As presented by Dr. Kristen Willeumier from The Amen Clinic at the Second Annual Independent Football Veterans Conference held April 20 -22 2012 in Las Vegas at the South Point Resort. You can watch this PowerPoint while playing the accompanying presentation by Dr. Willeumier on YouTube: http://www.youtube.com/watch?v=jNeHYx4B9fY

1. Amen Clinic NFL
Brain Imaging
Brain Rehab Study

2. Our NFL Story Started in 1991
 In 1991, brain SPECT imaging work
 Brain injuries greater part of psychiatric
problems than most people knew
 Saw many high school and college football
players with brain injuries on scans who had
troubled behavior

3. Middle Linebacker UC, Berkeley
Arrested for Domestic Violence
Healthy College Player

4. ESPN Highlights and Arrests
 As a fan I watched highlights
 Then who was arrested that day
 Thought there must be serious
brain damage among many
active and retired players

5. Just imagine
someone like
Ron Yary
hitting you
30 -50 times
a game

6. NFL Position On Brain Trauma
 Started 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

7. The Problem with the NFL Position
 IF 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

8. 2000
Brent Boyd
Minnesota Vikings
Offensive Guard
6 Seasons

9. Brent Came To See Us For:
 Headaches
 Depression
 Fatigue
 Memory Problems
 Dizziness
 He was also overweight

10. Clear Evidence of Serious Brain Trauma
Healthy BB

11. NFL Hired Doctor’s
 Scans mean nothing
 They say his problems not work-related
 Deny his claim
 Brent gets traumatized twice
 once by his brain injuries and
 again by being called a liar or a faker

12. 2007
Anthony Davis
College Football Hall of
Fame Running Back
from USC and NFL
Player

13. Healthy At age 54,
brain looked 85

14. Before Treatment After Treatment

15. 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

16. 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

17. 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)

18. Current Status of Our Study
• 115 Active and Retired Players
• From 27 teams
• All positions
• Ages 25 – 85

19. Reported Number of Concussions
• 0 = 14%
• 1-2 = 24%
• 3-5 = 19%
• > 5 = 43%

20. Important Numbers
• Obese = 48% • Microcog = below
• Sleep apnea = 30% average in all
• Depression = 28% categories except
• Dementia = 19% spatial processing and
reaction time
• CPT = 81% abnormal

21. Outcomes
• > 90% had brain trauma pattern on brain
SPECT and QEEGs
• Severe decreased activity … across whole
brain
• Results are HIGHLY STATISTICALLY
SIGNIFICANT!

22. Damage Seen
Across Whole Brain

23. •Confirmation Number: 82635741
Damage Seen
Across Whole Brain

24. 20 Year Player
Damage across whole brain

25. Offensive Lineman 12 yr NFL

26. Running Back 4 yr NFL

27. Defensive Back 3 yr NFL

28. Linebacker 10 yr NFL

29. Wide Receiver 8 yr NFL

30. Tight End 8 yr NFL

31. Quarterback 18 yr NFL

32. Damage Seen Especially In Prefrontal,
Temporal and Cerebellar Regions
judgment, focus, and
impulse control
memory, learning,
emotion & moods
physical coordination and
thought coordination

33. 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)

34. 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

35. 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%)

36. MicroCog Before After p value #> 50% better
General cognitive 31.8 (24.1) 43.4 (25.7) <0.000 14
functioning
General cognitive 24.7 (20.1) 35.2 (23.5) <0.000 14
proficiency
Processing speed 33.1 (24.8) 39.3 (25.5) 0.026 12
Processing 40.9 (28.7) 48.5 (29.1) 0.012 13
accuracy
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

37. 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%+

38. 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%+

39. “Little” Ed White

40. 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%+

41. 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%+

42. Tight End 8 yr NFL
Before After 8 mos

43. Tight End 10 yr NFL
Before After 18 months

44. Offensive Tackle 12 yr NFL
Before After 18 months

45. Defensive Tackle 2 yr NFL
Our interventions plus 40 Sessions of HBOT

46. 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

47. 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

48. 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

49. 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

50. 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

51. 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

52. BRAIN RECOVERY PLAN: PART A
STOP HURTING YOUR BRAIN
 Brain injuries  High blood pressure
 Drugs  Diabetes
 Alcohol  High sugar diets
 Obesity  Environmental toxins
 Sleep apnea  Chronic stress
 Smoking  Lack of exercise

53. BRAIN RECOVERY PLAN: PART B
START HELPING THE BRAIN
 Social connections  Green tea
 New learning  Exercise
 Great diet  Coordination
 Calorie restriction  Gratitude
 Omega 3s  Meditation
 Supplements, Vit D  Healthy sleep

54. With Gratitude
 All of our players
 Los Angeles Chapter of the Retired NFLPA,
especially Reggie Berry and Marvin Smith
 Independent Football Veterans Conference,
with special thanks to Dave Pear and Robert
Lee

55. With Gratitude to Our Research Team
Most Have Donated Their Time
 Kristen Willeumier, PhD, Amen Clinics
 Joe Wu, MD, UC, Irvine
 Andrew Newberg, MD, Univ of Pennsylvania
 Robert Thatcher, PhD, Applied Neuroscience
 Yi Jin, MD, NeoSync Technologies
 Jim Fallon, PhD, UC, Irvine

56. Daniel G. Amen, MD
docamen@amenclinics.com
949-266-3749

57. Fred McNeill on the cover of GQ