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

Daniel G. Amen, MD

docamen@amenclinics.com

949-266-3749

Fred McNeill on the cover of GQ