Objective:

To describe results of skin biopsy for phosphorylated alpha-synuclein (P-SYN) in former NFL football players, as well as clinical presentation.

Background:

Contact sports including football have been identified as a risk factor for Parkinson's disease(PD), parkinsonism, dementia, chronic traumatic encephalopathy or motor neuron disease. Athletes who have engaged in contact sports have been reported to have misfolded alpha-synuclein in their CSF. A study among Spanish professional football players has shown presence of synucleinopathy tissue biomarkers in those with REM behavior disorder (RBD).

Design/Methods:

We did a retrospective chart review of all former NFL players who were seen at the Movement Disorders Center of Arizona from 2012-2024 who had skin biopsies for P-SYN. We reviewed demographic data, skin biopsies, DAT scans, motor UPDRS scores, and neuropsychological findings.

Results:

We identified 3 NFL players who were assessed for cognitive decline primarily, and who also had skin biopsy for P-SYN. All 3 manifested with RBD. Age of onset of cognitive decline was 42,43 and 59 (mean=48yrs). Age at time of biopsy was 47, 51 and 60 (mean=52.7yrs). Neuropsychological testing revealed dementia from CTE  in 1/3, and mild cognitive impairment in 2/3. The demented individual also had fluctuating parkinsonism with motor UPDRS ranging from 14-22, and was assessed to have psychogenic parkinsonism; his DAT scan was normal and skin biopsy was negative. The other 2 had no extrapyramidal symptoms with motor UPDRS=2 each, with one being P-SYN(+) in the neck only and the other in distal leg only. Both P-SYN(+) asymptomatic patients had abnormal DAT scans.

Conclusions:

Former NFL players may be more prone to developing a synucleinopathy. Skin biopsy may be used to determine risk for developing PD among previous NFL players. It may also help identify players with psychogenic parkinsonism. A larger study of cutaneous testing for P-SYN among former NFL players is needed.