Immediate Post-Concussion Assessment And Cognitive Testing Research Articles

Preliminary Evidence of a Dose-Response for Continuing to Play on Recovery Time After Concussion.

To investigate a dose-response relationship between continuing to play following concussion and outcomes. A total of 130 athletes (age 11-19 years). Repeated-measures design comparing symptoms, neurocognitive performance, and recovery time between 52 athletes immediately removed from play (Removed), 24 who continued to play for 15 minutes or less (Short-Play), and 32 who continued to play for more than 15 minutes (Long-Play). Recovery was the number of days from injury to clearance. Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) measured neurocognitive outcomes and the Post-Concussion Symptom Scale (PCSS) measured symptom severity. Long-Play (44.09 ± 27.01 days) took longer to recover than Short-Play (28.42±12.74 days) and Removed (18.98 ± 13.76 days). Short-Play was 5.43 times more likely, and Long-Play 11.76 times more likely, to experience protracted recovery relative to Removed. Both Play groups had worse neurocognitive performance and higher symptom scores than Removed at days 1 to 7, with Long-Play demonstrating worse reaction time than Short-Play. At days 8 to 30, both Play groups performed worse than Removed on visual memory and visual motor speed, while only Long-Play performed worse on verbal memory and reaction time. Results provide initial evidence of a dose-response effect for continuing to play on recovery from concussion, highlighting the importance of removal from play.

Factors Associated With Self-Reported Concussion History in Middle School Athletes.

Identifying personal characteristics associated with sustaining a concussion is of great interest, yet only a few have examined this in children. The purpose of this study was to examine the association between sex, neurodevelopmental disorders, health history, and lifetime history of self-reported concussion in 12- and 13-year-old athletes. Cross-sectional study. Middle schools. Participants were 1744 twelve- and thirteen-year-old student athletes who completed preseason Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) testing, including a self-report questionnaire about previous concussions, developmental diagnoses, and previous medical treatment. Age, sex, attention-deficit/hyperactivity disorder (ADHD), learning disabilities (LDs), and previous treatment for migraine. Self-reported history of concussion. A minority of athletes (13.7%) reported previous concussions (1 concussion, n = 181; 2 concussions, n = 41; and 3+ concussions, n = 17). A small proportion reported a history of ADHD (4.4%), LD (2.8%) or migraine treatment (4.0%). Higher rates of self-reported previous concussions were associated with male sex [16.9% vs 9.1%; χ(1) = 21.47, P < 0.001] and previous migraine treatment [31.9% vs 13.0%; χ(1) = 20.08, P < 0.001]. There were no differences in self-reported concussion history between 12- and 13-year olds (P = 0.18) and those with/without ADHD (P = 0.41) or LDs (P = 0.06). The overall logistic regression model was statistically significant [χ(5) = 42.01, P < 0.001] but explained only 4.3% of the variance. Previous treatment for migraine [P < 0.001, Exp(B) = 3.30] and male sex [P < 0.001, Exp(B) = 2.06] were independently associated with a self-reported concussion history, whereas age, LD, and ADHD were not (P's > 0.05). Male sex and previous migraine treatment were associated with higher rates of self-reported previous concussions in both independent and multivariate models in middle school athletes, whereas age, ADHD, and LDs were not.

Post-concussive depression: evaluating depressive symptoms following concussion in adolescents and its effects on executive function

ABSTRACTBackground: Post-concussive depression describes an elevation of depressive symptoms following concussion that occurs in conjunction with other symptoms of concussion. Children with concussion are more likely to diagnosed with depression. The overlapping symptoms between clinical depression and concussion make the diagnosis of depression difficult. The purpose of this study is to explore how post-concussive depression relates to post-concussion symptoms and cognition by investigating symptom-reporting in youth with post-concussive depression and executive function.Methods: Adolescents (age 10–17 years) diagnosed with concussion were divided into two groups based on depression scores on the Children’s Depression Inventory (post-concussion depression; non-depression groups). Symptom reporting on the Post-Concussion Symptom Inventory and performance on Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) were compared.Results: Participants with post-concussive depression had heightened emotionality, irritability, and nervousness. Sadness and fatigue were reported by both groups. ImPACT was unable to distinguish between groups but the group overall demonstrated severe neurocognitive deficits.Conclusion: Reports of greater emotionality, irritability, and nervousness on concussion symptom scales may be indicators of post-concussion depression. It is important for clinicians to take note when an adolescent with concussion scores high on these three emotional symptoms as they may be indicative of greater emotional distress.

