Neurological Institute of, 200–201
coma, 13, 17, 32, 74–75, 81, 86, 206
computer games, 93
computer models, three-dimensional, 147–48
concentrating, difficulty in, 6, 65, 87, 95, 117, 128, 174, 274, 278
Concord, Mass., 12–16
concussion management, 15, 33, 44, 56, 129, 133, 246, 250, 257, 259–64, 273–75
new NFL policies for, 248–49, 255–56, 261–62, 263–65
recovery time in, 6–7, 15–16, 26, 34, 36–37
see also return-to-play decisions
concussions:
cumulative effects of, 7, 54, 68, 127, 191, 193, 210, 215, 218, 223
definition of, 10–11, 15, 48
as dingers and bellringers, xii, 2, 6, 10, 25, 37, 47–48, 131
education on, xi–xii, 31–32, 103, 118, 138–39, 255–58, 260, 264, 273, 275
estimated annual number of, xii, 11
failed recognition of, 57, 65
force of impact threshold for, 259, 260
formal identification date of, 11
incidence of, 26, 27, 30, 48, 56–57, 64–65
long-term consequences of, 12, 158, 245, 246, 247, 250–53, 256, 273–74, 274–75
media coverage of, 133
public consciousness about, 270
regarded as benign and transient, 10, 11, 25, 36–37, 44, 46, 47–48, 102, 116, 128, 216, 223, 246
reporting of, 44, 48, 56–58, 59, 63–64, 249, 258, 271; see also traumatic brain injuries (TBIs), undocumented
concussion-safety laws, 33–35, 257, 261
confusion, 10, 60, 117, 181, 183, 187, 254, 277
Congress, U.S., 244
House Judiciary Committee hearings in, 252–53, 255, 257
Connecticut, University of, 114
Connecticut Sun, 30–31
consciousness, loss of, 2, 11, 13, 16, 21, 23, 32, 34, 42, 43, 45, 54, 61, 66, 117, 187, 194, 241, 248–49, 254, 262, 277
Cornell University, 12–14
Corsellis, Nick, 191–92, 193
Cranmer, Ron, 183
Crider, Michael, 99–101
Critchley, Macdonald, 189–90
Crosby, Sidney, 271–72
Cruise, Tom, 43
Dallas Cowboys, 17–24, 43–44
Damasio, Hanna, 147–48
Dartmouth College, 12–14
Davis, Butch, 260
deaths, 157, 175–76, 177
in boxing, 206–7, 210
in football, 11–14, 15, 16, 49–50, 51, 253, 259
in ice hockey, 52–53
from second-impact syndrome, 15, 16, 245, 251, 253
“Decade of the Brain, The,” 161
Defense and Veterans Brain Injury Center, 115
Defense Department, U.S., 115, 118, 119
DeKosky, Steven, 215, 216
Delaney, J. Scott, 56–57
dementia, early-onset, xiii, 220, 238, 245, 246, 247, 252, 256, 258
dementia pugilistica (punch-drunk syndrome), 178–211, 213, 214–15, 216, 217–19, 233
Alzheimer’s resemblance to, 177, 185, 192, 205, 211, 231, 232
brain changes in, 182, 184, 191–92, 193, 230–32
champions afflicted by, 192–95, 209–11, 231
as chronic traumatic encephalopathy, 189, 205, 206, 217–18, 244; see also chronic traumatic encephalopathy, football-induced
coinage of term, 189
delayed onset of, 208, 209–11, 231
genetic factors in, 205–6
medical research on, 185–92, 204–6, 207
in movies, 192–93, 195, 196
neurological testing for, 181–82, 190, 199, 208
prevalence of, 190–91
progression of, 183–85, 189, 203–4, 210–11
risk factors for, 189–90, 191, 193, 194, 195, 204–6
symptoms of, 181, 183, 184, 185, 186–88, 189, 190, 192, 193
see also Parkinson’s disease
Dempsey, Jack, 185, 186, 187, 188
depression, 20, 54, 65, 82, 83–84, 107, 117, 246, 247, 249, 256, 258–59
in football-induced CTE, 213, 217, 218–19, 223, 224, 225, 227, 240, 258, 274
diffuse axonal injury, 157–65, 159, 174–77
accumulated injuries in, 164–65
amyloid beta generated by, 175–77
black bulbs of protein formed in, 157–59, 159, 162, 163, 164, 165, 175, 176
calcium, potassium, and sodium ion exchange in, 165, 170–72
