Late Presentation of Chronic Traumatic Encephalopathy in a Former Association Football Player

BackgroundChronic traumatic encephalopathy (CTE) is a neurodegenerative disease characterized by widespread accumulation of hyperphosphorylated tau that typically occurs in people who have suffered repetitive head impacts. To date, very few cases have been reported in association football players. ObjectivesTo describe the clinicopathological features of a case of CTE in an 84-year-old former football player who was clinically diagnosed as having dementia with Lewy bodies (DLB). MethodsA retrospective review of the patient's primary care and hospital medical records was performed along with a comprehensive neuropathological examination. ResultsThis patient presented at age 84 with symmetrical parkinsonism and cognitive impairment that was exacerbated by prochlorperazine. His condition was rapidly progressive with recurrent falls within 1 year. Other features included headaches, depression, anxiety, suicidal ideation, disturbed sleep and aggression. He received a clinical diagnosis of DLB and died approximately 2 years after the onset of symptoms. A post-mortem examination revealed stage 4 CTE. ConclusionsWhile the contemporaneous onset of parkinsonism and cognitive symptoms in the context of possible neuroleptic sensitivity is suggestive of DLB, the additional symptoms of aggressive behavior, depression and suicidality in a former football player are consistent with the neuropathological diagnosis of CTE. This case, which is notable for the late presentation, demonstrates that CTE may masquerade as other dementias and highlights the importance of seeking a history of repetitive head impacts.

Automated summary

This study describes a clinical case of chronic traumatic encephalopathy (CTE) in an 84-year-old former football player. Initially misdiagnosed as Parkinson's disease and dementia with Lewy bodies (DLB), the patient was found to have CTE through post-mortem examination. This case highlights the importance of considering a history of repetitive head impacts and the possibility of CTE, as it can mimic other dementias.