Effect of Diagnosed Sleep Disorders on Baseline Concussion Symptom, Cognitive, and Balance Assessments in Collegiate Athletes

Background: Symptoms, cognition, balance, and other domains are commonly assessed at baseline testing as part of comprehensive preseason evaluations among collegiate student-athletes. Although approximately 27% of college students have at least 1 sleep disorder, researchers have yet to examine the role of a preexisting sleep disorder on preinjury baseline performance. Purpose: To compare athletes with and without a reported history of diagnosed sleep disorders on commonly used baseline concussion assessments. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 666 National Collegiate Athletic Association student-athletes completed baseline measures including the Balance Error Scoring System (BESS), Brief Symptom Inventory–18 (BSI-18), Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Post-Concussion Symptom Scale (PCSS), Sport Concussion Assessment Tool–5th Edition (SCAT5), and Standardized Assessment of Concussion (SAC). There were 333 athletes with a history of diagnosed sleep disorders who were matched on age, sex, sport, and concussion history to 333 athletes with no history of diagnosed sleep disorders. Participants in both groups had a mean age of 19.89 ± 1.36 years and included 182 (54.7%) male athletes, and 126 (37.8%) reported a history of ≥1 concussions. Results: A series of 1-way analyses of covariance with Bonferroni corrections revealed significant group differences on the BESS (F1,559 = 8.88; P < .01); BSI-18 somatization (F1,640 = 18.48; P < .01), depression (F1,640 = 18.78; P < .01), anxiety (F1,640 = 19.42; P < .01), and global severity index (F1,640 = 27.18; P < .01); PCSS (F1,424 = 29.42; P < .01); SCAT5 symptom number (F1,634 = 28.79; P < .01) and symptom severity (F1,634 = 31.74; P < .01); and SAC (F1,578 = 4.36; P = .037). Specifically, while the sleep disorder group did perform better on the BESS, they also reported higher symptoms on the BSI-18, PCSS, and SCAT5 and performed worse on the SAC. There were no group differences on ImPACT performance. Conclusion: Collegiate student-athletes with diagnosed sleep disorders reported elevated affective and concussion symptoms at baseline that could affect the interpretation of postinjury impairments and symptoms. Based on the small effect sizes of our findings, however, the magnitude of these differences is of questionable clinical significance. Still, clinicians should consider diagnosed sleep disorders as reported during preparticipation sports physical examinations when interpreting baseline and postinjury concussion assessments.

Differential Expression of Circulating Inflammatory Proteins Following Sport-Related Traumatic Brain Injury.

Sport-related traumatic brain injury (TBI) elicits a multifaceted inflammatory response leading to brain injury and morbidity. This response could be a predictive tool for the progression of TBI and to stratify the injury of which mild TBI is most prevalent. Therefore, we examined the differential expression of serum inflammatory markers overtime and identified novel markers in repetitively concussed athletes. Neuropsychological assessment by Wechsler Adult Intelligence Scale (WAIS) and Immediate Post Concussion Assessment and Cognitive Test (ImPACT) was performed on rugby players and serum was taken from healthy, concussed and repetitively concussed athletes. Serum was also obtained <1 week and >1 week after trauma and analyzed for 92 inflammatory protein markers. Fibroblast growth factor 21 (FGF21) and interleukin-7 (IL-7) differentiated repetitively concussed athletes. Macrophage chemotactic protein-1 (MCP-1), tumor necrosis factor superfamily member 14 (TNFSF14) were significantly reduced >1 week and chemokine (C-X3-C motif) ligand 1 (CX3CL1) upregulated <1 week after injury. FGF21 and MCP-1 negatively correlated with symptoms and their severity. We have identified dynamic changes in the inflammatory response overtime and in different classes of concussion correlating with disease progression. This data supports the use of inflammatory biomarkers as predictors of symptom development due to secondary complications of sport-related mTBI.