damaged microtubules in, 162–63, 165, 175
delayed onset of, 158–59, 160, 163
electrical current propagation and, 171–72
fast vs. slow axonal stretch in, 160–65, 163, 175
in frontal lobes, 174–75
as lifelong degenerative process, 175–77
neprilysin and, 176
rapid acceleration or deceleration in, 159–60, 162
wavy axons in, 162–63, 165
disorientation, 3, 10, 28, 40, 134, 183, 190, 254
dizziness, 3, 4, 6, 10, 11, 19, 20, 23, 28, 57, 100, 134, 136, 139, 254, 277
DNA, 205
dopamine, 199–201
dorsolateral prefrontal cortex, 174–75
Doyle, Jimmy, 206–7
Dronkers, Nina, 151–52
drooling, 190, 199
DTI (diffusion tensor imaging), 174–75
Duerson, Dave, 270–71
dyslexia, 31
ears, ringing in, 60, 117, 121, 277
Education Department, U.S., 103
Ehrlich, Nathan, 187–88
88 Plan, 237, 244
electroencephalograms (EEGs), 61–62, 190, 207, 208
enriched environment, 167, 168–69
epilepsy, 6, 62, 96–97, 146, 152–56
episodic memory, 155
ESPN, 41, 262
executive function, 102, 105, 145–46, 148
dorsolateral prefrontal cortex in, 174–75
organizational skills in, 77, 87, 88–90, 100, 112, 114
explosions, see bomb blasts
facial expression, blank, 187, 188, 200, 202
facial recognition, impairment of, xii–xiii, 38, 74, 75, 124, 134
in dementia pugilistica, 183, 184, 193, 194
Fahn, Stanley, 200–201, 202, 208
falls, 15, 102, 134–41
fatigue, 20, 23, 45, 54, 106, 136, 140, 171, 174, 181, 199, 249, 277
Favre, Brett, 229
field hockey, 65–66, 256, 263
fistfights, 13, 14
fMRI (functional magnetic resonance imaging) scans, 173–74, 259
focusing difficulties, 77, 91
fogginess, mental, 6, 19, 20, 59–60, 128, 133, 277
football, xiii, 10–27, 31–35, 36–51, 120–41, 220–21
Camp’s creation of, 49
cheerleaders for, 134–41
concussion culture of, 248–54, 262, 263, 264–65, 268–70
concussion rates in, 48, 56–57, 223
deaths in, 11–14, 15, 16, 49–50, 51, 253, 259
early history of, 49–51
force of impacts in, 259, 260
helmets in, 43, 50, 51, 221, 259–60, 272
ImPACT test for, 120–27, 260–61
macho code of, 5, 27, 35, 39–51, 196
manliness instilled by, 38–39, 50
number of players of, 47
peewee, 36–40, 47, 253, 273
Pop Warner, 12, 48–49
post-concussion syndrome in, 1–9, 17–24, 25, 36–51, 220–29, 245, 273–75
safety rules of, 51
as war, 42, 49
football, college, 1, 2, 3–9, 39–40, 47–51, 53, 56–57, 123, 125, 126, 220, 253, 258, 259–61, 275
All-American, 39, 255
All-Ivy League, 221
brutality in, 49–51
concussion rate in, 56–57
CTE case in, 258
deaths in, 11–14, 49–50, 51, 253
force of impacts in, 259
> Harvard’s “flying wedge” in, 49, 51
hit count in, 259
HITS technology in, 259, 260
ImPACT software usage in, 260–61
medical research on, 25–26
return-to-play decisions in, 13–14, 46, 54, 255, 262
football, high school, 1, 2–3, 19, 25–27, 31–35, 47–49, 57–58, 120–27, 131, 220–21, 240–41, 250, 259–61
athletic trainers for, 260–61, 265
concussion rates in, 48
deaths in, 15, 16, 253, 259
hit count in, 259–60
ImPACT software usage in, 260–61
number of concussions in, 26–27
return-to-play decisions in, 12–17, 31, 32, 34, 46, 122–23, 127, 255, 260–61
football, professional, 17–27, 40–49, 56, 122–24, 125, 128–33, 212–44, 245–54, 273–75
All-Pro, 268, 269
average weight of players in, 42
forced retirements from, 19–20, 22–24, 25, 29–30, 40–41, 44, 46, 124, 129, 131, 245, 249–50, 264, 273, 274–75
force of impacts in, 42–43, 53, 218
helmets and faceguards of, 43, 218, 219
playing with injuries in, 42
Pop Warner football and, 48–49
