Ethics: All study protocols were approved by the VA Bedford Healthcare System and Boston University Medical Center Institutional Review Boards. Written and informed consent was obtained from all patients and family members participating.
Consent for publication: not applicable
Availability of data and materials: Anonymized data not published within the article will be shared upon reasonable request.
Competing Interests: Andrew E. Budson has has been a speaker for Eli Lilly, a consultant for General Electric, Eli Lilly, and Axovant. Lee E. Goldstein has received funding from the WWE and Ivivi Health Sciences. Robert A. Stern is a member of the Mackey-White Committee of the NFL Players Association. He is a paid consultant to Biogen (Cambridge, MA, USA) and Eli Lilly (Indianapolis, IN, USA). He receives royalties for published neuropsychological tests from Psychological Assessment Resources, Inc. (Lutz, FL, USA) and is a member of the Board of Directors of King-Devick Technologies (Chicago, IL, USA). Robert C. Cantu is a paid consultant to the NFL Head Neck and Spine Committee, NOCSAE, Concussion Legacy Foundation, receives royalties from book publications, and compensation from expert legal opinion. He is a member of the Mackey-White Committee of the NFL Players Association. Ann C. McKee is a member of the Mackey-White Committee of the NFL Players Association. All other authors have no competing interests or disclosures to report.
Funding: This work was supported by the United States (U.S.) Department of Veterans Affairs, Veterans Health Administration, Clinical Sciences Research and Development Merit Awards (I01-CX001038) (CX001698-01A2); Career Development Award-2 (# IK2 CX002065) Alzheimer’s Association (NIRG-305779, NIRG-362697); National Institute of Aging (RF1AG054156, R56AG057768, RF1AG057768, K23AG046377, U19AG068753, AG08122, AG054076); National Institute of Neurological Disorders and Stroke (U54NS115266, U01NS086659, K23NS102399); National Institute of Aging Boston University AD Center (P30AG13846; supplement 0572063345-5; pilot award 50204517 ); National Heart, Lung and Blood Institute (75N92019D00031 and HHSN2682015000011); Department of Defense Peer Reviewed Alzheimer’s Research Program (PRARP #13267017); and the Concussion Legacy Foundation. This work was also supported by unrestricted gifts from the Andlinger Foundation and WWE.
Author Contributions:
KWT played a major role in drafting manuscript writing, revisions, and data analysis and interpretation.
AG helped with initial manuscript drafting and data entry and analysis.
VEA helped with data generation and provided critical manuscript review for content.
WX helped with brain and CSF ELISA data generation and analysis, critical manuscript review for content.
JDC provided assistance with data interpretation, critical manuscript review for content.
RN provided assistance with brain and CSF data generation and analyses.
GM helped with brain and CSF ELISA data generation and analysis.
SD helped with brain and CSF ELISA data generation.
YT provided assistance with statistical plan, data generation and critical manuscript review for content.
BH helped with data generation, analyses and critical manuscript review for content.
AEB provided assistance with data analysis and critical manuscript review for content.
BD provided assistance with data analysis and critical manuscript review for content.
NK provided assistance with data analysis and critical manuscript review for content.
RCC provided assistance with data analysis and critical manuscript review for content.
LEG provided assistance with data analysis and critical manuscript review for content.
DIK provided assistance with data analysis and critical manuscript review for content.
RAS provided assistance with data analysis and critical manuscript review for content.
MLA provided assistance with data analysis and critical manuscript review for content.
JM provided assistance with statistical plan, data analysis and critical manuscript review for content.
ACM provided assistance with data analysis and critical manuscript review for content.
TDS led all aspects of study including concept and design, data analysis and interpretation, and critical manuscript writing and editing.
Acknowledgements: We gratefully acknowledge the use of resources and facilities at the Edith Nourse Rogers Memorial Veterans Hospital (Bedford, MA) as well as all the individuals whose participation and contributions made this work possible.