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59 Objectively-Measured Performance on Tests of Episodic Memory and Executive Function in Autopsy-Confirmed Chronic Traumatic Encephalopathy

Published online by Cambridge University Press:  21 December 2023

Madeline Uretsky*
Affiliation:
Boston University Alzheimer’s Disease and CTE Centers, Boston University School of Medicine, Boston, MA, USA. Neuropsychological Assessment Clinic, Brighton, MA, USA.
Evan Nair
Affiliation:
Boston University Alzheimer’s Disease and CTE Centers, Boston University School of Medicine, Boston, MA, USA.
Nicole Saltiel
Affiliation:
Boston University Alzheimer’s Disease and CTE Centers, Boston University School of Medicine, Boston, MA, USA.
Bobak Abdolmohammadi
Affiliation:
Boston University Alzheimer’s Disease and CTE Centers, Boston University School of Medicine, Boston, MA, USA.
Sydney Mosaheb
Affiliation:
Boston University Alzheimer’s Disease and CTE Centers, Boston University School of Medicine, Boston, MA, USA.
Julia Culhane
Affiliation:
Boston University Alzheimer’s Disease and CTE Centers, Boston University School of Medicine, Boston, MA, USA.
Brett Martin
Affiliation:
Boston University Alzheimer’s Disease and CTE Centers, Boston University School of Medicine, Boston, MA, USA. Biostatistics & Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA.
Joseph Palmisano
Affiliation:
Boston University Alzheimer’s Disease and CTE Centers, Boston University School of Medicine, Boston, MA, USA. Biostatistics & Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA.
Yorghos Tripodis
Affiliation:
Boston University Alzheimer’s Disease and CTE Centers, Boston University School of Medicine, Boston, MA, USA. Biostatistics & Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA.
Robert Stern
Affiliation:
Boston University Alzheimer’s Disease and CTE Centers, Boston University School of Medicine, Boston, MA, USA.
Victor Alvarez
Affiliation:
Boston University Alzheimer’s Disease and CTE Centers, Boston University School of Medicine, Boston, MA, USA. VA Boston Healthcare System, Boston, MA, USA
Bertrand Russell Huber
Affiliation:
Boston University Alzheimer’s Disease and CTE Centers, Boston University School of Medicine, Boston, MA, USA. VA Boston Healthcare System, Boston, MA, USA
Thor Stein
Affiliation:
Boston University Alzheimer’s Disease and CTE Centers, Boston University School of Medicine, Boston, MA, USA. VA Boston Healthcare System, Boston, MA, USA
Ann McKee
Affiliation:
Boston University Alzheimer’s Disease and CTE Centers, Boston University School of Medicine, Boston, MA, USA. VA Boston Healthcare System, Boston, MA, USA
Jesse Mez
Affiliation:
Boston University Alzheimer’s Disease and CTE Centers, Boston University School of Medicine, Boston, MA, USA.
Michael Alosco
Affiliation:
Boston University Alzheimer’s Disease and CTE Centers, Boston University School of Medicine, Boston, MA, USA.
*
Correspondence: Madeline Uretsky, Boston University Alzheimer’s Disease and CTE Centers, Boston University School of Medicine; Neuropsychological Assessment Clinic. muretsky@bu.edu
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Abstract

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Objective:

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease that can only be diagnosed at post-mortem. Revised criteria for the clinical syndrome of CTE, known as traumatic encephalopathy syndrome (TES), include impairments in episodic memory and/or executive function as core clinical features. These criteria were informed by retrospective interviews with next-of-kin and the presence and rates of objective impairments in memory and executive functions in CTE are unknown. Here, we characterized antemortem neuropsychological test performance in episodic memory and executive functions among deceased contact sport athletes neuropathologically diagnosed with CTE.

Participants and Methods:

The sample included 80 deceased male contact sport athletes from the UNITE brain bank who had autopsy-confirmed CTE (and no other neurodegenerative diseases). Published criteria were used for the autopsy diagnosis of CTE. Neuropsychological test reports (raw scores) were acquired through medical record requests. Raw scores were converted to z-scores using the same age, sex, and education-adjusted normative data. Tests of memory included long delay trials from the Rey Complex Figure, CVLT-II, HVLT-R, RBANS, and BVMT-R. Tests of executive functions included Trail Making Test-B (TMT-B), Controlled Oral Word Association Test, WAIS-III Picture Arrangement, and various WAIS-IV subtests. Not all brain donors had the same tests, and the sample sizes vary across tests, with 33 donors having tests from both domains. Twenty-eight had 1 test in memory and 3 had 2+. Eight had 1 test of executive function and 46 had 2+. A z-score of 1.5 standard deviations below the normative mean was impaired. Interpretation of test performance followed the American Academy of Clinical Neuropsychology guidelines (Guilmette et al., 2020). Bivariate correlations assessed cumulative p-tau burden (summary semiquantitative ratings of p-tau severity across 11 brain regions) and TMT-B (n=34) and CVLT-II (n=14), the most common tests available.

Results:

Of the 80 (mean age= 59.9, SD=18.0 years; 13, 16.3% were Black), 72 played football, 4 played ice hockey, and 4 played other contact sports. Most played at the professional level (57, 71.3%). Mean time between neuropsychological testing and death was 3.9 (SD= 4.5) years. The most common reason for testing was dementia-related (43, 53.8%). Mean z-scores fell in the average psychometric range(mean z= -0.52, SD=1.5, range= -6.0 to 3.0) for executive function and the low average range for memory (mean z= -1.3, SD=1.1, range= -4.0 to 2.0). Eleven (20.4%) had impairment on 1 test and 3 (5.6%) on 2+ tests of executive functions. The most common impairment was on TMT-B (mean z= -1.77, 13 [38.2%] impaired). For memory, 13 (41.9%) had impairment on 1 test. Of the 14 who had CVLT-II, 7 were impaired (mean z= -1.33). Greater p-tau burden was associated with worse performance on CVLT-II (r= -.653, p= .02), but not TMT-B (r= .187, p>.05).

Conclusions:

This study provides the first evidence for objectively-measured impairments in executive functions and memory in a sample with known, autopsy-confirmed CTE. Furthermore, p-tau burden corresponded to worse memory test performance. Examination of neuropsychological tests from medical records has limitations but can overcome shortcomings of retrospective informant reports to provide insight into the cognitive profiles associated with CTE.

Type
Poster Session 03: Dementia | Amnesia | Memory | Language | Executive Functions
Copyright
Copyright © INS. Published by Cambridge University Press, 2023