Retired contact sports athletes with cognitive concerns: promoting lifelong brain health.

There is widespread concern among former athletes about the link between head injury and dementia. Neurologists are increasingly assessing ex-contact sports athletes with cognitive and behavioural issues following repetitive head impacts and traumatic brain injury. Their assessment and management can be challenging due to the broad differential diagnosis, including psychiatric issues, trauma-related impairment and, in some cases, neurodegeneration. There may be a range of pathologies present after trauma exposure, including Alzheimer's disease and chronic traumatic encephalopathy. Currently, we have only limited understanding of specific clinical phenotypes for distinct types of post-traumatic dementia, nor are there in vivo tests for many of the pathologies. Informed by our experience running a midlife brain health clinic for retired elite contact sport athletes, we describe a practical framework for the workup of athletes with cognitive concerns, highlighting key clinical features, an approach to investigation including neuroimaging and advanced fluid biomarkers, symptomatic management strategies and research directions.