The Role Of Sex As A Moderator Of Cognitive Outcome Following A Sport-related Concussion

Abstract

Despite increasing research, results regarding sex as a moderator of outcome following a concussion are conflicting and management guidelines remain uncertain. PURPOSE: To determine if there is a gender difference in the long-term cognitive outcomes of athletes with a history of concussion (HOC). METHODS: 196 collegiate athletes (49 HOC women, HOC 49 men, 49 women matched controls, 49 men matched controls) completed a modified Cogstate test battery, to which a 2-back condition (N-back task) was added to increase our ability to detect persistent deficits in higher cognition. All participants were symptom-free at time of testing and those with a HOC were 6+ months from injury (24.0 ± 15.8 months, 1.44 ± 1.3 prior concussions). RESULTS: A significant interaction of error type × HOC × sex was observed. Specifically, HOC men exhibited a greater number of omission errors relative to HOC women (2.94 ± 2.5 vs. 0.31 ± 0.9, p<0.05). Moreover, irrespective of sex, HOC athletes exhibited a greater number of errors on the 1-back (2.30 ± 1.5 vs. 0.79 ± 0.9, p<0.01) and 2-back conditions (3.34 ± 2.6 vs. 1.46 ± 1.4, p<0.01), relative to controls. HOC athletes also exhibited decreased accuracy on the 1-back (95.45 ± 3.0% vs. 98.21± 2.2%, p<0.01) and 2-back conditions (93.98 ± 4.1% vs. 96.65 ± 3.3%, p<0.05). CONCLUSIONS: The current results suggest that beyond the acute phase of the injury, sex does not seem as a moderating variable of cognitive outcomes following concussion. Furthermore, the results reaffirm that concussive injuries can result in persistent deficits in aspects of higher cognition.