The Story of the Amen Clinics Retired NFL Player Brain Imaging/Brain Rehab Study

Daniel G. Amen, MD

Brent Boyd
Retired Minnesota Viking offensive guard Brent Boyd came to see me in 2000, complaining of headaches, depression, fatigue, dizziness and cognitive dysfunction. He had suffered a number of concussions in his playing career. In fact, his teammate on the Vikings, Joe Sensor, told me privately that he recalled hearing one of the hits on Brent all the way across the field. His brain scans showed clear evidence of damage, consistent with prior brain trauma. But in his disability hearings, the NFL hired doctors called me a quack and my findings ridiculous. I wondered how other professionals could call hard brain imaging data ridiculous when all they relied on were just their own clinical evaluations and opinions. Who was being ridiculous? But Brent persisted on the legal path to get the help he needed.

Image 1. Normal SPECT Scan

Image 2. Brent Boyd

Unfortunately, Brent spent many years as a young man, getting married, starting a family and a career, dealing with symptoms of post-concussive syndrome. It was hell, he said, to experience decades of being called lazy and crazy by friends, family and loved ones, not to mention employers - and then internalizing it and believing it myself. Prior to the concussions, Brent had always been a high-motor self-starter kind of guy- straight A's, graduated with Honors from UCLA, a high NFL draft choice - not exactly an indication of a lazy guy!

Brent wrote to me, I am eternally grateful to you for finally correctly diagnosing my problem and putting an end to the self talk and put-downs by others. I had been so embarrassed by my condition, that for over a decade I had cut myself off from friends, family, ex-teammates; and crawled under my blanket to die. Change your brain - change your life? Damn right! You have had a profound effect on my life. In 2007, Brent was the first NFL player to testify in front of Congress about brain injuries in football. Before then no one had ever spoken to Congress, the media, or the public about the ramifications of postconcussions on the younger players - young NFL players down to high school and youth programs. All the "official" conversation prior to his testimony had involved only a few post-mortem cases when guys had advanced in years became demented. Brent described what happened to him - no diagnosis for 20 years until I had diagnosed and located his brain damage. Even so, the NFL was still calling him a faker and me a quack.

AD
In July 2007, Anthony Davis came to see me as a patient at the Amen Clinics. He was concerned about the cognitive problems he saw in other former retired professional football players. AD, as he is called by most who know him, is a College Football Hall of Fame running back from the University of Southern California. AD is called the Notre Dame Killer, because in 1972 he scored 6 touchdowns against the University of Notre Dame. The students at Notre Dame hated AD so much that they put his picture on the walkways of the campus so they could walk all over him. In 1974, he scored 4 more touchdowns against Notre Dame. At the Amen Clinics, we are known worldwide for our work with brain SPECT imaging, a nuclear medicine study that looks at blood flow and activity patterns in the brain. AD had heard about us and thought perhaps we could be helpful to him. At age 54, ADs brain looked like he was 85. It showed clear evidence of brain trauma. Image 3 is an example of a healthy brain SPECT study; Image 4 is ADs brain SPECT scan, showing clear evidence of damage to the prefrontal cortex and left temporal lobe. For the last 20 years the work at the Amen Clinics has been about brain rehabilitation. We have demonstrated over and over that the brain has the ability to improve after trauma and when we change or improve peoples brains, we change their lives. ADs case was no exception. I put AD on a group of brain enhancement supplements that included high quality fish oil, a comprehensive multiple vitamin and mineral supplement, and supplements targeted to support blood flow and neurotransmitter levels in the brain. Within several months AD told me that he felt better, more focused, and he had better energy and a better memory. I decided to rescan AD in January 2008. Image 5 shows that ADs scan showed significant improvement in blood flow and activity.

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Image 3: Healthy SPECT Scan

Image 4: ADs SPECT Scan

Underside Surface View full, even, symmetrical activity decreases in prefrontal and left temporal areas

Image 5. ADs Follow-up Scan

People who are familiar with AD, know that he is a kind, gregarious, thoughtful man. As he received benefit from our work, he started to tell others about it and referred a number of retired athletes to us. AD and I talked about other retired NFL players and his concern that many of these players showed evidence of brain trauma and should come to see us.

