Abstract
Multiple sports-related concussions have been associated with neurocognitive impairments ranging from a mild dementia to full Alzheimer’s disease. Quantifying injuries and associated impairments is important to a diagnosis and management strategy. In addition to a necessary history and physical exam, other testing is always needed to confirm clinical suspicions. Radiology and imaging is often added, but they are often insensitive and nonspecific. An often neglected alternative or addition is electrophysiological assessment. Quantitative EEG, such as eVox, (which we call functional EEG) is one such readily available, objective electrophysiological system that has a large database with which to refer. In our clinic we evaluated a case series of 150 retired former professional American Football players who presented with histories of concussion and persistent symptoms of cognitive impairments. Their evaluations included comprehensive examinations, brain MRI (concussion protocol,) neurocognitive testing, and quantitative electroencephalography (Evoke NeuroScience.). Males, ages 32 to 65 years with professional football careers ranging from 1 to 18 years. Physical exams included ataxia of speech and gait, word finding impairments, nystagmus, pendular reflexes, and abnormal affect. Neurocognitive testing revealed impairments in up to five cognitive domains. MRI (concussion protocol) were positive findings in only 34%. Evoke EEG findings included delayed P300a and P300b, reduced EEG power in regions associated with working memory, and information processing and alterations in heart rate variability. The physical-neurological exam provided some objective findings, but they were often subtle. Brain MRIs were abnormal in only 34%. Neurocognitive testing identified abnormalities in all cases. The Evoke EEG provided electrophysiological abnormalities in all cases. Evoke EEG is sensitive and objective, and adds confirmatory neurophysiological data that correlate tightly with formal neurocognitive impairments and symptoms. Additionally, specific abnormal patterns provided objective rationale for targeted treatment regimens, including neurofeedback and neurocognitive training.