amen clinic nfl study by dr. willeumier at ifv conference 2012
TRANSCRIPT
Amen Clinic NFLBrain Imaging
Brain Rehab Study
Our NFL Story Started in 1991
In 1991, brain SPECT imaging work Brain injuries greater part of psychiatric
problems than most people knewSaw many high school and college football
players with brain injuries on scans who had troubled behavior
Middle Linebacker UC, BerkeleyArrested for Domestic Violence
Healthy College Player
ESPN Highlights and ArrestsAs a fan I watched highlights
Then who was arrested that day
Thought there must be serious
brain damage among many
active and retired players
Just imagine someone like
Ron Yary hitting you
30 -50 timesa game
NFL Position On Brain TraumaStarted Committee on MTBI in 1994“Said they didn’t know if football caused long
term brain damage, more studies needed.”Curiously, had the same position in 2009??NFL acting like many employers with worker’s
compensation claims – delay, deny, and blame the employee … steroids, alcohol, laziness
The Problem with the NFL PositionIF YOU DON’T ADMIT YOU HAVE A
PROBLEM, YOU CANNOT DO ANYTHING
TO SOLVE IT
Many, many brain damaged retired players
are currently left without help or hope
2000Brent Boyd
Minnesota VikingsOffensive Guard
6 Seasons
Brent Came To See Us For:HeadachesDepressionFatigueMemory ProblemsDizzinessHe was also overweight
Healthy BB
Clear Evidence of Serious Brain Trauma
NFL Hired Doctor’sScans mean nothingThey say his problems not work-relatedDeny his claimBrent gets traumatized twice
once by his brain injuries andagain by being called a liar or a faker
2007Anthony Davis
College Football Hall of Fame Running Back from USC and NFL
Player
Healthy At age 54, brain looked 85
Before Treatment After Treatment
Los Angeles Chapter NFLPA
• AD Invites me to speak February 2009
• Meet many players who clearly needed help
• Someone has to answer question, “Does playing football in the NFL cause brain damage?”
• Team up with Reggie Berry, Marvin Smith and Dr. Joe Wu to design our study
• LA Chapter helps us recruit our first players
Where To Get The Money?• First arm of study paid for by me personally to
insure independence
• Total cost is about $5,000 a player
• Most of researchers who helped volunteered their time
Study Design
• Brain SPECT imaging (blood flow)
• Conners’ CPT (Continuous Performance Test)
• QEEG (Quantitative Electroencephalography)
• MCIS (Mild Cognitive Impairment Screen)
• Microcog (Measures 9 different cognitive scales)
Current Status of Our Study
• 115 Active and Retired Players
• From 27 teams
• All positions
• Ages 25 – 85
Reported Number of Concussions
• 0 = 14%
• 1-2 = 24%
• 3-5 = 19%
• > 5 = 43%
Important Numbers• Obese = 48%
• Sleep apnea = 30%
• Depression = 28%
• Dementia = 19%
• CPT = 81% abnormal
• Microcog = below
average in all
categories except
spatial processing and
reaction time
Outcomes
• > 90% had brain trauma pattern on brain
SPECT and QEEGs
• Severe decreased activity … across whole
brain
• Results are HIGHLY STATISTICALLY
SIGNIFICANT!
Damage Seen Across Whole Brain
Damage Seen Across Whole Brain
• Confirmation Number: 82635741
20 Year PlayerDamage across whole brain
Offensive Lineman 12 yr NFL
Running Back 4 yr NFL
Defensive Back 3 yr NFL
Linebacker 10 yr NFL
Wide Receiver 8 yr NFL
Tight End 8 yr NFL
Quarterback 18 yr NFL
Damage Seen Especially In Prefrontal, Temporal and Cerebellar Regions
judgment, focus, and
impulse control
memory, learning,
emotion & moods
physical coordination and
thought coordination
Brain Rehab Program• Damage so high, we added a “pragmatic”
rehab component• Brain healthy strategies• weight loss for obese players • coordination exercises• healthy diet• recommended sleep apnea evaluations• avoid toxic substances (drugs, much alcohol)
Brain Rehab Program• High potency multiple vitamin
• Omega 3 supplement, 5.6 grams a day
• Brain and Memory Power Boost Formula – vinpocitine, gingko, PS, huperzine A, acetyl-l-carnitine, n-acetylcysteine, alpha lipoic acid
• Other recommendations for individual player needs, such as treating depression, anxiety, alcoholism, ADD, dementia or using HBOT
Preliminary Results• 30 players with follow up
scans/cognitive tests• 25 showed improvement • Especially in:
