Patient B was a 41-year-old right-handed ex-professional football player. He started feeling depressed at age of 30 and it gradually worsened over the years. He developed significant mood swings for three to four years where he cycled between feeling sad, crying, laughing, and becoming angry. He was not diagnosed or treated for mood problems, for he never sought medical help. He has lost interest in his hobbies and slowly reduced his daily activities to lying around at home.
Memory problems started at about age of 39. The memory problems had an insidious onset and gradual progression. Patient B had trouble recalling details of events. He needed to write things down; otherwise, they would not get done. He repeated questions several times a day.
His activities of daily living (ADLs), which are daily self-care activities, including eating, bathing, dressing toileting, transferring, and continence, were not entirely intact. He required reminders to take showers. Although he could dress himself, he required prompting to dress appropriately for the occasion. His instrumental ADLs (iADLs), which are activities requiring skills to successfully live independently, were affected. He was able to go shopping by himself; he could pick out the items and pay for them. His wife took over paying the bills completely, to ensure that bills were paid on time, because he forgot to pay certain bills. His driving was unaffected. He had not had any accidents and had not gotten lost. However, he used the GPS to help him get around. He continued to participate in doing household chores but typically needed assistance. For example, he could start the laundry but would forget to finish the laundry.
He started playing football since age of 13. He played 9-year professional football and 4-year college football. He played football for total of 18 years. He has had numerous events associated with seeing stars/seeing light/dazed for a few minutes during the season. He could not remember how many he had but reported having had quite a few. He did remember experiencing being knocked out four times and being escorted off the field.
His MOCA score was 23/30 and the CDR was 1. On the neuropsychological testing, patient exhibited significant deficit in multiple domains, including complex attention and executive functioning (Table 2). MRI was normal. His neuropsychological testing results and clinical history fulfilled the criteria of DSM V for major neurocognitive disorder, for he had deficits, which interfered with daily life in two different domains.