Patient A was a 39-year-old right-handed former professional football player. He presented to Memory Disorders Clinic in a tertiary care hospital for evaluation of memory problems. He first developed mood problems with irritability, depression, and social withdrawal about the time he retired from professional football in his early 30s. He experienced significant mood swings, sometimes laughing uncontrollably, rocking, pacing, and grumbling. He also had suicidal ideations. Later, short-term memory problems started insidiously and gradually worsened into his mid-30s. He was quick to forget, constantly repeated questions, often forgot his appointments, and misplaced objects. He had difficulty with directions and relied on GPS to get around. He would forget to pay his bills, and thus management of the finances was taken over by his caregiver. He had difficulty performing at his job, for he could not remember the tasks. He also became frustrated easily and could not multitask.
Patient A started playing football at age of 5. He played football for total of 25 years. He experienced eight concussions, in which he lost consciousness in four of them. In addition, he experienced brief "bell rung," hitting his head and seeing stars, which occurred at least once if not more every time he played football. There is no family history of Alzheimer's disease.
His MOCA score was 20/30 and the CDR was 1. On the neuropsychological testing, patient exhibited significant deficit in multiple domains, including complex attention and executive and memory functioning (Table 2). Patient A's MRI brain was normal. Patient did not carry a psychiatric diagnosis previously. Diagnosis was major neurocognitive disorder, chronic traumatic encephalopathy, and major depressive disorder based on history and neuropsychological testing.