Baseline Neurocognitive Testing Research Articles

Exposure to Serial Post-Concussion Neurocognitive Testing Does not Affect Future “Updated” Baseline Neurocognitive Performance in Adolescent Athletes

Abstract Purpose We investigated a dose response for serial post-concussion neurocognitive testing exposure on updated post-concussion baseline testing performance. Methods Athletes (13-18 yrs) that completed two, valid baseline neurocognitive testing (ImPACT) sessions approximately 1-3 years apart participated in this study. A sub-sample of athletes that sustained a SRC between baseline sessions were categorized into dose-response groups based on the number of serial, post-concussion neurocognitive tests completed following SRC: ONE (n=76), TWO (n=99), and THREE OR MORE (n=111). Athletes that did not sustain a SRC comprised the ZERO group (n=289). Change scores between the first to the second baseline were calculated for the ImPACT Composite and Symptom Scores and compared between the dose-response groups and controls with 5 ANOVAs, with a Bonferroni-corrected p-value of (p<.01). Baseline testing was administered using ImPACT stimuli within the “Baseline” administration, and all post-concussion ImPACT testing was administered using alternate-form associated with that specific post-injury assessment (Post-Injury1, Post-Injury2, etc). Results ANOVAs revealed no effect of number of post-concussion assessments (0, 1, 2, or 3+) on magnitude of the change between first and final baselines, for Verbal Memory (p=.08), Visual Memory (p=.96), Visual Motor Speed (p=.47), Reaction Time (p=.91), or Total Symptom Scores (p=.86). Conclusion Repeated exposure to neurocognitive testing has revealed improvements in Visual Motor Speed among normal controls, across test-retest intervals of 1-month, 1-year, and 2-years. However, in this study, exposure to post-concussion, serial neurocognitive testing had no effect on future performance on post-concussion baseline neurocognitive testing.

Performance Validity in Collegiate Football Athletes at Baseline Neurocognitive Testing.

To assess the prevalence of invalid performance on baseline neurocognitive testing using embedded measures within computerized tests and individually administered neuropsychological measures, and to examine the influence of incentive status and performance validity on neuropsychological test scores. Sport-related concussion management program at a regionally accredited university. A total of 83 collegiate football athletes completing their preseason baseline assessment within the University's concussion management program and a control group of 140 nonathlete students. Cross-sectional design based on differential incentive status: motivated to do poorly to return to play more quickly after sustaining a concussion (athletes) versus motivated to do well due to incentivizing performance (students). Immediate Post-Concussion and Cognitive Testing (ImPACT), performance validity tests, and measures of cognitive ability. Half of the athletes failed at least 1 embedded validity indicator within ImPACT (51.8%), and the traditional neuropsychological tests (49.4%), with large effects for performance validity on cognitive test scores (d: 0.62-1.35), incentive status (athletes vs students; d: 0.36-1.15), and the combination of both factors (d: 1.07-2.20) on measures of attention and processing speed. Invalid performance on baseline assessment is common (50%), consistent across instruments (ImPACT or neuropsychological tests) and settings (one-on-one or group administration), increases as a function of incentive status (risk ratios: 1.3-4.0) and results in gross underestimates of the athletes' true ability level, complicating the clinical interpretation of the postinjury evaluation and potentially leading to premature return to play.

Rationale and Design for the Remote Ischemic Preconditioning for Carotid Endarterectomy Trial

