NFL's Concussion Settlement Testing May Miss Cognitive Decline, Study Finds

Researchers at Boston University have completed the largest study to date characterizing the cognitive symptoms of NFL players with autopsy-confirmed chronic traumatic encephalopathy (CTE) who underwent neuropsychological testing while alive. CTE is a neurodegenerative disease linked to repeated head impacts that cannot yet be accurately diagnosed during life, partly because its specific symptoms have not been established.

The study examined 33 former NFL players who were diagnosed with CTE at autopsy and had completed the NFL Concussion Settlement's Baseline Assessment Program (BAP), a standardized paper-and-pencil neuropsychological test battery. Their average age at testing was 63, and their average age at death was 65; the families of the 33 participants, who donated their brains, provided the BAP records. The results were published in JAMA Network Open.

Memory problems, particularly short-term memory, were the most common finding, affecting 63% of participants, with more advanced CTE associated with worse memory performance. The researchers also found impairments in executive function (52%), language (41%) and attention (26%). "This is the largest study of its kind to directly link the amount of CTE pathology found at autopsy with objective cognitive testing during life," said lead author Anna Aaronson, a PhD student at the Boston University CTE Center.

The researchers also found that the settlement's testing program may miss cases of cognitive decline. Seven participants had advanced CTE (stage 3 or 4); six of them showed measurable cognitive impairment on testing, yet all seven received the BAP's lowest impairment rating, Level 0.

"The BAP's diagnostic criteria might miss cases of cognitive impairment that are objectively measurable and associated with confirmed CTE pathology," said Michael Alosco, co-director of clinical research at the BU CTE Center, adding that this has implications for former players seeking diagnosis and compensation through the settlement.