quarterbacks as tackling targets in, 17, 20–24, 43–44, 132–33, 224
return-to-play decisions in, 42, 44–46, 122–23, 128, 132–33, 246, 248–49, 254, 255, 264–65, 268
sideline evaluations in, 265
televised, 40–41, 47, 133, 219, 255–56, 264–65, 273
violence of, 40–42, 213, 268–70
see also chronic traumatic encephalopathy (CTE), football-induced; National Football League (NFL)
Football Hall of Fame, 29–30, 40–41, 129, 212, 235, 238, 255, 264, 274
Foreman, George, 183, 196–97, 204
forensic pathologists, 185–89
see also Omalu, Bennet
Forrest, Anne, 95–101
Foster, Bob, 203
Fox network, 40, 264
Framingham Heart Study, 229, 233
Fraser, Kerry, 263
Frazier, Joe, 178, 179, 180, 183, 184
Ali’s fights with, 196, 197–98, 201
frontal lobe damage, 73–74, 88–94, 142–52, 238
in Broca’s area, 148–52, 150
case histories of, 143–52
diffuse axonal injury in, 174–75
hallmark symptoms of, 92
personality change and, 145–48, 152
frontotemporal dementia, 238
Futch, Eddie, 197
Gage, Phineas (case history), 143–48, 156
skull of, 146–48
genetic factors, 176
in dementia pugilistica, 205–6
Gennarelli, Thomas, 159–60, 161
gestures, communication by, 149, 150
Glasgow, University of, 157–58
Gleason, Jackie, 195
glucose metabolism, 166–67, 171, 172–73
Goodell, Roger, 237, 244, 248, 252–58, 262, 268
Gordon, Wayne, 102–8, 115, 118
Great Britain, 189–91, 207
Green Bay Packers, 41–42, 229, 251
Gretzky, Wayne, 55, 271
Grimsley, John, 232–33
Grimsley, Virginia, 232–33
Guskiewicz, Kevin, 25–26, 246, 259–60, 261
hallucinations, 183
hand-eye coordination, 105
Haraldson, Sam, 262
Harbaugh, Robert, 13–14
Harlow, John, 144–47
Harrison, James, 268
Hartford Hospital, 152–54
Harvard University, 49–51, 221–22
“flying wedge” tactic of, 49, 51
Medical School of, 147, 222
Warren Anatomical Museum of, 147
Hauser, Thomas, 200–201
Hayworth, Rita, 194
HBO, 243, 247
headaches, 2, 4, 6, 10, 13, 16, 19, 20, 23, 31, 36–37, 38, 45, 54, 57, 60, 65, 67, 76, 95, 108–14, 128, 134, 137, 174, 221, 222, 232, 254, 274, 277
Head Games: Football’s Concussion Crisis (Nowinski), 226
Henry, Chris, 258
Herring, Stan, 33–34
Hill, James, 113
hippocampus, 143, 153, 192, 233
as Alzheimer’s site of origin, 215
neurosurgical destruction of, 152–56
“hit count” proposal, 258–60
HITS (Head Impact Telemetry System), 259–60
“H.M.” (Henry Gustav Molaison), 152–56
hockey, see field hockey; ice hockey
Hockey Hall of Fame, 30, 55, 272
Hoge, Charles, 116–17, 118
Hoge, Merril, 22, 25, 40, 46, 122, 124
Holmes, Larry, 199, 201
homeless people, 108, 212–13
House of Representatives, U.S., Judiciary Committee hearings of, 252–53, 255, 257
Houston Oilers, 232
Hovda, David, 166–73
Howe, Gordie, 52
Humphries, Stan, 22
I Am the Central Park Jogger: A Story of Hope and Possibility (Meili), 101
ice hockey, 31, 51–56, 57, 233, 263
bodychecking in, 262–63
catastrophic head injuries in, 52
college, 56
concussion rate in, 56, 263
deaths in, 52–53
forced retirements in, 30, 53–56
force of impact in, 53
helmets in, 52–53, 54
neuropsychological testing and, 129, 248
player size in, 53, 55
return-to-play guidelines of, 55, 262–63
women’s, 56
youth, 53, 56, 263
ImPACT (Immediate Post-concussion Assessment and Cognitive Testing), 122–27, 129, 132, 136–37, 138, 139, 141
incorrect usage of, 260–61
impact seizures, 6
improvised explosive devices (IED), 69–71, 76–77, 115, 159
inhibition, loss of, 102
insurance providers, 98–99, 235, 261
Inzitari, Alyssa, 66–67
Inzitari, Melissa, 58–67
