A-11 Sex Differences in Performance Validity Testing in the Immediate Post-Concussion Assessment and Cognitive Test

Abstract

Abstract Purpose Sex differences have frequently been investigated in concussion and poor effort is a known confound in baseline testing. However, research has yet to investigate if insufficient effort is different or has differential effects on baseline cognitive scores between male and female athletes. Methods Collegiate athletes (n=1,505; 43% female) completed ImPACT during their baseline concussion evaluation. Research has identified four embedded effort indicies in ImPACT which were used to estimate effort across a continuum. We evaluated the relationship between effort, sex, memory performance and speed performance using linear regression models. Results We found that athletes who failed one, two, or three+ effort indicators performed worse on all cognitive domains compared to athletes who failed zero effort indicators (p<0.05). More male athletes failed two or three+ effort indicators compared to female athletes (p<0.001). Female athletes performed faster overall on visual-motor speed tasks (p=0.001), but there was no interaction between sex and failed effort indicators. Female athletes also performed faster on reaction time and better verbal memory tasks compared to male athletes, but only when they failed three+ effort indicators (p<0.01). Conclusions These results suggest that as expected, athletes performed worse when they failed more effort indicators. Insufficient or poor effort appears to be different between male and female athletes, with male athletes demonstrating more indicators of poor effort than female athletes. Poor effort also appears to differentially effect cognitive scores with differences in reaction time and verbal memory only identified between groups when athletes failed three or more effort measures.