While the perioperative stroke rate after carotid endarterectomy (CEA) is low, "silent" microinfarctions identified by magnetic resonance imaging (MRI) are common and have been correlated with postoperative neurocognitive decline. Our study will investigate the role of remote ischemic preconditioning (RIPC) as a potential neuroprotective mechanism. RIPC is a well-tolerated stimulus that, through neuronal and humoral pathways, generates a systemic environment of greater resistance to subsequent ischemic insults. We hypothesized that patients undergoing RIPC before CEA will have improved postoperative neurocognitive scores compared with those of patients undergoing standard care. Patients undergoing CEA will be randomized 1:1 to RIPC or standard clinical care. Those randomized to RIPC will undergo a standard protocol of 4 cycles of RIPC. Each RIPC cycle will involve 5min of forearm ischemia with 5min of reperfusion. Forearm ischemia will be induced by a blood pressure cuff inflated to 200mm Hg or at least 15mm Hg higher than the systolic pressure if it is >185mm Hg. This will occur after anesthesia induction and during incision/dissection but before manipulation or clamping of the carotid; thus, patients will be blinded to their assignment. Before carotid endarterectomy, all patients will undergo baseline neurocognitive testing in the form of a Montreal Cognitive Assessment (MoCA) and National Institutes of Health (NIH) Toolbox. MoCA testing only will be conducted on postoperative day 1 in the hospital. The full neurocognitive testing battery will again be conducted at 1-month follow-up in the office. Changes from baseline will be compared between arms at the follow-up time points. Assuming no drop-ins or dropouts and a 10% loss to follow-up, we would need a sample size of 43 patients for 80% power per treatment arm. The primary endpoint, change in MoCA scores, will be analyzed using a random effects model, and secondary outcomes will be analyzed using either linear or logistic regression where appropriate. RIPC, if shown to be effective in protecting patients from neurocognitive decline after CEA, represents a safe, inexpensive, and easily implementable method of neuroprotection.

Concussions in High School Sports in the Eastern Panhandle of West Virginia 2008-2017

The incidence and prevalence of sport-related concussion has increased over the past decade as a result of an increase in athletic participation, improved diagnostic methods, and an overall increased awareness of the symptoms and signs of concussions. This is a retrospective study identifying high school athletes in the Eastern Panhandle of West Virginia who participated in baseline and post-concussion neurocognitive ImPACT testing from 2008-2017. A total of p40 unique first post injury tests were performed, and a total of 9,850 unique baseline tests were perlormed. The athletes were baseline tested at the beginning of their freshman and junior years. New students and any student who had had a concussion in the previous year were tested prior to starting, their respective sport season. The number of post-concussion tests was compared to the number of baseline tests and stratified each year by age, sex, and sport. Comparing our findings with the incidence by sport reported in the medical literature demonstrated that the same sports identified as being the highest and lowest risk were generally congruent with the sports reported to be the highest and lowest risk in two large literature reviews » B. The notable exception was cheerleading; our study found it to be among the sports with a higher incidence of concussion. A review of the literature demonstrated that cheerleaders, like participants in other contact sports, are at significant risk for concussion. Previously concussion rates in cheerleading bad been reported to be relatively low (4- 6% of cheerleading injuries) compared to other injuries and compared to concussion rates in other sports. However, concussions were noted to be the most common cheerleading injury, accounting for 31.1% of injuries. " and also reported that the number and rate of cheerleading related concussions had increased by 290% from 2001 to 2012.

Elevated markers of brain injury as a result of clinically asymptomatic high-acceleration head impacts in high-school football athletes.

