A tracer-enhanced PET scan for beta-amyloid plaques was used to diagnosis a former NFL player with post-traumatic dementia related to Chronic Traumatic Encephalopathy (CTE). This case illustrated the importance of differentiating Alzheimer’s from CTE. The individual, in his 70’s, was concerned with his progressive cognitive impairment and sought an evaluation to determine the nature of his problems and possible routes of treatment. He was given a full array of testing including the tracer-enhanced PET scan and neuropsychological tests. The neuropsychological tests showed that certain aspects of his cognitive abilities were relatively intact such as working memory and perceptual reasoning. Other areas, including auditory and visual memory, verbal comprehension, immediate memory and delayed memory were in the severely impaired range with scores no higher than the 16th percentile. The tracer-enhanced PET scan showed none of the beta-amyloid plaques which are associated with Alzheimer’s.
The man played in the NFL for 10-years in the 1960’s and 70’s and experienced multiple concussions, some accompanied by memory loss and disorientation. Following his retirement from football he enjoyed success in another career until his cognitive problems progressed and he sought a diagnostic opinion. Tests such as tracer-enhanced PET scan are not covered by Medicare following a tentative ruling earlier this month. This forced the former NFL player to pay-out-of-pocket for the assessment which likely identified that he did not have Alzheimer’s. The inter-disciplinary team evaluating the results determined that he likely had some form of dementia pugilistica- a tauopathy resulting from repeated blows to the head. They did not rule out Alzheimer’s as a possibility. Had the testing not been performed he would have received a diagnosis of Alzheimer’s without consideration of a tau-related condition and would have likely received treatment for that diagnosis and perhaps even been involved in a medication study for Alzheimer’s.
The tracer-enhanced PET scan offers an opportunity to establish a differential diagnosis and a treatment plan appropriate to CTE. Currently CTE can only be confirmed at autopsy. The use of tracer-enhanced PET technology is potentially important to diagnosing CTE in former NFL players as well as with the high number of veterans from Iraq and Afghanistan who experienced multiple TBI’s and in the years to come are at-risk to develop cognitive and psychological problems associated with aging with a brain injury.
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