• Memory (69%)• Attention (53%)• Mood (38%)• Motivation (38%)• Sleep (25%)
General cognitive functioning
31.8 (24.1) 43.4 (25.7) <0.000 14
General cognitive proficiency
24.7 (20.1) 35.2 (23.5) <0.000 14
Processing speed 33.1 (24.8) 39.3 (25.5) 0.026 12
Processing accuracy
40.9 (28.7) 48.5 (29.1) 0.012 13
Attention 38.4 (26.2) 48.7 (27.6) 0.025 9
Reasoning 32.7 (25.7) 41.6 (28.0) 0.006 11
Memory 33.8 (27.4) 42.9 (28.4) 0.022 17
Spatial processing 69.0 (21.8) 74.3 (13.2) 0.154 3
Reaction time 70.2 (24.5) 74.67 (22.9) 0.669 6
MicroCog Before After p value #> 50% better
Elston Ridgle (45) Before After %
• General Cognitive Fun. 39 61 56%+
• Information Processing 53 81 53%+
• Attention 45 45 0%
• Reasoning 50 77 54%+
• Memory 25 73 192%+
Big Ed White (62) Before After %
• General Cognitive Fun. 21 39 90%+
• Information Processing 25 58 > 100%+
• Attention 21 25 2%
• Reasoning 3 13 > 400%+
• Memory 14 66 > 470%+
“Little” Ed White
John Hauser (74) Before After %
• General Cognitive Fun. 19 42 121%+
• Information Processing 55 90 64%+
• Attention 12 58 383%+
• Reasoning 39 50 28%+
• Memory 23 39 70%+
Gern Nagler (77) Before After %
• General Cognitive Fun. 63 77 22%+
• Information Processing 42 70 66%+
• Attention 45 73 62%+
• Reasoning 75 75 0%
• Memory 50 86 72%+
Before After 8 mos
Tight End 8 yr NFL
Before After 18 months
Tight End 10 yr NFL
Before After 18 months
Offensive Tackle 12 yr NFL
Defensive Tackle 2 yr NFL
Our interventions plus 40 Sessions of HBOT
Conclusions• Based on our sample, playing football in
the NFL puts players at risk for brain damage & long-term cognitive and mood problems
• Preliminarily: The brain has potential to improve with a comprehensive rehab program
• More studies immediately needed to evaluate components of our study and other interventions such as HBOT, neurofeedback, and meds such as memantine and modafinil
Conclusions• General brain health principles should be
taught to all active and former players
• More intense brain rehab offered to current and former players
• Targeted supplements, such as omega 3s and the ones we used
• Start using brain imaging tools, like SPECT and QEEG on any player with a concussion
Conclusions• Implications go beyond NFL to:
• High school and college athletes
• Military personnel (15% of soldiers returning from Iraq and Afghanistan have brain injuries)
• 2 million people each year who acquire brain injuries
NFL/Amen Clinics Collaboration?• We have a great cohort for a long term study
• We have a waiting list of dozens of players and could easily recruit hundreds more, players trust us
• We could add DTI and genetic markers
• Help us on design better studies
• Help us find funding to continue our work
If I Was The Commissioner• Be an advocate and a leader for brain health
among football players, stop the bad press with genuine care and concern
• Invest in unbiased studies, with researchers who have a sense of urgency
• Evaluate all players coming into the league to establish baseline level of brain function
If I Was The Commissioner
• Treat concussions early and effectively• Work to identify retired players who are
troubled and get them the help they need
• It will be less expensive in the long run
• Lawyers and legal battles are very expensive
High blood pressure
Diabetes
High sugar diets
Environmental toxins
Chronic stress
Lack of exercise
Brain injuries
Drugs
Alcohol
Obesity
Sleep apnea
Smoking
BRAIN RECOVERY PLAN: PART A STOP HURTING YOUR BRAIN
BRAIN RECOVERY PLAN: PART BSTART HELPING THE BRAIN
Social connections
New learning
Great diet
Calorie restriction
Omega 3s
Supplements, Vit D
Green tea
Exercise
Coordination
Gratitude
Meditation
Healthy sleep
With GratitudeAll of our playersLos Angeles Chapter of the Retired NFLPA,
especially Reggie Berry and Marvin SmithIndependent Football Veterans Conference,
with special thanks to Dave Pear and Robert Lee
With Gratitude to Our Research TeamMost Have Donated Their Time
Kristen Willeumier, PhD, Amen ClinicsJoe Wu, MD, UC, IrvineAndrew Newberg, MD, Univ of PennsylvaniaRobert Thatcher, PhD, Applied NeuroscienceYi Jin, MD, NeoSync TechnologiesJim Fallon, PhD, UC, Irvine
Fred McNeill on the cover of GQ