This prospective observational cohort study of high-school football athletes was performed to determine if high-acceleration head impacts (HHIs) that do not result in clinically diagnosed concussion still lead to increases in serum levels of biomarkers indicating traumatic brain injury (TBI) in asymptomatic athletes and to determine the longitudinal profile of these biomarkers over the course of the football season. Sixteen varsity high-school football athletes underwent baseline neurocognitive testing and blood sampling for the biomarkers tau, ubiquitin C-terminal hydrolase L1 (UCH-L1), neurofilament light protein (NF-L), glial fibrillary acidic protein (GFAP), and spectrin breakdown products (SBDPs). All athletes wore helmet-based accelerometers to measure and record head impact data during all practices and games. At various time points during the season, 6 of these athletes met the criteria for HHI (linear acceleration > 95g and rotational acceleration > 3760 rad/sec2); in these athletes a second blood sample was drawn at the end of the athletic event during which the HHI occurred. Five athletes who did not meet the criteria for HHI underwent repeat blood sampling following the final game of the season. In a separate analysis, all athletes who did not receive a diagnosis of concussion during the season (n = 12) underwent repeat neurocognitive testing and blood sampling after the end of the season. Total tau levels increased 492.6% ± 109.8% from baseline to postsession values in athletes who received an HHI, compared with 164% ± 35% in athletes who did not receive an HHI (p = 0.03). Similarly, UCH-L1 levels increased 738.2% ± 163.3% in athletes following an HHI, compared with 237.7% ± 71.9% in athletes in whom there was no HHI (p = 0.03). At the end of the season, researchers found that tau levels had increased 0.6 ± 0.2 pg/ml (p = 0.003) and UCH-L1 levels had increased 144.3 ± 56 pg/ml (p = 0.002). No significant elevations in serum NF-L, GFAP, or SBDPs were seen between baseline and end-of-athletic event or end-of-season sampling (for all, p > 0.05). In this pilot study on asymptomatic football athletes, an HHI was associated with increased markers of neuronal (UCH-L1) and axonal (tau) injury when compared with values in control athletes. These same markers were also increased in nonconcussed athletes following the football season.

No reliable gene expression biomarkers of current or impending neurocognitive impairment in peripheral blood monocytes of persons living with HIV.

Events leading to and propagating neurocognitive impairment (NCI) in HIV-1-infected (HIV+) persons are largely mediated by peripheral blood monocytes. We previously identified expression levels of individual genes and gene networks in peripheral blood monocytes that correlated with neurocognitive functioning in HIV+ adults. Here, we expand upon those findings by examining if gene expression data at baseline is predictive of change in neurocognitive functioning 2years later. We also attempt to validate the original findings in a new sample of HIV+ patients and determine if the findings are HIV specific by including HIV-uninfected (HIV-) participants as a comparison group. At two time points, messenger RNA (mRNA) was isolated from the monocytes of 123 HIV+ and 60 HIV- adults enrolled in the Multicenter AIDS Cohort Study and analyzed with the Illumina HT-12 v4 Expression BeadChip. All participants received baseline and follow-up neurocognitive testing 2years after mRNA analysis. Data were analyzed using standard gene expression analysis and weighted gene co-expression network analysis with correction for multiple testing. Gene sets were analyzed for GO term enrichment. Only weak reproducibility of associations of single genes with neurocognitive functioning was observed, indicating that such measures are unreliable as biomarkers for HIV-related NCI; however, gene networks were generally preserved between time points and largely reproducible, suggesting that these may be more reliable. Several gene networks associated with variables related to HIV infection were found (e.g., MHC I antigen processing, TNF signaling, interferon gamma signaling, and antiviral defense); however, no significant associations were found for neurocognitive function. Furthermore, neither individual gene probes nor gene networks predicted later neurocognitive change. This study did not validate our previous findings and does not support the use of monocyte gene expression profiles as a biomarker for current or future HIV-associated neurocognitive impairment.

Prevalence of Invalid Performance on Baseline Testing for Sport-Related Concussion by Age and Validity Indicator