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Letter to Roger Goodell Offering Help

AD asked me send to send a summary of my work together to NFL Commissioner Roger Goodell. AD provided a letter of introduction. I sent Mr. Goodell ADs scans and our Brain SPECT Atlas, Images of Human Behavior. He never wrote back. I was not surprised by his lack of response. Who was I? Some private practice doctor who thought he had a better mouse trap. Plus, the NFL hired experts in Brent Boyds case had called me a quack. The NFL had started their traumatic brain injury committee in 1994 and 15 years later they were still saying that they did not know whether or not playing football in the NFL caused long term brain damage. Heck, after 15 years, I thought they would have sponsored 8 or 9 brain imaging studies to find out. How do you know unless you look? Functional brain imaging studies such as SPECT, PET, fMRI and QEEG (quantitative EEG) are the most common and effective ways to look at living brain tissue. I knew most thoughtful brain imaging experts could answer the question of whether or not playing football in the NFL caused long term brain damage within a year with the right resources. I certainly knew I could look at the brains of retired players with functional brain imaging tools. Over the years, listening to the NFLs argument from afar - that they did not know if playing football caused long term brain damage - seemed disingenuous. I just thought that the NFL acted like many big employers who - when an employee claims he is hurt on the job - hire experts to deny that the employee has a problem. I have had many patients denied appropriate workers compensation benefits through the unfair games employers and insurance carriers have played with them. In essence, when you deny a legitimate employees claim, they are not only traumatized by the work-related injury and loss of function, they are traumatized again by being called a liar. Through the years that technique, which I have seen dozens of times, has really irritated me. Dont get me wrong, I know there are cases of employees who fake injuries so they can take advantage of their employer. As an employer with over 80 people, I can see the issue from both sides. But I had an advantage when it came to football players and traumatic brain injury. I had scanned the brains of more than anyone else on earth, including many high school and college players who suffered concussions and had seen the damage that was clearly visible on brain SPECT studies. The brain is soft, about the consistency of soft butter, and the skull is hard with many sharp boney ridges. With the forces from these huge human beings, how could there not be trauma? Nonetheless, I thought that by 2007 some thoughtful research groups would have done definitive brain imaging studies on retired football players to show whether they had damage or not. No one in the functional imaging world seemed to be stepping onto the playing field. In 2002 neuropathologist Dr. Bennet Omalu autopsied the brain of former Pittsburgh Steelers Mike Webster and saw a very unusual process in his brain consistent with a boxers brain called chronic traumatic encephalopathy or CTE. That made the news. Then he autopsied the brains of other former NFL players including Andre Waters, who killed himself in his 40s, and wrestler Chris Benoit, who killed his wife and son and then killed himself. He also found CTE in their brains. As can be expected, the NFL did not meet Dr. Omalus findings with an openness of spirit. They saw his work as threatening to the fabric of football. Dr. Omalu published several papers in the Journal of Neurosurgery, which caused more

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criticism to be directed his way, including NFL-paid physicians writing in the journal that he was practicing voodoo medicine and demanding he retract the article. Being a deeply religious man, Dr. Omalu persisted on a path that he believed was correct and continued to seek out the brains of retired players who died. He has now autopsied 25 brains of former football players, wrestlers, mixed martial artists and boxers and has seen similar trouble in many of their brains.

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Lecture to Los Angeles Chapter of the Retired NFL Players Association

In January 2009, AD invited me to speak at the Los Angeles Chapter of the Retired NFL Players Association. I was excited to do it, because growing up I was a huge Los Angeles Ram fan. I loved football and played throughout my youth and in high school. Not being very tall, I never went far, but I loved the game. I spoke to a group of about 40 retired players. I told them about our work at the Amen Clinics, my work with AD, and how important it was for them to work to have a healthy brain. I remember being interrupted by one player who asked me five times about whether marijuana was bad for the brain. Either he didnt want to hear my answer (yes, it is bad for the brain), or he kept forgetting it. At the meeting, it was very clear to me that many of the retired players could benefit from our work. At the time there had been more and more publicity about whether playing football in the NFL caused long term brain damage. The formal position of the NFL was that they did not know. At the meeting I met a representative from the NFL Players Association. He seemed to have an odd effect. He seemed to downplay the impact of potential brain damage and was not interested in talking to me about our work and its potential benefit to retired players. Given that he represented players, I thought it was unusual. I had no idea of the politics. That was a lesson to come. At the meeting, after talking to some of the players and their wives, it became clearer to me that someone should undertake a definitive brain imaging study on living retired NFL players. These players had given their bodies and their brains to entertain us and now it seemed as though few people were really trying to understand their needs. At the meeting was my friend and colleague, Dr. Joe Wu, who was clinical director of the brain imaging lab at UC, Irvine. Joe had come to hear me speak. Perhaps Joe and I could spearhead the study, I thought, if no one else was going to do it. Joe is a world class neuroscientist and brain imaging researcher. He and I wrote the chapter in the Comprehensive Textbook of Psychiatry on the clinical application of functional brain imaging in psychiatric practice.

