Neuropsychological test performance of former American football players
Authors: Alosco Michael L. , Barr William B. , Banks Sarah J. , Wethe Jennifer V. , Miller Justin B. , Pulukuri Surya Vamsi , Culhane Julia , Tripodis Yorghos , Adler Charles H. , Balcer Laura J. , Bernick Charles , Mariani Megan L. , Cantu Robert C. , Dodick David W. , McClean Michael D. , Au Rhoda , Mez Jesse , Turner Robert W. , Palmisano Joseph N. , Martin Brett , Hartlage Kaitlin , Cummings Jeffrey L. , Reiman Eric M. , Shenton Martha E. , Stern Robert A. ,   for the DIAGNOSE CTE Research Project, Su Yi , Chen Kewei , Protas Hillary , Boker Connie , Farrer Lindsay , Helm Robert , Katz Douglas I. , Kowall Neil , Mercier Gustavo , Otis James , Weller Jason , Simkin Irene , Andino Alondra , Conneely Shannon , Diamond Courtney , Fagle Tessa , Haller Olivia , Hunt Tennyson , Gullotti Nicole , Mayville Brian , McLaughlin Kathleen , Nanna Mary , Platt Taylor , Rice Fiona , Sestak Madison , Annis Douglas , Chaisson Christine , Dixon Diane B. , Finney Carolyn , Gallagher Kerrin , Lu Jun , Ojo Emmanuel , Pine Brittany , Ramachandran Janani , Bouix Sylvain , Fitzsimmons Jennifer , Lin Alexander P. , Koerte Inga K. , Pasternak Ofer , Arciniega Hector , Billah Tashrif , Bonke Elena , Breedlove Katherine , Coello Eduardo , Coleman Michael J. , Jung Leonhard , Liao Huijun , Loy Maria , Rizzoni Elizabeth , Schultz Vivian , Silva Annelise , Vessey Brynn , Wiegand Tim L. T. , Ritter Aaron , Sabbagh Marwan , de la Cruz Raelynn , Durant Jan , Golceker Morgan , Harmon Nicolette , Kaylegian Kaeson , Long Rachelle , Nance Christin , Sandoval Priscilla , Marek Kenneth L. , Serrano Andrew , Geda Yonas , Falk Bryce , Duffy Amy , Howard Marci , Montague Michelle , Osgood Thomas , Babcock Debra , Bellgowan Patrick , Goldberg Judith , Wisniewski Thomas , Kirov Ivan , Lui Yvonne , Marmar Charles , Hasanaj Lisena , Serrano Liliana , Al-Kharafi Alhassan , George Allan , Martin Sammie , Riley Edward , Runge William , Peskind Elaine R. , Colasurdo Elizabeth , Marcus Daniel S. , Gurney Jenny , Greenwald Richard , Johnson Keith A. 
Published: January 2023

Abstract
Background
Patterns of cognitive impairment in former American football players are uncertain because objective neuropsychological data are lacking. This study characterized the neuropsychological test performance of former college and professional football players.

Methods
One hundred seventy male former football players (n=111 professional, n=59 college; 45–74 years) completed a neuropsychological test battery. Raw scores were converted to T-scores using age, sex, and education-adjusted normative data. A T-score ≤ 35 defined impairment. A domain was impaired if 2+ scores fell in the impaired range except for the language and visuospatial domains due to the limited number of tests.

Results
Most football players had subjective cognitive concerns. On testing, rates of impairments were greatest for memory (21.2% two tests impaired), especially for recall of unstructured (44.7%) versus structured verbal stimuli (18.8%); 51.8% had one test impaired. 7.1% evidenced impaired executive functions; however, 20.6% had impaired Trail Making Test B. 12.1% evidenced impairments in the attention, visual scanning, and psychomotor speed domain with frequent impairments on Trail Making Test A (18.8%). Other common impairments were on measures of language (i.e., Multilingual Naming Test [21.2%], Animal Fluency [17.1%]) and working memory (Number Span Backward [14.7%]). Impairments on our tasks of visuospatial functions were infrequent.

Conclusions
In this sample of former football players (most of whom had subjective cognitive concerns), there were diffuse impairments on neuropsychological testing with verbal memory being the most frequently impaired domain.