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Contact: Maria Ober, mpober@bu.edu , 617-224-8963
Boston University study provides first window into the cognitive impairments that people experience from autopsy proven CTE
(BOSTON) – Researchers at Boston University have completed the largest study to date characterizing the cognitive symptoms of NFL players with confirmed chronic traumatic encephalopathy (CTE) who underwent neuropsychological tests while they were alive. CTE is the neurodegenerative disease linked to repeated head impacts that cannot yet be diagnosed accurately during life in part because its specific symptoms need to be determined.
The study examined 33 NFL players who were diagnosed with CTE at autopsy and completed the NFL Concussion Settlement's testing program known as the baseline assessment program (BAP). Their average age at the time of testing was 63, and their average age of death was 65. As part of the BAP, players completed a standardized paper-and-pencil neuropsychological test battery. The families of the 33 participants who donated their brains also provided the participant’s BAP assessment records. The researchers used this objective battery to complete the largest study to date linking cognitive test performance during life with CTE confirmed after death. The study provides important information on the type of thinking skills believed to be most impacted by CTE.
The results were published today in JAMA Network Open.
Memory problems were the most common finding, affecting 63% of participants with autopsy-confirmed CTE, particularly short-term memory. More advanced CTE was associated with worse memory performance. Researchers also found impairments in executive function (52%), language (41%), and attention (26%). Because CTE can currently only be definitively diagnosed after death, identifying the pattern of cognitive changes associated with the disease is an important step toward improving diagnosis during life.
"This is the largest study of its kind to directly link the amount of CTE pathology found at autopsy with objective cognitive testing during life," said Anna Aaronson, lead author and a PhD student at the Boston University CTE Center. "These findings provide an important roadmap for recognizing CTE in living patients."
Researchers also identified potential limitations related to the NFL Concussion Settlement's testing program, which is a program that can help players receive financial compensation for cognitive decline. Many players who showed measurable cognitive impairment on standardized testing, and were ultimately confirmed to have CTE at autopsy, did not meet the settlement's criteria for cognitive impairment. Seven participants had advanced CTE (stage 3 or 4). Six showed measurable cognitive impairment on testing, yet all seven received the BAP's lowest impairment rating (Level 0). Differences between the settlement's scoring rules and clinical standards typically used to diagnose cognitive disorders may contribute to suboptimal identification of former players deserving of support.
"The BAP's diagnostic criteria might miss cases of cognitive impairment that are objectively measurable and associated with confirmed CTE pathology," said Michael Alosco, PhD, co-director of clinical research at the BU CTE Center. "This has important implications for former players seeking diagnosis and potential compensation through the NFL Concussion Settlement."
JAMA Network Open
10.1001/jamanetworkopen.2026.31754
Case study
People
Neuropsychological Profile of Autopsy-Confirmed Chronic Traumatic Encephalopathy
2-Sep-2026
Dr Nowinski reported receiving personal fees from Players Advocacy Committee for the NFL Concussion Settlement, travel support fromWorldWrestling Entertainment, National Football League, World Rugby, All EliteWrestling, and Total Nonstop ActionWrestling, and stock options from Oxeia Biopharmaceuticals and StataDx outside the submitted work. Dr Nowinski is employed by the Concussion & CTE Foundation and has served as an expert witness in cases related to concussion and CTE. Dr Asken reported receiving grants from the National Institutes of Health (NIH) and University of Florida outside the submitted work. Dr Banks reported receiving grants from the National Institute on Aging outside the submitted work. Dr Barr reported receiving royalties for published works on unrelated topics and consulting and expert witness fees for legal cases involving concussion and chronic traumatic encephalopathy. Dr Dams-O'Connor reported receiving grants from the NIH, US Department of Defense (DOD), and National Institute on Disability Independent Living and Rehabilitation Research and serving as a consultant for Tampa Veterans Affairs Research Foundation during the conduct of the study and providing expert testimony for various law firms and serving on advisory boards for Pink Concussion and InvisibleWounds Foundation outside the submittedwork. DrWethe reported owning stock in King-Devick Technologies outside the submitted work and having a patent for Systems and Methods for Executive Function Rehabilitation pending (Mayo Clinic). Dr Stern reported receiving personal fees from NIH/DOD and Eisai, royalties from UpToDate and Psychological Assessment Resources Inc, and stock options from King Devick Technologies. Dr Tripodis reported receiving personal fees from the American Medical Association outside the submittedwork. Dr Stein reported receiving grants from Department of Veterans Affairs and NIH outside the submitted work. Dr Mez reported receiving grants from the DOD and Gates Ventures outside the submitted work. Dr Alosco reported receiving grants from the NIH, DOD, and Life Molecular Imaging Inc during the conduct of the study and royalties from Oxford University Press Inc Royalties and an honorarium from the Michael J Fox Foundation outside the submitted work. No other disclosures were reported.