Utility of a Brief Open Source Test of Working Memory to Enhance Concussion Assessment and Management

Abstract

PURPOSE: Develop an assessment approach more sensitive to sports-related concussions by collecting an athlete’s cognitive performances at baseline along with historical concussion data. METHODS: A community college and university took part in the study with a total of (n=255) participants. There were (n=59) participants who had a history of concussions and (n=196) who did not have a history of concussions. At baseline, participants were administered the Standard Concussion Assessment Tool 3 (SCAT3; an open source screening measure of the common signs and symptoms of concussion), the Auditory Consonant Trigram (ACT; an open source test of working memory), and a questionnaire to assess concussion frequency, concussion related post-traumatic amnesia (PTA) and retrograde amnesia (RA), and basic demographics. The SCAT3 and ACT were re-administered and PTA and RA were assessed within 48 hours of the concussion. RESULTS: Statistical analysis was conducted through t-tests, correlations, hierarchical linear regression, and simple linear regression. Male and female data was analyzed separately, as gender differences were found in variables of interest. The threshold for significance was p<0.05. For males, ACT 18 second scores predicted PTA duration related to past-concussions, SCAT3 symptoms predicted past concussion frequency, PTA frequency, and RA frequency, and SCAT3 symptom severity predicted past concussion frequency. For females, ACT 18 second scores and SCAT3 symptom severity predicted concussion frequency and SCAT3 Balance Error Scoring System predicted PTA frequency and RA frequency. CONCLUSION: Overall, ACT adds predictive power and can enhance concussion assessment. ACT scores were found to correlate with concussion history unlike any of the cognitive scores from SCAT3. The data suggest that a concussion assessment that better taps into cognitive areas affected by concussions and does not prematurely return athletes to play needs to be developed. Any new tool that is developed should take into account potential gender differences in concussive histories and outcomes.