Estimated base rates of invalid performance on baseline testing (base rates of failure) for the management of sport-related concussion range from 6.1% to 40.0%, depending on the validity indicator used. The instability of this key measure represents a challenge in the clinical interpretation of test results that could undermine the utility of baseline testing. To determine the prevalence of invalid performance on baseline testing and to assess whether the prevalence varies as a function of age and validity indicator. This retrospective, cross-sectional study included data collected between January 1, 2012, and December 31, 2016, from a clinical referral center in the Midwestern United States. Participants included 7897 consecutively tested, equivalently proportioned male and female athletes aged 10 to 21 years, who completed baseline neurocognitive testing for the purpose of concussion management. Baseline assessment was conducted with the Immediate Postconcussion Assessment and Cognitive Testing (ImPACT), a computerized neurocognitive test designed for assessment of concussion. Base rates of failure on published ImPACT validity indicators were compared within and across age groups. Hypotheses were developed after data collection but prior to analyses. Of the 7897 study participants, 4086 (51.7%) were male, mean (SD) age was 14.71 (1.78) years, 7820 (99.0%) were primarily English speaking, and the mean (SD) educational level was 8.79 (1.68) years. The base rate of failure ranged from 6.4% to 47.6% across individual indicators. Most of the sample (55.7%) failed at least 1 of 4 validity indicators. The base rate of failure varied considerably across age groups (117 of 140 [83.6%] for those aged 10 years to 14 of 48 [29.2%] for those aged 21 years), representing a risk ratio of 2.86 (95% CI, 2.60-3.16; P < .001). The results for base rate of failure were surprisingly high overall and varied widely depending on the specific validity indicator and the age of the examinee. The strong age association, with 3 of 4 participants aged 10 to 12 years failing validity indicators, suggests that the clinical interpretation and utility of baseline testing in this age group is questionable. These findings underscore the need for close scrutiny of performance validity indicators on baseline testing across age groups.

Post-transplant adaptive function in childhood cerebral adrenoleukodystrophy.

ObjectiveHematopoietic stem cell transplantation (HSCT) is the only treatment known to slow or halt inflammatory demyelination among boys with the cerebral form of X‐linked adrenoleukodystrophy (cALD), a devastating childhood condition affecting the central nervous system. HSCT can lead to a range of adverse outcomes including fatality. Previous studies have examined the potential predictors of post‐HSCT survival and neurologic functioning. However, little is known about patients' daily‐life adaptive functional outcomes (i.e., ability to communicate, maintain social relationships, and independently execute tasks of daily living). The purpose of this retrospective cohort study was to identify which patient characteristics and treatment‐related variables predict long‐term adaptive function among the survivors of HSCT for cALD.MethodsWe obtained caregiver ratings of adaptive functioning of 65 transplant survivors at an average of 4.6 years (range: 1.0–24.1 years) post‐HSCT. Using linear regression with penalized maximum likelihood estimation, we modeled the relative contribution of pre‐transplant neurocognitive test performance, MRI severity, transplant regimen, and length of time since transplant on patient adaptive functioning outcomes.ResultsHigher radiographic disease severity and poorer performance on baseline neurocognitive tests requiring fine motor skills and visual perception were associated with inferior adaptive functioning after HSCT. Use of radiation during the transplant preparative regimen also predicted poorer adaptive outcomes.InterpretationIn addition to radiological disease severity, baseline neurocognitive test performance is associated with post‐transplant adaptive functional outcomes. Neurocognitive measures may play an important role in prognostic counseling and post‐transplant treatment planning for patients considering HSCT for cALD.

Self-reported history of seizure and baseline neurocognitive test performance in student-athletes: an initial investigation

ABSTRACTObjectives: Baseline neurocognitive assessment data can be critical in return to play (RTP) decision-making following a sport-related concussion (SRC). The literature indicates that many modifying factors of SRC have been studied empirically; however, there has been little investigation into the effect of a self-reported history of seizure(s) on baseline neurocognitive test data. The objective of this investigation was to determine whether a self-reported history of seizure(s) is associated with differences in baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) performance.Methods: A retrospective analysis of 18,245 adolescent and young adult athletes’ ImPACT scores was performed. After application of inclusion and exclusion criteria, 7,391 participants were dichotomized into groups based on the presence or absence of a self-reported history of seizure. Participants reporting a history of seizure (n = 60) were matched on multiple variables in a 1:3 ratio with controls (n = 180) without a history of self-reported seizure. Baseline ImPACT composite scores were then compared between groups using either a 2-tailed t-test or a Mann-Whitney U-Test.Results: A significant between-group difference was observed in ImPACT visual motor speed composite scores (35.28 vs. 37.64, p = 0.029, Hedge’s g = 0.327), with the group self-reporting a history of seizure performing at inferior average scores. No significant between-group differences were detected in verbal memory, visual memory, reaction time, impulse control, or total symptom scores.Conclusion: Athletes with a history of self-reported seizure scored significantly lower on ImPACT visual motor speed compared to matched controls. As a solitary finding with a small effect size, the clinical significance of this difference is unclear. Apart from the decrease in visual-motor speed, this preliminary analysis suggests that athletes with a history of seizure might not have significantly different neurocognitive baseline test scores when compared with matched controls. Further empirical investigation is warranted to determine if a history of seizure is a modifying factor for SRC.

