center, Bedford, Mass. (TDS, ACM); the Departments of Psychiatry and Ophthalmology, Boston University School of Medicine, Boston (LEG); the Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston (LEG); the Concussion Legacy Foundation (RCC, CJN); the Department of Neurosurgery, Boston University School of Medicine, Boston (RAS); the Department of Neurosurgery, Emerson Hospital, Concord, Mass. (RCC); Braintree Rehabilitation Hospital, Braintree, Mass. (DIK); and the Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston (PHM, RAS).
authors.forename: Robert C
authors.initials: RC
authors.lastname: Cantu
authors.affiliation: From Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, RCC, TMS, PTK, LM, BA, DD, PHM, CJN, RAS, ACM); the Department of Neurology, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, DIK, TMS, PTK, LM, BA, DD, PHM, RAS, ACM); Internal Medicine Department, North Shore Medical Center (DD); the VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston (NWK, TDS, ACM); the Departments of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston (NWK, TDS, ACM); the Department of Veterans Affairs Medical Center, Bedford, Mass. (TDS, ACM); the Departments of Psychiatry and Ophthalmology, Boston University School of Medicine, Boston (LEG); the Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston (LEG); the Concussion Legacy Foundation (RCC, CJN); the Department of Neurosurgery, Boston University School of Medicine, Boston (RAS); the Department of Neurosurgery, Emerson Hospital, Concord, Mass. (RCC); Braintree Rehabilitation Hospital, Braintree, Mass. (DIK); and the Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston (PHM, RAS).
authors.forename: Douglas I
authors.initials: DI
authors.lastname: Katz
authors.affiliation: From Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, RCC, TMS, PTK, LM, BA, DD, PHM, CJN, RAS, ACM); the Department of Neurology, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, DIK, TMS, PTK, LM, BA, DD, PHM, RAS, ACM); Internal Medicine Department, North Shore Medical Center (DD); the VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston (NWK, TDS, ACM); the Departments of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston (NWK, TDS, ACM); the Department of Veterans Affairs Medical Center, Bedford, Mass. (TDS, ACM); the Departments of Psychiatry and Ophthalmology, Boston University School of Medicine, Boston (LEG); the Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston (LEG); the Concussion Legacy Foundation (RCC, CJN); the Department of Neurosurgery, Boston University School of Medicine, Boston (RAS); the Department of Neurosurgery, Emerson Hospital, Concord, Mass. (RCC); Braintree Rehabilitation Hospital, Braintree, Mass. (DIK); and the Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston (PHM, RAS).
authors.forename: Todd M
authors.initials: TM
authors.lastname: Solomon
authors.affiliation: From Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, RCC, TMS, PTK, LM, BA, DD, PHM, CJN, RAS, ACM); the Department of Neurology, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, DIK, TMS, PTK, LM, BA, DD, PHM, RAS, ACM); Internal Medicine Department, North Shore Medical Center (DD); the VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston (NWK, TDS, ACM); the Departments of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston (NWK, TDS, ACM); the Department of Veterans Affairs Medical Center, Bedford, Mass. (TDS, ACM); the Departments of Psychiatry and Ophthalmology, Boston University School of Medicine, Boston (LEG); the Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston (LEG); the Concussion Legacy Foundation (RCC, CJN); the Department of Neurosurgery, Boston University School of Medicine, Boston (RAS); the Department of Neurosurgery, Emerson Hospital, Concord, Mass. (RCC); Braintree Rehabilitation Hospital, Braintree, Mass. (DIK); and the Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston (PHM, RAS).
authors.forename: Patrick T
authors.initials: PT
authors.lastname: Kiernan
authors.affiliation: From Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, RCC, TMS, PTK, LM, BA, DD, PHM, CJN, RAS, ACM); the Department of Neurology, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, DIK, TMS, PTK, LM, BA, DD, PHM, RAS, ACM); Internal Medicine Department, North Shore Medical Center (DD); the VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston (NWK, TDS, ACM); the Departments of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston (NWK, TDS, ACM); the Department of Veterans Affairs Medical Center, Bedford, Mass. (TDS, ACM); the Departments of Psychiatry and Ophthalmology, Boston University School of Medicine, Boston (LEG); the Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston (LEG); the Concussion Legacy Foundation (RCC, CJN); the Department of Neurosurgery, Boston University School of Medicine, Boston (RAS); the Department of Neurosurgery, Emerson Hospital, Concord, Mass. (RCC); Braintree Rehabilitation Hospital, Braintree, Mass. (DIK); and the Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston (PHM, RAS).
authors.forename: Lauren
authors.initials: L
authors.lastname: Murphy
authors.affiliation: From Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, RCC, TMS, PTK, LM, BA, DD, PHM, CJN, RAS, ACM); the Department of Neurology, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, DIK, TMS, PTK, LM, BA, DD, PHM, RAS, ACM); Internal Medicine Department, North Shore Medical Center (DD); the VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston (NWK, TDS, ACM); the Departments of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston (NWK, TDS, ACM); the Department of Veterans Affairs Medical Center, Bedford, Mass. (TDS, ACM); the Departments of Psychiatry and Ophthalmology, Boston University School of Medicine, Boston (LEG); the Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston (LEG); the Concussion Legacy Foundation (RCC, CJN); the Department of Neurosurgery, Boston University School of Medicine, Boston (RAS); the Department of Neurosurgery, Emerson Hospital, Concord, Mass. (RCC); Braintree Rehabilitation Hospital, Braintree, Mass. (DIK); and the Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston (PHM, RAS).