A Normative Reference vs. Baseline Testing Compromise for ImPACT: The CARE Consortium Multiple Variable Prediction (CARE-MVP) Norms.

Sports medicine clinicians routinely use computerized neurocognitive testing in sport-related concussion management programs. Debates continue regarding the appropriateness of normative reference comparisons versus obtaining individual baseline assessments, particularly for populations with greater likelihood of having below- or above-average cognitive abilities. Improving normative reference methods could offer alternatives to perceived logistical and financial burdens imposed by universal baseline testing. To develop and validate the Concussion Assessment, Research, and Education (CARE) Consortium Multiple Variable Prediction (MVP) norms for the Immediate Postconcussion Assessment and Cognitive Testing (ImPACT). We developed the CARE-MVP norms for ImPACT composite scores using regression-based equations. Predictor variables included sex, race (white/Caucasian, black/African American, Asian, or Multiple Races), medical history [attention-deficit/hyperactivity disorder (ADHD), learning disorder (LD), prior concussion(s), prior psychiatric diagnosis], and an estimate of premorbid intellect (Wechsler Test of Adult Reading). CARE-MVP norms were first validated in an independent sample of healthy collegiate athletes by comparing predicted and actual baseline test scores using independent-samples t-tests and Cohen's d effect sizes. We then evaluated base rates of low scores in athletes self-reporting ADHD/LD (vs. non-ADHD/LD) and black/African American race (vs. white/Caucasian) across multiple normative reference methods (Chi square, Cramer's V effect size). Lastly, we validated the CARE-MVP norms in a concussed sample (dependent samples t test, Cohen's d effect size). A total of 5233 collegiate athletes (18.8 ± 1.2years, 70.5% white/Caucasian, 39.1% female) contributed to the CARE-MVP norms (development N = 2616; internal validation N = 2617). Race and WTAR score were the strongest and most consistent ImPACT score predictors. There were negligible mean differences between observed and predicted (CARE-MVP) baseline scores (Cohen's d < 0.1) for all ImPACT composite scores except Reaction Time (predicted ~ 20ms faster than observed, d = - 0.28). Low score base rates were similar for athletes across subpopulations when using CARE-MVP norms (ADHD/LD, V = 0.017-0.028; black/African American, V = 0.043-0.053); while, other normative reference methods resulted in disproportionately higher rates of low scores (ADHD/LD, V = 0.062-0.101; black/African American race, V = 0.163-0.221). Acute (24-48h) postconcussion ImPACT scores were significantly worse than CARE-MVP norms but notably varied as a function of concussion symptom severity. Results support CARE-MVP norm use in populations typically underrepresented or not adjusted for in traditional normative reference samples, such as those self-reporting ADHD/LD or black/African American race. CARE-MVP norms improve upon prior normative methods and may offer a practical, simple alternative for collegiate institutions concerned about logistical and financial burden associated with baseline testing. An automated scoring program is provided.

Estimated Age of First Exposure to Contact Sports and Neurocognitive, Psychological, and Physical Outcomes in Healthy NCAA Collegiate Athletes: A Cohort Study.

Collegiate football players who started playing tackle football before age 12years did not show worse neuropsychological test performance than those who started playing tackle football after age 12years. It is unknown if beginning other contact sports, such as lacrosse, at a younger age is associated with worse neurocognitive performance, greater psychological distress, or worse postural stability in collegiate student athletes. The purpose of this study was to examine the association between estimated age of first exposure (eAFE) to repetitive head impacts (RHI) and these outcome measures in collegiate student athletes. 1891 female and 4448 male collision/contact (i.e., football, ice hockey, lacrosse, wrestling, soccer) and non-contact (i.e., golf, rifle, rowing/crew, swimming, tennis) sport athletes completed baseline testing, including the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Brief Symptom Inventory 18 (BSI-18), and Balance Error Scoring System (BESS). For women, the eAFE-by-sport interaction was associated with ImPACT Verbal Memory and Visual Memory, whereby earlier eAFE to contact sports was associated with higher composite scores (B = - 0.397, B = - 0.485, respectively). For men, the eAFE-by-sport interaction was associated with BSI-18 Depression and Global Severity Index and symptom severity scores, whereby earlier eAFE to football was associated with lower psychological distress and symptom severity [Depression, Exp(B) = 1.057; Global Severity Index, Exp(B) = 1.047; Symptom Severity, Exp(B) = 1.046]. Parameter estimates were small suggesting these results may have minimal practical relevance. Findings suggest that RHI during early adolescence is unrelated to brain health as measured by these specific outcome measures in collegiate student athletes.