Impact of Diagnosed Sleep Disorder on Baseline Concussion Assessments in Collegiate Athletes

Research suggests at least 27% of college students are at risk for at least one sleep disorder. Adolescents with sleep-related symptoms and reduced sleep duration perform worse on baseline neurocognitive testing, although this effect size is small and samples have not included older or collegiate-level athletes. Previous research has not taken into consideration the effects of previously diagnosed sleep disorders on performance of preinjury baseline assessment. PURPOSE: The purpose of the current study was to compare athletes with and without a history of diagnosed sleep disorders on commonly used baseline concussion assessments. METHODS: All participants completed baseline testing including: the Balance Error Scoring System (BESS), Brief Symptom Inventory (BSI), Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Post-Concussion Symptom Score (PCSS), Standardized Assessment of Concussion (SAC) and Vestibular/Ocular Motor Screening (VOMS). A total of 632 NCAA student-athletes participated in the study including 316 with previously diagnosed sleep disorders and 316 with no history of sleep disorder, matched for age, sex, sport, concussion history and race. Both groups were 19.87 years old (SD = 1.36), consisted of 176 males (55.7%), with 119 athletes (37.7%) previously having sustained a concussion, and represented a multitude of sports. RESULTS: A series of one-way ANOVAs with Bonferroni corrections revealed significant differences between groups on BESS (F(1, 535) = 4.02, p = .045), BSI somatization (F(1,623) = 11.41, p < .01), BSI depression (F(1, 623) = 13.59, p < .01), BSI anxiety (F(1, 623) = 20.97, p < .01), BSI global severity index (F(1, 623), p < .01) and PCSS (F(1, 396) = 22.86, p < .01). Specifically, the diagnosed sleep disorder group scored worse on the BESS and reported higher BSI and PCSS symptoms. No differences were noted between groups on VOMS, ImPACT neurocognitive measures, and SAC. CONCLUSION: Collegiate student-athletes with sleep disorders may have elevated affective and concussion symptoms at baseline that could affect interpretation of post-injury impairment and symptoms. Clinicians should assess diagnosed sleep disorders during pre-participation sport physicals and consider them when interpreting post-injury assessments.

Laser thermal ablation for mesiotemporal epilepsy: Analysis of ablation volumes and trajectories.

To identify features of ablations and trajectories that correlate with optimal seizure control and minimize the risk of neurocognitive deficits in patients undergoing laser interstitial thermal therapy (LiTT) for mesiotemporal epilepsy (mTLE). Clinical and radiographic data were reviewed from a prospectively maintained database of all patients undergoing LiTT for the treatment of mTLE at the University of Miami Hospital. Standard preoperative and postoperative evaluations, including contrast-enhanced magnetic resonance imaging (MRI) and neuropsychological testing, were performed in all patients. Laser trajectory and ablation volumes were computed both by manual tracing of mesiotemporal structures and by nonrigid registration of ablation cavities to a common reference system based on 7T MRI data. Among 23 patients with at least 1-year follow-up, 15 (65%) were free of disabling seizures since the time of their surgery. Sparing of the mesial hippocampal head was significantly correlated with persistent disabling seizures (p = 0.01). A lateral trajectory through the hippocampus showed a trend for poor seizure outcome (p = 0.08). A comparison of baseline and postoperative neurocognitive testing revealed areas of both improvement and worsening, which were not associated with ablation volume or trajectory. At 1-year follow-up, LiTT appears to be a safe and effective tool for the treatment of mTLE, although a longer follow-up period is necessary to confirm these observations. Better understanding of the impact of ablation volume and location could potentially fine-tune this technique to improve seizure-freedom rates and associated neurologic and cognitive changes.