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The Birth of the Amen Clinics Retired NFL Player Brain Imaging Study
Joe and I met with AD, Reggie Berry, the outgoing president of the Los Angeles Chapter of the Retired NFL Players Association and Marvin Smith, the incoming president about a potential study. Reggie and Marvin thought it was a great idea and were willing to help us recruit participants. Now we just needed to find funding. One myth most people believe is that retired players are all millionaires. I was to learn that nearly half of them file for bankruptcy or divorce within a few years of retirement. Most of the players, especially the ones that needed us most, could not afford our services. I decided to fund a small pilot. I own the Amen Clinics, so I could do all the research at our cost. I thought we could afford to do about 30 players. That would be a big enough group to get a statistically significant, publishable result on whether or not retired players had significant brain damage. At that point we had already performed nearly 50,000 brain SPECT scans over the past 18 years, so I would be able to tell quickly whether playing in the NFL caused long term brain damage. I had already invested in obtaining a large normal database of scans that we could compare to the players. So, with the help of the Los Angeles Chapter of the Retired Players Association, Dr. Joe Wu, and my research staff, we embarked on the study. Dr. Chris Hanks, on my research staff, wrote the research protocol, which was approved by an outside Institutional Review Board (IRB). I gave a recruitment lecture to another meeting of the Los Angeles Chapter of the Retired NFL Players Association and the study was born in March 2009.

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Amen Clinic Research Protocol on Retired NFL Players

Each player or their family filled out an extensive medical history and brain injury form. They filled out questionnaires on depression, attentional problems, substance abuse, legal history, educational and work history. Each player had a brain SPECT scan, performed while they did a concentration task (Connors Continuous Performance Task CCPT). Each player had a QEEG (quantitative electro-encephalogram) to measure their brains electrical activity. Each player underwent a battery of neuropsychological tests including the CCPT, Mild Cognitive Impairment Screen (MCIS) and the MicroCog, which is a screening test for neuropsychological problems. It included 9 subtests for General Cognitive Functioning, General Cognitive Proficiency, Information Processing Speed, Information Processing Accuracy, Attention, Reasoning, Memory, Spatial Processing and Reaction time. By the end of April, we had recruited 15 players, and it was very clear that most of these scans showed significant brain trauma. It was an emotional trap for me, however. I had to do something to try to help the damaged brains. I spend my days helping people. That is what I was trained to do and that is what I love doing. I spend my days treating people with brain trauma, anxiety, depression, attentional problems, obsessiveness, memory problems, temper problems and low energy. Now I had a developing a group of retired players who needed brain rehab. What to do, I thought? I talked to my wife and the people at our clinic and the second arm of the study was born. We decided to start treating these players for the brain trauma we saw. We developed a protocol using education, diet, exercise, and natural supplements to see if we could help to reverse the brain damage. We also decided to expand the study up to 50 players, so that no one would be able to criticize our results. Damn, this was getting expensive for us! But I believed that somehow the investment would come back to help us as a company. We decided to treat the players and then do the whole evaluation process all over again!

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NFL Summit in Las Vegas and Dave Pears Blog

In our next attempt to recruit players, Marvin Cobb invited me to speak at the NFL Summit in Las Vegas at the end of May 2009. The NFL Summit is an independent group of retired players. I had just hired UCLA trained neuroscientist Kristen Willeumier, PhD to help in our research effort. I decided to bring her along with me. Dr. Willeumier is a 6-foot tall ex-model - sweet and smart. I somehow thought that the players might rather talk to her than me. Perhaps players might not be interested in talking to a short, 54year old guy but if nothing else, they would stand in line to talk to her! It turned out to be a brilliant move on my part - Kristen signed up 20 new players for our study! Now we had a quorum. We also had the opportunity to meet Dave Pear and Robert Lee. Dave Pear was a Super Bowl and Pro Bowl player who had been writing a blog for his fellow retired players and had the attention of many players who potentially needed our help. The blog has subsequently sent many players our way and some of them have written about their experiences on the blog. http://www.davepear.com/ Over the summer we reached 40 players, then 50, then 60, as players referred their friends to us. The Minnesota Vikings did a piece on our study in their magazine for retired players. What was a study of 30 players, turned into a study now of over 90 players. The expense was stressing us, especially because the clinic paid for the supplements and all the follow up scans and tests. This was done in a bad economic year. But the results were nothing short of astounding. My research staff and I became very fond of the players and it was clear they needed help. We recruited other world class researchers to help us at no cost, including: Andrew Newberg, MD from the University of Pennsylvania, and expert in brain SPECT imaging, Robert Thatcher, PhD from Applied Neuroscience Institute, Inc., and Yi Jin, MD and Bill Phillips, PhD from NeoSync, world experts in the use of quantitative EEG. William Rod Shankle, MD, a world authority on dementia screening. Dr. Shankle and I coauthored the book Preventing Alzheimers.