ImPACT Normative Data of Ethnically Diverse Adolescent Athletes.

The aim of this research was to develop preliminary norms for the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) administered to a large sample of adolescent athletes from diverse ethnic backgrounds. A retrospective records review. Middle and high school athletic departments. A total of 5741 male and female adolescent athletes in Hawaii, aged 13 to 18 years, in grades 9 to 12 were included in the study. Age, sex, ethnicity, and sport. ImPACT Composite scores (Verbal Memory, Visual Memory, Visual Motor Speed, Reaction Time, and Impulse Control) and Total Symptom score from baseline testing. The results indicated statistically significant differences between age and sex groups, as well as between ethnic and sport groups. The findings support the continued use of stratified norms for age and sex for ethnically diverse adolescent athletes. Comparisons of ethnic and sport groups deserve further investigation. When baseline scores are not available for postconcussion comparison, present observations tentatively support the cautious use of standard ImPACT norms with ethnically diverse athletes.

Influence of Test Environment, Age, Sex, and Sport on Baseline Computerized Neurocognitive Test Performance

Background: Baseline computerized testing is a common component of concussion assessments, and the testing environment has been suggested to influence test performance and validity. Purpose: To compare concussion baseline computerized neurocognitive test performance and validity among adolescent athletes based on testing environment (group, individual), age group (10-12, 13-15, 16-18 years), sex (male, female), and sport type (collision/combat, contact, noncontact). Study Design: Cohort study; Level of evidence, 3. Methods: Through a concussion community outreach program, participants completed baseline computerized neurocognitive testing using Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). A total of 2845 athletes aged 10 to 18 years completed the baseline assessment. A total of 2241 (79%) athletes completed baseline testing in a group environment, and 604 (21%) completed testing in an individual environment. A random subsample of 500 athletes from each group was selected for statistical comparison. Results: No significant differences were supported in baseline computerized neurocognitive test performance between the group and individual administration environments. Test validity was statistically similar across testing environment, age group, and sex. However, patients of older age (16-18 years), female sex, and collision/combat and contact sports performed better on ImPACT. There were differences in total symptom severity scores (t = 2.19, df = 998, P = .03), with participants in the group testing environment reporting lower total symptom severity scores than those in the individual testing environment. The rates of invalid tests were low across all age groups, averaging from 4.0% in the 10- to 12-year age group to 4.8% in the 13- to 15-year age group. Conclusion: The findings indicated that concussion baseline neurocognitive test performance is similar when administered in group and individual testing environments. However, differences based on age group, sex, and sport type should be considered when interpreting baseline computerized neurocognitive test scores. The finding of higher symptom scores in older adolescents in the individual testing environment suggests that they may be less forthcoming about symptoms in a group setting.

The Influence of Self-Reported Tobacco Use on Baseline Concussion Assessments.