Comparison of baseline and post-concussion ImPACT test scores in young athletes with stimulant-treated and untreated ADHD

ABSTRACTObjectives: Baseline and post-concussion neurocognitive testing is useful in managing concussed athletes. Attention deficit hyperactivity disorder (ADHD) and stimulant medications are recognized as potential modifiers of performance on neurocognitive testing by the Concussion in Sport Group. Our goal was to assess whether individuals with ADHD perform differently on post-concussion testing and if this difference is related to the use of stimulants.Methods: Retrospective case-control study in which 4373 athletes underwent baseline and post-concussion testing using the ImPACT battery. 277 athletes self-reported a history of ADHD, of which, 206 reported no stimulant treatment and 69 reported stimulant treatment. Each group was matched with participants reporting no history of ADHD or stimulant use on several biopsychosocial characteristics. Non-parametric tests were used to assess ImPACT composite score differences between groups.Results: Participants with ADHD had worse verbal memory, visual memory, visual motor speed, and reaction time scores than matched controls at baseline and post-concussion, all with p ≤ .001 and |r|≥ 0.100. Athletes without stimulant treatment had lower verbal memory, visual memory, visual motor speed, and reaction time scores than controls at baseline (p ≤ 0.01, |r|≥ 0.100 [except verbal memory, r = −0.088]) and post-concussion (p = 0.000, |r|> 0.100). Athletes with stimulant treatment had lower verbal memory (Baseline: p = 0.047, r = −0.108; Post-concussion: p = 0.023, r = −0.124) and visual memory scores (Baseline: p = 0.013, r = −0.134; Post-concussion: p = 0.003, r = −0.162) but equivalent visual motor speed and reaction time scores versus controls at baseline and post-concussion.Conclusions: ADHD-specific baseline and post-concussion neuropsychological profiles, as well as stimulant medication status, may need to be considered when interpreting ImPACT test results. Further investigation into the effects of ADHD and stimulant use on recovery from sport-related concussion (SRC) is warranted.

Neurocognitive Function in Children with Primary Hypertension

To compare neurocognitive test performance of children with primary hypertension with that of normotensive controls. Seventy-five children (10-18 years of age) with newly diagnosed, untreated hypertension and 75 frequency-matched normotensive controls had baseline neurocognitive testing as part of a prospective multicenter study of cognition in primary hypertension. Subjects completed tests of general intelligence, attention, memory, executive function, and processing speed. Parents completed rating scales of executive function and the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire (PSQ-SRBD). Hypertension and control groups did not differ significantly in age, sex, maternal education, income, race, ethnicity, obesity, anxiety, depression, cholesterol, glucose, insulin, and C-reactive protein. Subjects with hypertension had greater PSQ-SRBD scores (P = .04) and triglycerides (P = .037). Multivariate analyses showed that hypertension was independently associated with worse performance on the Rey Auditory Verbal Learning Test (List A Trial 1, P = .034; List A Total, P = .009; Short delay recall, P = .013), CogState Groton Maze Learning Test delayed recall (P = .002), Grooved Pegboard dominant hand (P = .045), and Wechsler Abbreviated Scales of Intelligence Vocabulary (P = .016). Results indicated a significant interaction between disordered sleep (PSQ-SRBD score) and hypertension on ratings of executive function (P = .04), such that hypertension heightened the association between increased disordered sleep and worse executive function. Youth with primary hypertension demonstrated significantly lower performance on neurocognitive testing compared with normotensive controls, in particular, on measures of memory, attention, and executive functions.