Iraq War, 68–85, 108–19
irritability, 20, 65, 110, 111, 117, 134, 189, 277
Japan, 176
Jerry Maguire, 43–44
job loss, 89–90, 91, 97, 101, 102, 112, 118, 212
jockeys, steeplechase, 247
Johansson, Ingemar, 209
Johnson, Ted, 248–50
Joiner, Liz, 99–100
Jordan, Barry, 204–6, 208
Journal of Neuropathology & Experimental Neurology, 159, 233
Journal of Neuroscience, 165
Journal of the American Medical Association, 14, 26, 188, 205–6, 207
Kelly, James, 55
Kennedy, John F., 217
Kruth, Angelica, 134–41
Kruth, Doreen, 134–41
lacrosse, 256
LaFontaine, Pat, 30, 272
post-concussion syndrome of, 53–55
Lancet, 164
Landstuhl Regional Medical Center, 72–73
Lane, Tracy, 225
Lawrence University, 255
laws, concussion-safety, 33–35, 257, 261
lawsuits, 17
malpractice, 15
L-dopa, 199–200
learning disabilities, 7–8, 26, 29, 38, 60, 87, 88–89, 133, 138–41, 155, 167–70, 267–68, 277
special education classes for, 103–7, 167
viewed as malingering, 138–40
Leborgne (case history), 148–52, 150
Lelong (case history), 149–52, 150
Lenkiewicz, Diane, 121, 125–27
Lenkiewicz, Mark, 120–27, 131
Leonard, Sugar Ray, 194, 204
light sensitivity, 60, 61, 67, 76, 121, 174, 274, 277
Lindros, Eric, 55–56
Lipton, Michael, 174–75
Liston, Sonny, 197, 209
Little League Bas
eball, 258–59
lobotomies, 152
Lombardi, Vince, 41–42, 49, 251
Long, Terry, 217–19, 220, 224, 225, 227, 232, 234, 246
Louis, Joe, 193–94, 199
Lovell, Mark, 120–33, 135–41
car accident of, 127–28
career of, 129–33
ImPACT test developed by, 122–27, 129, 132, 136–37, 138, 139, 141
Lundberg, George, 207
Lux, Warren, 115, 116
Lystedt, Victor, 32, 33, 35
Lystedt, Zackery, 32–35, 257
McGill University, 56–57, 154
McHale, Tom, 250
macho code, xi, 5, 27, 35, 39–67, 196
in ice hockey, 51–56
McKee, Ann, 228–34, 250, 251, 253, 255, 257, 258
McKee, Charles, 255
Mackey, John, 234, 235–44
concussion history of, 238
NFL players’ union led by, 236, 237, 238
playing style of, 237–38
symptoms of, 238–40
Mackey, Sylvia, 235–44
NFL lobbied by, 236–37, 243–44
Madden NFL, 270
Majewski, Katrina, 65–66
Malanga, Gerard, 47
malpractice lawsuits, 15
Marine Corps, U.S., 108–14
Marino, Dan, 131
marital problems, 79, 91–92, 102, 118, 274
Maroon, Joseph, 122–24, 128, 129, 132–33, 218, 254
Martin, Tamar, 104–7
Martland, Harrison, 185–89, 190, 194, 202
Maryland, 85–94, 235–44
Rehabilitation Services Division of, 90, 91–93
Maryland, University of, Shock Trauma Center of, 86, 87
Massachusetts Medical Society, 146–47
Masterton, Bill, 52–53
Mawae, Kevin, 269
Mayo Clinic, 54, 199, 262–63
medications, 137, 138
Meili, Trisha, 101
memory:
episodic, 155
hippocampus and, 143, 152–56, 153
long-term, 153–54, 155
procedural, 155
working, 155–56
memory loss, 4–5, 7, 9, 20, 27, 29, 37–38, 39, 40, 61, 75, 76, 77–80, 97–98, 100, 102, 104, 106, 112, 114, 117, 122, 128, 136–37, 174, 222, 246, 252, 254, 262, 277
in Alzheimer’s, 230, 232, 233
in dementia pugilistica, 181, 182, 189, 190, 193, 210–11
in football-induced CTE, 215, 224, 232, 233, 238–39, 240–41, 270
long-term, 78–80, 81
short-term, 18–19, 67, 77–78, 80–81, 82, 105, 143, 182, 274
Mendoza, Freddy, 16
metabolic cascade, 170–72
metallic taste, 2, 4, 5–6
Michigan, University of, 251–52
microtubules, 162–63, 165, 175
mild cognitive impairment, 241
Miller, Chris, 22
Millspaugh, J. A., 189
Milner, Brenda, 154
mitochondria, 171
Molaison, Henry Gustav (case history), 152–56
Monday Night Football, 40
The Concussion Crisis Page 39