Right away, we learned several important lessons: 1. The retired NFL brain seemed to have its own pattern, which showed damage in the prefrontal cortex, temporal lobes, occipital lobes and cerebellum. Very soon a pattern emerged of chronic brain damage, affecting the front part of the brain called the prefrontal cortex (called the executive part of the brain that controls judgment, impulse control, attention span, organization and planning); the temporal lobes (mood stability and memory); the occipital lobes (visual processing) and the cerebellum (coordination and thought coordination). We expected all the findings except the lower cerebellar activity. The cerebellum is the major coordination center of the brain. These were world class athletes. But low cerebellar activity was very clear on a majority of the scans. This led us to develop a series of recommendations to enhance cerebellar activity, such as dancing, table tennis, juggling, cursive handwriting, and calligraphy. Of the players who took our recommendations seriously, we saw improvement in their cerebellum and in their whole brains.

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2. Not all brains were damaged. Some brains showed signs of clear brain trauma, especially to the prefrontal cortex and temporal lobes but not all of them. I remember coming into work one day and seeing a set of scans on a supposed NFL player. The scans actually looked quite normal. This was after seeing 20 really bad scans. I was confused and wondered what happened. When I met the player, it was very clear. He rarely played and was a backup quarterback for 6 years. I was a backup quarterback in high school and now I was grateful for my short stature and bench warming years! Another player had a relatively healthy looking brain and he played in the NFL for 16 years but he was a long snapper center who only played on punts. In the case of the NFL brain, less is more. Less playing time means more brain function. A number of other players had healthy looking brains, so it was clear not all players - even those who played for a long time - experienced the same level of trauma. There were clearly other factors at work, including genetic factors, number of concussions, number of years played, plus concurrent drug abuse, alcohol use, steroid use and other environmental stresses. 3. Players who went on to wrestle, box or participate in mixed martial arts after their football careers tended to have the worst brains. Some of the worst brains we saw were those who did other brain damaging sports after football. 4. Retired NFL players have a problem with obesity. Many of them were flat-out fat! Not big-boned, (although many were) and not having excessive muscle (although many did). They were obese and that was causing them serious problems with their health and brain. As we were doing our study, a new study came out from the University of Pittsburgh that reported as a persons weight went up the actual physical size of their brain goes down. Holy Smokes! So we started a weight loss group for players run by Dr. Willeumier. Many of our players have had great success. Big Ed White from the Minnesota Vikings, who played in four Pro Bowls and four Super Bowls, weighed 365 pounds when he first came to see us and lost 40 pounds in 6 months. All of his cognitive scores improved as well. Chuck Detwiler, defensive back for the San Diego Chargers, wrote, I just went to a new Doctor I weighed in at an incredible 180 lbs., down from 211. What you have done for all of us is truly amazing. I cannot say enough about your sincere efforts to help us. That was Chucks playing weight. 5. Players tended to score very poorly on the neuropsychological tests we gave them, except for reaction time and spatial processing. 6. Recovery is possible. The most exciting part of our study we have seen is that recovery and improvement in function is possible. To date, we have done follow up scans and testing on 19 players. Fifteen of them have achieved significant improvement, both on their SPECT scans and on their neuropsychological testing. We found after our first 5 follow up studies that our initial group of supplements was not powerful enough for the brain damage we have seen. That led us to develop a second group of supplements that have made a much more substantial difference, especially our fish oil and Brain and Memory Power Boost formula. 7. Fewer players were on heavy duty pain medications than we anticipated. I had thought that many of our players would be taking strong pain medications like Oxycontin and Vicodin. Actually, very few of them were taking them, even though almost all of the players had undergone multiple surgeries. We also found

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that when we put them on our fish oil, many of them were able to decrease or eliminate the pain medicines they were taking. 8. Sleep apnea was very common, especially among our obese players. Getting this evaluated and treated is essential, as sleep apnea increases the risk for developing dementia.