Baseline symptom, balance, and neurocognitive scores have become an integral piece of the concussion management process. Factors such as sleep, learning disorders, fitness level, and sex have been linked to differences in performance on baseline assessments; however, it is unclear how tobacco use may affect these scores. The objective of this study was to compare baseline concussion assessment scores between service academy cadets who use and do not use tobacco. Cadets completed a standard battery of concussion baseline assessments per standard of care and were classified into two groups: tobacco users (n=1,232) and nonusers (n=5,922). Dependent variables included scores on the Balance Error Scoring System, Standardized Assessment of Concussion, Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Brief Symptom Inventory-18, and Brief Sensation Seeking Scale (BSSS). Separate Mann-Whitney U-tests were used to compare all baseline assessment scores between groups with an adjusted P-value<0.004. Cadets that used tobacco performed significantly worse on the impulse control (P<0.001) section of the ImPACT, reported greater ImPACT symptom severity scores (P<0.001), and were more likely to take risks as measured by the BSSS (P<0.001). No differences were detected for Balance Error Scoring System, Standardized Assessment of Concussion, Brief Symptom Inventory-18, and Sport Concussion Assessment Tool-3 symptom scores, verbal memory, visual memory, visual-motor speed, or reaction time on the ImPACT (P>0.004). Tobacco users performed significantly worse than tobacco nonusers on the impulse control section of the ImPACT, reported greater symptom severity scores on the ImPACT, and were more likely to take risks as measured by the BSSS. Despite statistical significance, these results should be interpreted with caution, as the overall effect sizes were very small. Future research should examine the influence of tobacco use on recovery post-concussion.

Relationship Between the King-Devick Test and Commonly Used Concussion Tests at Baseline

Comprehensive assessments are recommended to evaluate sport-related concussion (SRC). The degree to which the King-Devick (KD) test adds novel information to an SRC evaluation is unknown. To describe relationships at baseline among the KD and other SRC assessments and explore whether the KD provides unique information to a multimodal baseline concussion assessment. Cross-sectional study. Five National Collegiate Athletic Association institutions participating in the Concussion Assessment, Research and Education (CARE) Consortium. National Collegiate Athletic Association student-athletes (N = 2258, age = 20 ± 1.5 years, 53.0% male, 68.9% white) in 11 men's and 13 women's sports. Participants completed baseline assessments on the KD and (1) the Symptom Inventory of the Sport Concussion Assessment Tool-3rd edition, (2) the Brief Symptom Inventory-18, (3) the Balance Error Scoring System, (4) the Standardized Assessment of Concussion (SAC), (5) the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) test battery, and (6) the Vestibular/Ocular Motor Screening tool during their first year in CARE. Correlation coefficients between the KD and the 6 other concussion assessments in isolation were determined. Assessments with ρ magnitude >0.1 were included in a multivariate linear regression analysis to evaluate their relative association with the KD. Scores for SAC concentration, ImPACT visual motor speed, and ImPACT reaction time were correlated with the KD (ρ = -0.216, -0.276, and 0.164, respectively) and were thus included in the regression model, which explained 16.8% of the variance in baseline KD time (P < .001, Cohen f2 = 0.20). Better SAC concentration score (β = -.174, P < .001), ImPACT visual motor speed (β = -.205, P < .001), and ImPACT reaction time (β = .056, P = .020) were associated with faster baseline KD performance, but the effect sizes were small. Better performance on cognitive measures involving concentration, visual motor speed, and reaction time was weakly associated with better baseline KD performance. Symptoms, psychological distress, balance, and vestibular-oculomotor provocation were unrelated to KD performance at baseline. The findings indicate limited overlap at baseline among the CARE SRC assessments and the KD.

The effects of socioeconomic status on baseline neurocognitive testing scores

Baseline neurocognitive testing has been recommended to provide a more accurate representation of the pre-concussion cognitive status of individual athletes. Socioeconomic status is not typically controlled for when obtaining baseline scores, which may lead to inaccurate findings if post-injury scores are compared to normative data. Understanding the role of socioeconomic status in baseline testing is important for the accurate analysis of test scores and proper evaluation of patients if individualized baseline data are not available. Our purpose was to investigate the effects of socioeconomic status, as determined by eligibility for free or reduced cost lunch on baseline neurocognitive test scores in secondary school athletes. 1,788 secondary school athletes (females = 778, males = 1,010, age = 14.96 ± 1.11 years, height = 171.25 ± 17.83 cm, mass = 66.82 ± 21.63 kg) completed the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) upon starting scholastic athletics. ImPACT components (symptom severity scores and composite scores of verbal memory, visual memory, visual motor speed, and reaction time) served as the dependent variables. School administration coded free or reduced cost lunch eligibility (N = 1255 not eligible, N = 563 eligible) for each participant (group), which served as the independent variable. Free or reduced cost lunch eligibility significantly altered the combined dependent variables (multivariate F 5,1780=14.41, p < .001, ɳ2 = .04) when sex and age were controlled. Follow up ANOVAs showed that participants eligible for free or reduced cost lunch scored significantly worse on verbal memory (F 1,1784 = 24.81, p < .001, ɳ2 = .01), visual memory (F 1,1784 = 24.90, p < .001, ɳ2 = .01), and visual motor speed (F 1,1784 = 50.54, p < .001, ɳ2 = .03). In addition, slower reaction times (F 1,1784 = 35.10, p < .001, ɳ2 = .02) and higher symptom severity scores (F 1,1784 = 10.37, p < .01, ɳ2 = .01) were observed in those eligible for free or reduced cost lunch. If normative data are used instead of individual baselines, potential modifiers such as socioeconomic status should be taken into account when analyzing concussion scores to provide accurate diagnoses.