authors.forename: Bobak
authors.initials: B
authors.lastname: Abdolmohammadi
authors.affiliation: From Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, RCC, TMS, PTK, LM, BA, DD, PHM, CJN, RAS, ACM); the Department of Neurology, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, DIK, TMS, PTK, LM, BA, DD, PHM, RAS, ACM); Internal Medicine Department, North Shore Medical Center (DD); the VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston (NWK, TDS, ACM); the Departments of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston (NWK, TDS, ACM); the Department of Veterans Affairs Medical Center, Bedford, Mass. (TDS, ACM); the Departments of Psychiatry and Ophthalmology, Boston University School of Medicine, Boston (LEG); the Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston (LEG); the Concussion Legacy Foundation (RCC, CJN); the Department of Neurosurgery, Boston University School of Medicine, Boston (RAS); the Department of Neurosurgery, Emerson Hospital, Concord, Mass. (RCC); Braintree Rehabilitation Hospital, Braintree, Mass. (DIK); and the Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston (PHM, RAS).
authors.forename: Daniel
authors.initials: D
authors.lastname: Daneshvar
authors.affiliation: From Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, RCC, TMS, PTK, LM, BA, DD, PHM, CJN, RAS, ACM); the Department of Neurology, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, DIK, TMS, PTK, LM, BA, DD, PHM, RAS, ACM); Internal Medicine Department, North Shore Medical Center (DD); the VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston (NWK, TDS, ACM); the Departments of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston (NWK, TDS, ACM); the Department of Veterans Affairs Medical Center, Bedford, Mass. (TDS, ACM); the Departments of Psychiatry and Ophthalmology, Boston University School of Medicine, Boston (LEG); the Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston (LEG); the Concussion Legacy Foundation (RCC, CJN); the Department of Neurosurgery, Boston University School of Medicine, Boston (RAS); the Department of Neurosurgery, Emerson Hospital, Concord, Mass. (RCC); Braintree Rehabilitation Hospital, Braintree, Mass. (DIK); and the Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston (PHM, RAS).
authors.forename: Philip H
authors.initials: PH
authors.lastname: Montenigro
authors.affiliation: From Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, RCC, TMS, PTK, LM, BA, DD, PHM, CJN, RAS, ACM); the Department of Neurology, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, DIK, TMS, PTK, LM, BA, DD, PHM, RAS, ACM); Internal Medicine Department, North Shore Medical Center (DD); the VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston (NWK, TDS, ACM); the Departments of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston (NWK, TDS, ACM); the Department of Veterans Affairs Medical Center, Bedford, Mass. (TDS, ACM); the Departments of Psychiatry and Ophthalmology, Boston University School of Medicine, Boston (LEG); the Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston (LEG); the Concussion Legacy Foundation (RCC, CJN); the Department of Neurosurgery, Boston University School of Medicine, Boston (RAS); the Department of Neurosurgery, Emerson Hospital, Concord, Mass. (RCC); Braintree Rehabilitation Hospital, Braintree, Mass. (DIK); and the Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston (PHM, RAS).
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Nowinski
authors.affiliation: From Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, RCC, TMS, PTK, LM, BA, DD, PHM, CJN, RAS, ACM); the Department of Neurology, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, DIK, TMS, PTK, LM, BA, DD, PHM, RAS, ACM); Internal Medicine Department, North Shore Medical Center (DD); the VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston (NWK, TDS, ACM); the Departments of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston (NWK, TDS, ACM); the Department of Veterans Affairs Medical Center, Bedford, Mass. (TDS, ACM); the Departments of Psychiatry and Ophthalmology, Boston University School of Medicine, Boston (LEG); the Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston (LEG); the Concussion Legacy Foundation (RCC, CJN); the Department of Neurosurgery, Boston University School of Medicine, Boston (RAS); the Department of Neurosurgery, Emerson Hospital, Concord, Mass. (RCC); Braintree Rehabilitation Hospital, Braintree, Mass. (DIK); and the Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston (PHM, RAS).
authors.forename: Robert A
authors.initials: RA
authors.lastname: Stern
authors.affiliation: From Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, RCC, TMS, PTK, LM, BA, DD, PHM, CJN, RAS, ACM); the Department of Neurology, Boston University School of Medicine, Boston (MLA, JM, NWK, TDS, LEG, DIK, TMS, PTK, LM, BA, DD, PHM, RAS, ACM); Internal Medicine Department, North Shore Medical Center (DD); the VA Boston Healthcare System, U.S. Department of Veteran Affairs, Boston (NWK, TDS, ACM); the Departments of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston (NWK, TDS, ACM); the Department of Veterans Affairs Medical Center, Bedford, Mass. (TDS, ACM); the Departments of Psychiatry and Ophthalmology, Boston University School of Medicine, Boston (LEG); the Departments of Biomedical, Electrical & Computer Engineering, Boston University College of Engineering, Boston (LEG); the Concussion Legacy Foundation (RCC, CJN); the Department of Neurosurgery, Boston University School of Medicine, Boston (RAS); the Department of Neurosurgery, Emerson Hospital, Concord, Mass. (RCC); Braintree Rehabilitation Hospital, Braintree, Mass. (DIK); and the Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston (PHM, RAS).
authors.forename: Ann C
authors.initials: AC
authors.lastname: McKee
mesh_terms: D017668:Age of Onset; D000368:Aged; D056352:Athletes; D001265:Athletic Injuries / Q000150:complications / Q000175:diagnosis / Q000523:psychology; D001526:Behavioral Symptoms; D000070627:Chronic Traumatic Encephalopathy / Q000175:diagnosis / Q000209:etiology / Q000523:psychology*; D060825:Cognitive Dysfunction / Q000175:diagnosis / Q000209:etiology / Q000523:psychology; D058245:Cognitive Reserve; D004522:Educational Status; D005190:Family; D005538:Football; D006801:Humans; D007407:Interviews as Topic; D016014:Linear Models; D008297:Male; D009790:Occupations; D012189:Retrospective Studies