A Case of Possible Chronic Traumatic Encephalopathy and Alzheimer's Disease in an Ex-Football Player

Abstract

Introduction: Chronic traumatic encephalopathy (CTE) is a debilitating neurodegenerative disease, which is often the sequelae of repetitive head trauma. Although the definitive diagnosis of CTE is made postmortem, there are proposed clinical algorithms aimed at identifying characteristic features of CTE, based on a combination of clinical history, serum, cerebrospinal fluid and neuroimaging biomarkers. There are promising new advances in positron emission tomography neuroimaging, including tau specific ligands, which will potentially provide a robust assessment as well as an exploratory tool of the disease semiology and progression. Case Report: Here is a unique case of an ex-football player, who suffered multiple prior traumatic brain injuries throughout his career, and presented to our clinic with significant episodic memory, visuospatial and executive functioning deficits, as well as comorbid mood and behavioral changes in the absence of prior psychiatric history or substance use. His clinical presentation and biomarkers were consistent with a suspected diagnosis of CTE comorbid with Alzheimer disease, which comprises a significant portion of overall CTE cases. Conclusion: This case report presents a patient with a subtle case of dementia, which could be easily mistaken for behavioral variant frontotemporal dementia or primary progressive aphasia. This in turn highlights the importance of detailed longitudinal history taking, as well as rigorous biomarker studies.