Data from an emerging UK sports concussion clinic; should athlete assessment be sports-specific?

ObjectiveTo provide an overview of the Cambridge Sports Concussion Clinic; to investigate trends in patients’ neurocognition utilising assessment with the Immediate Post-concussion Assessment and Cognitive Test (ImPACT) as stratified by sport.BackgroundProfessional sporting litigation in the USA has brought to the fore the issue of sports concussion. Despite this, UK outpatient management remains in its infancy, with less than five centres offering specialised post-injury review. This poster presents data from the Cambridge Sports Concussion Clinic (CSCC), comparing ImPACT assessments across motorsport and rugby.Design/MethodsThe data is a retrospective analysis of a prospectively maintained database cohort, in which demographic, clinical and neurocognitive data are archived. The submission includes CSCC patients who attended Addenbrooke’s Hospital, Cambridge for clinical review June 2017-March 2019, who were diagnosed with concussion and completed an ImPACT assessment.Results36 post-injury reviews were completed across 19 clinical encounters with patients aged 15yrs+. 47% of athletes were injured during motorsport (saloon car, rally, motocross and single seater racing), 47% in rugby and 5% during equestrian activity. The majority were professional (47%) or competed in collegiate (21%) or high school (21%) competition with 1–13 years at their current sporting level (mean4.2 +/−SD 4.2 years). Only 22% of 18 patients were concussion-naïve prior to their current injury, with a range of 0–4 physician-confirmed diagnoses (1.7 +/− 1.3). Comparison of motorsport drivers versus rugby athletes reveals trends towards lower scores in ImPACT memory composite values (verbal F 0.57, t −1.4, p 0.15; memory F 2.1, t −0.9, p 0.37) and improved reaction time (F 3.3, t 1.8, p 0.08) with significant differences in visual motor speed (F 0.90, t−4.1, p &lt; 0.001).ConclusionsPreliminary cross-sport analyses indicate that motorsport competitors have worse composite memory scores, better reaction times and significantly altered visual motor speed. These early data provide support for sports-specific approaches.

Estimated age of first exposure to American football and outcome from concussion

ObjectiveTo examine the association between estimated age of first exposure (eAFE) to American football and clinical measures throughout recovery following concussion.BackgroundIn collegiate football players, we reported no association between eAFE and baseline neurocognitive function. It is possible that neurocognitive deficits from earlier eAFE to American football, if present, are sufficiently compensated for in otherwise healthy individuals, but when faced with concussion, earlier eAFE may associate with longer symptom recovery, worse cognitive performance, or greater psychological distress.Design/MethodsParticipants were recruited as part of the NCAA–DoD Concussion Assessment, Research and Education (CARE) Consortium. There were 340 NCAA football players (age = 18.9 ± 1.4 years) who were evaluated 24–48 hours following concussion and had valid baseline data and 360 (age = 19.0 ± 1.3 years) who were evaluated at the time they were asymptomatic and had valid baseline data. Participants sustained a medically-diagnosed concussion between baseline testing and post-concussion assessments. Outcome measures included the number of days until asymptomatic, Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) composite scores, Brief Symptom Inventory 18 (BSI-18) sub-scores, and Hospital Anxiety and Depression Scale (HADS) scores. The eAFE was defined as the participant’s age at the time of assessment minus the self-reported number of years playing football.ResultsResults of generalized linear modeling suggested that younger eAFE was only associated with lower (better) BSI-18 Somatization (estimate = 0.046, p = 0.046, CI = 0.001–0.091) and BSI-18 Anxiety sub-scores (estimate = 0.053, p = 0.039, CI = 0.003–0.104) at 24–48 hours. The eAFE was not associated with days until asymptomatic, ImPACT composite scores, HADS scores, or other BSI-18 sub-scores.ConclusionsEarlier eAFE to football was not associated with longer symptom recovery, worse cognitive performance, or greater psychological distress following concussion. Longer duration of exposure to football during childhood and adolescence appears to be unrelated to clinical recovery following concussion.

