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Published Online: 19 August 2016

Cognitive Reserve as a Modifier of Clinical Expression in Chronic Traumatic Encephalopathy: A Preliminary Examination

Michael L. Alosco, Ph.D., Jesse Mez, M.D., M.S., Neil W. Kowall, M.D., Thor D. Stein, M.D., Ph.D., Lee E. Goldstein, M.D., Ph.D., Robert C. Cantu, M.D., Douglas I. Katz, M.D., … Show All … , Todd M. Solomon, Ph.D., Patrick T. Kiernan, B.A., Lauren Murphy, B.A., Bobak Abdolmohammadi, B.A., Daniel Daneshvar, M.D., Ph.D., Philip H. Montenigro, B.S., Christopher J. Nowinski, B.A., Robert A. Stern, Ph.D., and Ann C. McKee, M.D.Authors Info & Affiliations
Publication: The Journal of Neuropsychiatry and Clinical Neurosciences
Volume 29, Number 1
https://doi.org/10.1176/appi.neuropsych.16030043
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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.

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Go to The Journal of Neuropsychiatry and Clinical Neurosciences
Go to The Journal of Neuropsychiatry and Clinical Neurosciences
The Journal of Neuropsychiatry and Clinical Neurosciences
Volume 29 • Number 1 • Winter 2017
Pages: 6 - 12
PubMed: 27539377

History

Received: 8 March 2016
Revision received: 28 April 2016
Accepted: 13 May 2016
Published online: 19 August 2016
Published in print: Winter 2017

Authors

Details

Michael L. Alosco, Ph.D.
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).
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Jesse Mez, M.D., M.S.
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).
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Neil W. Kowall, M.D.
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).
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Thor D. Stein, M.D., Ph.D.
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).
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Lee E. Goldstein, M.D., Ph.D.
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).
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Robert C. Cantu, M.D.
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).
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Douglas I. Katz, M.D.
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).
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Todd M. Solomon, Ph.D.
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).
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Patrick T. Kiernan, B.A.
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).
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Lauren Murphy, B.A.
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).
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Bobak Abdolmohammadi, B.A.
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).
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Daniel Daneshvar, M.D., Ph.D.
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).
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Philip H. Montenigro, B.S.
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).
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Christopher J. Nowinski, B.A.
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).
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Robert A. Stern, Ph.D.
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).
View all articles by this author
Ann C. McKee, M.D.
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).
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Notes

Send correspondence to Dr. McKee; e-mail: [email protected]

Funding Information

Department of Defense Peer Reviewed Alzheimer’s Research Program: DoD- PRARP #13267017
Department of Veterans Affairs, the Veterans Affairs Biorepository: CSP 501
U.S. Department of Defense10.13039/100000005: W81XWH-13-2-0064
National Institute on Aging10.13039/100000049: P30AG13846; supplement 0572063345–5, R01AG1649
National Institute of Neurological Disorders and Stroke10.13039/100000065: 1UO1NS086659–01, R01NS078337, R56NS078337
Supported by the National Institute of Neurological Disorders and Stroke (1UO1NS086659-01, R01NS078337, R56NS078337), the Department of Defense (W81XWH-13-2-0064), the Department of Veterans Affairs, the Veterans Affairs Biorepository (CSP 501), the National Institute of Aging Boston University Alzheimer’s Disease Center (P30AG13846; supplement 0572063345–5), the Department of Defense Peer Reviewed Alzheimer’s Research Program (DoD-PRARP #13267017), the National Institute of Aging Boston University Framingham Heart Study (R01AG1649), and the National Operating Committee on Standards for Athletic Equipment and the Concussion Legacy Foundation. This work was also supported by unrestricted gifts from the Andlinger Foundation, the WWE, and the NFL. Michael L. Alosco and research reported in this article are supported by the National Institutes of Health under grant 1F32NS096803-01.Dr. Goldstein is a paid consultant to Johnson & Johnson (New Brunswick, N.J.)/Janssen Research & Development, LLC (Raritan, N.J.), and Rebiscan, Inc. (Cambridge, Mass.); and he has received funding from the WWE and Ivivi Health Sciences. Dr. Nowinski is a member of the Mackey-White Committee of the NFL Players Association and receives fees for speaking at educational programs. Dr. Stern has received research funding from the NFL, the NFL Players Association, and Avid Radiopharmaceuticals, Inc. (Philadelphia); he is a member of the Mackey-White Committee of the NFL Players Association; he is a paid consultant to Athena Diagnostics/Quest Laboratories (Marlborough, Mass.), Amarantus BioScience Holdings, Inc. (San Francisco), and Avanir Pharmaceuticals, Inc. (Aliso Viejo, Calif.); he receives royalties for published neuropsychological tests from Psychological Assessment Resources, Inc. (Lutz, Fla.), as well as compensation from expert legal opinion. Dr. McKee has received funding from the NFL, WWE, and is a member of the Mackey-White Committee of the NFL Players Association. All other authors report no financial relationships with commercial interests.

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