Severe CTE and TDP-43 pathology in a former professional soccer player with dementia: a clinicopathological case report and review of the literature.

Suzan van Amerongen, Suzie Kamps, Kyra K M Kaijser, Yolande A L Pijnenburg, Philip Scheltens, Charlotte E Teunissen, Frederik Barkhof, Rik Ossenkoppele, Annemieke J M Rozemuller, Robert A Stern, Jeroen J M Hoozemans, Everard G B Vijverberg

Journal: Acta neuropathologica communications 2023;11(1):77

PMID: 37161501

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Abstract

In the last decades, numerous post-mortem case series have documented chronic traumatic encephalopathy (CTE) in former contact-sport athletes, though reports of CTE pathology in former soccer players are scarce. This study presents a clinicopathological case of a former professional soccer player with young-onset dementia. The patient experienced early onset progressive cognitive decline and developed dementia in his mid-50 s, after playing soccer for 12 years at a professional level. While the clinical picture mimicked Alzheimer's disease, amyloid PET imaging did not provide evidence of elevated beta-amyloid plaque density. After he died in his mid-60 s, brain autopsy showed severe phosphorylated tau (p-tau) abnormalities fulfilling the neuropathological criteria for high-stage CTE, as well as astrocytic and oligodendroglial tau pathology in terms of tufted astrocytes, thorn-shaped astrocytes, and coiled bodies. Additionally, there were TAR DNA-binding protein 43 (TDP-43) positive cytoplasmic inclusions in the frontal lobe and hippocampus, and Amyloid Precursor Protein (APP) positivity in the axons of the white matter. A systematic review of the literature revealed only 13 other soccer players with postmortem diagnosis of CTE. Our report illustrates the complex clinicopathological correlation of CTE and the need for disease-specific biomarkers.

Address: Amsterdam Neuroscience, Neurodegeneration, Amsterdam, the Netherlands. [email protected].; Department of Neurology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Alzheimer Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands. [email protected].; Department of Neurology, Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA. [email protected].; Amsterdam Neuroscience, Neurodegeneration, Amsterdam, the Netherlands.; Department of Neurology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Alzheimer Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.; Amsterdam Neuroscience, Neurodegeneration, Amsterdam, the Netherlands.; Department of Pathology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.; Amsterdam Neuroscience, Neurodegeneration, Amsterdam, the Netherlands.; Department of Neurology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Alzheimer Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.; EQT Life Sciences, Amsterdam, the Netherlands.; Amsterdam Neuroscience, Neurodegeneration, Amsterdam, the Netherlands.; Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.; Amsterdam Neuroscience, Neurodegeneration, Amsterdam, the Netherlands.; Department of Radiology & Nuclear Medicine, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.; Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, London, UK.; Amsterdam Neuroscience, Neurodegeneration, Amsterdam, the Netherlands.; Department of Neurology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Alzheimer Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.; Clinical Memory Research Unit, Lund University, Lund, Sweden.; Department of Neurology, Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.; Departments of Neurosurgery, and Anatomy and Neurobiology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.; Amsterdam Neuroscience, Neurodegeneration, Amsterdam, the Netherlands.; Department of Neurology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Alzheimer Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.

DOI: 10.1186/s40478-023-01572-3

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MeSH Terms: Male, Humans, Soccer, Chronic Traumatic Encephalopathy, Sports, Brain, Alzheimer Disease