Association between Concussion Profiles and Neurocognitive Functioning

Abstract

ObjectiveTo examine the relationship between concussion profiles and neurocognitive functioning, as measured by CNS Vital Signs (CNSVS).BackgroundThe heterogeneity of clinical presentation following concussion poses a challenge for treating clinicians. Kontos and Collins proposed a model in which initial global symptoms delineate into specific clinical trajectories, termed concussion profiles.Design/MethodsThe study was a retrospective, blind review of patient data from a concussion specialty clinic. Clinicians determined if patients met criterion for a profile, and identified the primary profile. One-way ANOVA’s were used to determine the overall effect of concussion profile on CNSVS multi-test domains. Omega-squared (ω2) was used as an estimate of the overall effect size: 0.01 (small), 0.06 (medium), 0.14 (large). Hedge’s g was used post-hoc to determine the effect size of mean differences between profiles on each domain: 0.2 (small), 0.5 (medium), 0.8 (large).ResultsData consisted of 88 participants obtained from the UF Concussion and Sports program (median age = 26.5; IQR, 18.0–51.8; 90% Caucasian; Median days since injury = 71, IQR, 38–155). Headache/migraine was the most prevalent primary profile (23%), while cognitive was the least prevalent (8%). The cognitive profile was associated with worse scores on the neurocognitive index (ω2 = 0.008; g = 0.71–1.04), reaction time (ω2 = 0.081; g = 0.60–1.21), memory (ω2 = 0.016; g = 0.50–0.96), psychomotor speed (ω2 = 0.023; g = 0.34–0.62), complex attention (ω2 = 0.026; g = 0.30–0.72), and cognitive flexibility (ω2 = 0.029; g = 0.36–0.65) domains relative to other profiles. The vestibular (g = 0.39–0.83) and anxiety/mood profiles (g = 0.33–0.76) were associated with worse reaction time relative to all other profiles except cognitive. Lastly, the headache/migraine profile was associated with worse complex attention (g = 0.26–0.53) and cognitive flexibility (g = 0.29–0.65) relative to other profiles except cognitive.ConclusionsThe cognitive profile is characterized by global cognitive deficits, while deficits in other profiles are domain-specific. Clinicians should consider the role of non-cognitive profiles when interpreting neurocognitive scores.