Reduced cognitive resiliency ofattention-deficit/hyperactivity disorder against subconcussive head impacts

ObjectiveThe purpose of this study was to determine the subconcussive head impacts (SHI) effects on neurocognitive function in individuals diagnosed with attention-deficit/hyperactivity disorder (ADHD).BackgroundAthletes diagnosed with ADHD have a heightened risk (2 to 4-fold) for sustaining concussion. However, their response to repetitive SHI remain unclear.Design/MethodsIn this case-control intervention study, 17 soccer players clinically diagnosed with ADHD who take their prescribed medication daily, were assigned a heading intervention (ADHD-Heading group),individuals who met the ADHD criteria but were non-soccer players, were assigned into a kicking group, (ADHD-Kicking group, n = 15). Whereas 34 soccer players without ADHD diagnosis were randomized into either a heading or kicking intervention, yielding Non-ADHD-Heading group (n = 17) or Non-ADHD-Kicking group (n = 17). To implement SHI, the heading groups executed 10 headers with a standard soccer ball projected at a velocity of 25 mph (equivalent to a long throw-in) over 10 minutes by a JUGS soccer machine, while the kicking groups performed 10 kicks. Neurocognitive function was measured via the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) at pre-intervention baseline, 0h, 2h, and 24h post-intervention.ResultsThe vulnerability to SHI was notable in subjects diagnosed with ADHD particularly in memory, as illustrated by a significant group × time interaction, F(6,96) = 3.796, p = 0.002. Both Kicking groups improved verbal memory over time indicating the brain’s ability to learn, whereas the Non-ADHD-Heading group showed no improvement. The ADHD-Heading group showed a significant decline at 0h and 2h post-heading compared to other groups. As for visual memory, the ADHD-Heading group showed a significant decline at 24h post; however, all other groups displayed improvement. There were no group differences in remaining domains.ConclusionsData suggests neurocognitive vulnerability in athletes diagnosed with ADHD after experiencing SHI, specifically in memory performance. These outcomes can better inform clinicians; overall, promoting a better personalized care in athletes diagnosed with ADHD.

Estimated Age of First Exposure to Contact Sports Is Not Associated with Greater Symptoms or Worse Cognitive Functioning in Male U.S. Service Academy Athletes.

This study examined the association between estimated age of first exposure (eAFE) to contact sport participation and neurocognitive performance and symptom ratings in U.S. service academy National Collegiate Athletic Association (NCAA) athletes. Male cadets (N = 891), who participate in lacrosse (n = 211), wrestling (n = 170), ice hockey (n = 81), soccer (n = 119), rugby (n = 10), or non-contact sports (n = 298), completed the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) test before the season. Generalized linear modeling was used to predict each neurocognitive domain score and total symptom severity score. Predictor variables were entered in the following order: group (contact vs. non-contact); eAFE (eAFE <12 years vs. eAFE ≥12 years); group-by-eAFE; and covariates for learning accommodation status, concussion history, and age. The group-by-eAFE interaction was not significant for any of the ImPACT composite scores (Verbal Memory, Wald χ2 = 0.073, p = 0.788; Visual Memory, Wald χ2 = 2.71, p = 0.100; Visual Motor Speed, Wald χ2 = 0.078, p = 0.780; Reaction Time, Wald χ2 = 0.003, p = 0.955; Symptom Severity, Wald χ2 = 2.87, p = 0.090). Learning accommodation history was associated with lower scores on Visual Motor Speed (χ2 = 6.19, p = 0.013, B = -2.97). Older age was associated with faster reaction time (χ2 = 4.40, p = 0.036, B = -0.006) and lesser symptom severity (χ2 = 5.55, p = 0.019, B = -0.068). No other parameters were significant. We observed no association between eAFE, contact sport participation, neurocognitive functioning, or subjectively experienced symptoms in this cohort. Earlier eAFE to contact sport participation is not related to worse neurocognitive performance or greater subjectively experienced symptoms in male U.S. service academy NCAA athletes.

