Patient was a 54-year-old right-handed male, former professional football player. He first developed memory problems at the age of 46. Initially, he seemed more forgetful. The onset and the progression of the short-term memory problem were gradual over about eight years. He always did his own finances in the past. However at the age of 46, he started spending money more irrationally and was not paying the bills on-time. He repeated questions, sometimes even just a few minutes later. He had trouble learning new information. He could not manage his own calendar. He has become dependent on the GPS to get around. Patient had become less social. He did not have depressed mood; however, he had become more irritable and more easily angered. He had no behavioral issues. His activities of daily living (ADLs) were intact.
Patient started playing football when he was age 7 or 8. He played football in high school and college and then professionally. He played football for total of 23 years. Although he never lost consciousness, he experienced brief moment of flashes. This type of head injury averaged 3-4 times per game. There is no family history of dementia.
His mini-mental status exam (MMSE) was 24/30, and the clinical dementia rating (CDR) was 1. On neuropsychological testing, he had significant impaired verbal and nonverbal learning, recall, and recognition with rapid forgetting (more than two standard deviations). Patient's MRI showed cortical and subcortical atrophy, enlarged ventricles, and cavum septum pellucidum (Figure 1). The hippocampal volume was below 5 percentile and the inferior lateral ventricle volume was greater than 95 percentile. His diagnosis was major neurocognitive disorder, likely Alzheimer's disease due to CTE.