Neuropsychological Testing and Concussions

Abstract

R and clinicians have raised awareness about the serious consequences of sport-related concussion, which occur 1.6 to 3.8 million times per year in the United States alone. Although the concept of the second-impact syndrome (a second head trauma causing brain swelling and death) remains controversial, the published cases do raise concerns. Short-term concussion disabilities (eg, mood, memory, concentration) may last months and have detrimental effects on quality of life at home, school, work, and sport. Repeated concussions may affect cognition decades later. Despite this evidence, it remains unclear when physicians should allow return to play (RTP) after a concussion. More than 20 years ago, Cantu recommended RTP only when a patient had been symptom free for 1 week, both at rest and with exertion; similar recommendations have followed. The results of neuropsychologic (NP) testing, however, suggest that cognitive deficits may persist long after symptoms have resolved, and some question whether the older recommendations are appropriate. The most recent international consensus conference considered NP testing to be “an important component in any RTP protocol.” Others (with some conflict of interest) suggest that NP testing is a “cornerstone of concussion management” and, in addition, that baseline neuropsychologic (BNP) testing should be performed whenever possible. The National Football League began BNP in 1995 and the National Hockey League in 1997, and some have recommended it for university, high school, and other sport organizations. At least 1 jurisdiction in the United States has considered legislating BNP for athletes (State of New Jersey 214th Legislature Senate Resolution No. 74). Given these recommendations, NP with or without BNP may come to be perceived as a “standard of medical care,” with obvious medicolegal implications for both the sport medicine practitioner and sport organizations. But do the results of NP testing change patient management or provide other clinical benefit to the patient? Is there sufficient evidence to mandate it as standard of medical care?