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Preliminary Conclusions
We need to start thinking of our professional football players like we do our police and firefighters. We know that being a police officer or fire fighter is a dangerous job. We own it. If people get hurt on the job we take care of them. It should be the same way with our professional athletes. The NFL should OWN that playing football at the professional level is a brain damaging sport and if players get hurt they should be cared for them and given the resources for rehabilitation. The NFL has recently made strides towards admitting that playing football in the NFL is a brain damaging sport. Once you admit that you have a problem you can then do something about it. The NFL needs to be part of the solution rather than an impediment to progress and part of the problem. The implications for our study and this work in general go way beyond professional football. It has implications for Pop Warner, High School and College Sports. It impacts the 2 million new brain injuries that occur every year in the United States. It also could impact the 15% of soldiers coming back from Iraq and Afghanistan with brain injuries. Brain injuries have been called the signature wounds of those wars. This is only the beginning of many reports I will write on the study. We plan to keep at this for many years. If you can help support the study we would be most grateful. We have a 501(3)(c) foundation, the Change Your Brain, Change Your Life Foundation that receives donations to help us fund our research and educational projects.

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From Dave Pears Blog:

Larry Kaminski at the Amen Clinic
Mar 23, 2010

Larry Kaminski at Home

Hey gang Today (Monday March 22, 2010) I went to the Amen Clinic in Newport Beach, CA for my scheduled brain scan through their research program to challenge the NFL fiction that concussions and football hits have no effect on former players. It was very interesting. Dr. Amen is a well respected doctor/author and well-respected has several clinics throughout the country. This procedure was very expensive but at no cost to NFL everal players chosen for this study. The bad news is that I have brain damage. My 8 years of playing in the NFL under the old rules took its toll. However, its not as bad as some and may be improved. They have put me on a supplement program and neurotherapy for several months. I will be checked again to see if the issue is getting better after this period. My damage is in the temporal lobes ( (red). (And no, I dont have half a brain! Larry)

The good news is that I was exceptionally strong in cognitive skills and the possibility of dementia is slim. I will continue to read and keep up with my brain activities which I do on a daily basis. Another issue that was discovered is that I have a Hot brain. The electrical activity in my head is not normal. red This causes my anxiety and restlessness and worry. I will be working with a therapist to cool it off. It was discussed that my excessive drinking was probably a result of me trying to use alcohol to settle myself me down. That sure worked. I am glad I took the time to make use of the program. It has helped me to understand myself a lot better and explain my moods, anxiety and aggressiveness.

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Well, as Fred Forsberg once said, Prince, it is a wonder you are almost normal. I can only say that it could be worse and I can try to make it better with proper care and diet. Larry Kaminski Poulsbo, WA Denver Broncos 1966 1973 Na Zdrowie GO PURDUE!

Wayne Hawkins at the Amen Clinic

Mar 26, 2010

Wayne Hawkins has been fighting a losing battle with dementia and his wife, Sharon, finally got him in to the Amen Clinic recently. When she read Larry Kaminskis recent post about his visit, Sharon sent us an e-mail about Waynes visit. She graciously allowed us to share this with all of you. Our thoughts are with you and Wayne, Sharon!
Hi Dave, I just read Larry Kaminskis story of his experience at the Amen Clinic. Wayne and I spent last Wednesday at the clinic. Waynes results were dismal. The doctor told Wayne if he keeps living the lifestyle he has been following, he wont live very long! I am so happy we went to the clinic. Now we have the wakeup call and a new path to take to hopefully heal parts of Waynes brain. I asked Dr. Amen to videotape our consultation so Wayne could see it daily otherwise he would never remember any of it. They did this and Wayne is always shocked to see himself with the doctor, asking Who is that?!! His temporal lobes are severely compromised to the degree there is no electrical activity! His frontal lobe is severely impaired from physical trauma (three Class III concussions including one 12-hour coma!) thus his lack of short-term memory, executive skills and lack of self-control. He forgets information literally from minute-to-minute, yet his recall of the past remains fairly good. He scored only 30 out of 100 on the verbal, recall MCI test and he was unable to do the computer test. Recommendations for him: Attend a week at an alcohol detox facility, begin to use the sleep apnea mask again, weight loss of 50 lbs. to start, then 40 more lbs., on the Medifast Diet, then in a few months, a knee replacement.

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So I have a mountain to climb taking care of him through these steps. Ill do it slowly and in small steps. It has just been so tough with his dementia issu s issues. He is anxious and that showed in his brain scan, yet because he is so good natured and calm, I never know when he is anxious. So thats the news about Waynes Amen Clinic experience. The supplement program has me full of hope that I will see some improvement in his ability to recall vement recall. Thanks, Dave, for your ear.

Kindest Regards, Sharon, on behalf of Wayne Oakland Raiders 1960 -1969 1969

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