Obesity and neurocognitive recovery after sports-related concussion in athletes: a matched cohort study

ABSTRACTObjectives: Sports-related concussions (SRCs) are a significant public health concern in athletes. Data exist suggesting a link between obesity and decreased neurocognitive function, yet the effect of body mass index (BMI) on neurocognitive function and recovery after a SRC is unknown. The goal of our study was to discern the effect of BMI on recovery after SRC.Methods: This study was a retrospective observational cohort study. Between 2013 and 2014, 7,606 athletes between the ages of 13–20 years valid baseline neurocognitive testing performed at multiple regional concussion centers sustained a concussion. Out of these athletes, 711 normal weight athletes and 711 obese athletes were matched by age, gender, number of previous concussions, and sport. The proportions of athletes returning to baseline within two weeks between the groups were defined by using 80% confidence reliable change index (RCI) criteria and were compared using Fisher’s Exact Test. Kaplan-Meier survival curve analysis with log-rank test was used to compare the median time to neurocognitive recovery between groups.Results: Fewer obese athletes returned to baseline within 2 weeks on measures of verbal memory, visual motor speed, reaction time, postconcussion symptom scale (PCSS), and overall recovery compared to normal weight athletes. Obese athletes also had greater median time of return to baseline with respect to reaction time, PCSS, and overall recovery.Conclusion: Using RCI methodology, there exists an association between obesity and increased time to return to neurocognitive and symptom baseline after SRC in athletes, specifically reaction time, symptom scores, and overall recovery.

Neuropsychological Assessment Following Concussion: an Evidence-Based Review of the Role of Neuropsychological Assessment Pre- and Post-Concussion.

Neuropsychological evaluation is one component of a comprehensive and multifaceted assessment following concussion. Although some neuropsychologists use a "hybrid" assessment approach integrating computerized neurocognitive testing batteries with traditional paper and pencil tests, computerized neurocognitive test batteries are the predominant testing modality for assessment of athletes from the youth to professional level. This review summarizes the most recent research supporting the utility of neuropsychological evaluation and highlights the strengths and weaknesses of both computerized and traditional neuropsychological testing approaches. The most up to date research and guidelines on baseline neurocognitive testing is also discussed. This paper addresses concerns regarding reliability of neuropsychological testing while providing an overview of factors that influence test performance, both transient situational factors (e.g., pain level, anxiety) and characteristics of particular subgroups (e.g., age, preexisting learning disabilities), warranting the expertise of an experienced neuropsychologist for interpretation. Currently, research is moving forward by integrating neuropsychological evaluation with emerging assessment approaches for other domains of brain function (e.g., vestibular function) vulnerable to concussion.

Attention-Deficit Hyperactivity Disorder Status and Baseline Neurocognitive Performance in High School Athletes

Approximately 136,000 concussions occur annually in American high school sports. Neuropsychological data indicate that children with preexisting cognitive difficulties, such as attention-deficit hyperactivity disorder (ADHD), may have protracted recovery from concussion. ADHD, with an estimated prevalence of 11% in youth, may increase an athlete's vulnerability to sustaining sports-related traumatic brain injury (TBI). The preponderance of evidence focusing on TBI and ADHD has derived from motor vehicle accidents rather than sports-related incidents. Thus, it is paramount to explore how ADHD may relate to injury in the sports concussion context, as well as to assess how ADHD may affect baseline neurocognitive testing. Adolescent athletes with ADHD (n = 256) demonstrated significantly reduced Verbal Memory, Visual Motor, and Impulse Control index scores compared with their peers without ADHD (n = 256). Athletes with ADHD were nearly twice as likely to have sustained a prior concussion (ADHD, 14.1%; non-ADHD, 7.8%). Knowledge regarding the unique neurocognitive profile of athletes with ADHD may enhance clinical management decisions.

Professional Rugby Union players have a 60% greater risk of time loss injury after concussion: a 2-season prospective study of clinical outcomes

AimTo investigate incidence of concussion, clinical outcomes and subsequent injury risk following concussion.MethodsIn a two-season (2012/2013, 2013/2014) prospective cohort study, incidence of diagnosed match concussions (injuries/1000 h), median time interval...

A-58Factors Associated with Invalid Scores on Baseline Neurocognitive Testing in Athletes

A-58Factors Associated with Invalid Scores on Baseline Neurocognitive Testing in Athletes

Are psychotropic medications associated with differences in baseline neurocognitive assessment scores for young athletes? A pilot study

Objectives. Baseline and post-concussive neurocognitive testing is useful in managing concussed athletes. The Concussion in Sport Group has postulated that the use of psychotropic medications is a modifying factor in the management of sport-related concussion. About 7% of US adolescents are prescribed psychotropics in a given year. Our aim was to investigate whether psychotropic medication use or psychiatric illness is associated with differences in baseline neurocognitive test scores. Methods. From 2007 to 2012, over 7000 athletes underwent pre-participation baseline neurocognitive testing using the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) battery. Following application of inclusion and exclusion criteria, athletes’ self-reported medication lists were reviewed and: 1) classified as psychotropic or not and 2) subclassified. Group subclassification yielded: 1) use of any psychotropic medication, 2) psychostimulant use, 3) antidepressant use and 4) self-reported history of depression and/or anxiety without psychotropic use. Each group was matched, by sex, age, body mass index, education level and concussion history with athletes who were not reportedly prescribed psychotropic medications or did not report a depression/anxiety history, respectively. Each group’s baseline ImPACT scores were compared to matched controls. Results. The use of prescribed psychotropic medications without regard to subclass had no effect on baseline ImPACT composite scores among athletes ages 13–25. However, athletes reportedly prescribed psychostimulants displayed significantly lower visual motor speed scores (32.8 vs 37.1, p = 0.030) and slower reaction times (0.65 vs 0.60, p = 0.044) than non-users. In contrast, antidepressant users displayed significantly faster reaction times (0.58 vs 0.61, p = 0.029). Those reporting a history of depression/anxiety, not treated with psychotropics, displayed significantly lower visual memory (70.4 vs 75.2, p = 0.010) and higher symptom scores (8.83 vs 4.72, p = 0.005). Conclusions. This pilot study suggests that self-reported psychotropic medications are associated with differences in baseline ImPACT test scores, which appear dependent on medication subclass. Our preliminary results support the inclusion of psychotropic medications, specifically psychostimulants and antidepressants, as well as history of depression/anxiety as potential concussion modifiers.

Relationship of Attention Deficit Hyperactivity Disorder and Postconcussion Recovery in Youth Athletes.

To investigate whether attention deficit hyperactivity disorder (ADHD) influences postconcussion recovery, as measured by computerized neurocognitive testing. This is a retrospective case control study. Computer laboratories across 10 high schools in the greater Atlanta, Georgia area. Immediate postconcussion assessment and cognitive testing (ImPACT) scores of 70 athletes with a self-reported diagnosis of ADHD and who sustained a sport-related concussion were compared with a randomly selected age-matched control group. Immediate postconcussion assessment and cognitive testing scores over a 5-year interval were reviewed for inclusion. Postconcussion recovery was defined as a return to equivalent baseline neurocognitive score on the ImPACT battery, and a concussion symptom score of ≤7. Athletes with ADHD had on average a longer time to recovery when compared with the control group (16.5 days compared with 13.5 days), although not statistically significant. The number of previous concussions did not have any effect on the rate of recovery in the ADHD or the control group. In addition, baseline neurocognitive testing did not statistically differ between the 2 groups, except in verbal memory. Although not statistically significant, youth athletes with ADHD took on average 3 days longer to return to baseline neurocognitive testing compared with a control group without ADHD. Youth athletes with ADHD may have a marginally prolonged recovery as indexed by neurocognitive testing and should be considered when prognosticating time to recovery in this subset of student athletes.