Confirmatory factor analysis of two computerized neuropsychological test batteries: Immediate post-concussion assessment and cognitive test (ImPACT) and C3 logix

ABSTRACTIntroduction: Tests of memory and speed of cognitive and motor responses have been the primary foci in sports-related concussion assessment. This study sought to assess the construct validity of neuropsychological tests within C3 Logix.Method: Results of both baseline C3 Logix and the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) computerized tests from 86 Division I collegiate athletes were submitted to a two-factor confirmatory analysis using structural equation modeling. The two factors of Speed and Memory have been confirmed in previous studies of ImPACT.Results: Results confirmed the two-factor model of ImPACT, whereas C3 Logix did not conform to a pure two-factor model. Instead, along with additional error terms, a cross-loading was required between Speed and Memory factors in order to obtain the best model fit (χ2 = 22.91, p= 0.12, CFI = 0.94, TLI = .90, RMSEA = 0.07 (90% CI [0.00, 0.13], SRMR = .06)): all factor loadings exceeded 0.30.Conclusions: The final model suggested C3 Logix employs three pure indicators of Speed and one indicator of both Speed and Memory. The lack of a pure indicator of Memory in C3 Logix raises a concern about its specificity and ultimately, its sensitivity to a sports-related concussion.

Test-Retest Reliability of ImPACT Across a Two-Year Interval in Collegiate Athletes

Abstract Purpose To examine the two-year test-retest reliability of Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) in a sample of collegiate athletes. Methods A total of 163 college athletes (63.8% female) completed two pre-season baseline assessments two years apart as mandated by their athletic programs. Participants completed the first baseline prior to their first year of competition (M age=18.38, M edu=12.13). Individuals with baselines flagged as invalid by ImPACT were excluded. No diagnosed concussions occurred between baseline assessments. Results Pearson r correlations for ImPACT composite scores between assessments ranged from .32 to .70. Paired samples t-tests indicated significant differences between verbal memory (t(162)=-4.61, p&lt;.001, MD=-3.6) and visual-motor speed (t(162)=-4.10, p&lt;.001, MD=-1.5) at time 1 and time 2. Intraclass correlation coefficients (ICCs) with a “two-way mixed” model and “consistency” type indicated higher reliability for all composite scores. Visual-motor speed (mean ICC=.83; .76–.87 95% confidence interval [CI]) was the most reliable composite score, followed by visual memory (.66; 95% CI .53-.75), impulse control (.62; 95% CI .48–.72), verbal memory (.58; 95% CI .43–.69), and reaction time (.49; 95% CI .30-.62). The total symptom score showed moderate reliability (.63; 95% CI .50–.73). Conclusion Overall, ImPACT composite and total symptom scores appear to maintain relative long-term stability in a collegiate sample across a two-year period. ImPACT composite scores showed moderate to good reliability, and total symptom scores showed moderate reliability. Results of this study corroborate previous research indicating moderately stable ImPACT scores across a 2-year test-retest period in collegiate athletes (Schatz, 2010).

Preliminary Examinations of Concussion in Older Adults

Abstract Purpose This study sought to investigate whether concussion in older adults improves through evaluating their performance on the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and Vestibular/Ocular-Motor Screen (VOMS) across visits and to describe and better characterize concussion in this at-risk population. Methods We conducted a retrospective review of medical records for 69 older adult patients (40 females, 29 males) that presented to a concussion specialty clinic. Participants averaged 64.71 (SD=4.1) years in age and presented within 6-998 days of injury (SD=170.9). Demographics and clinical data were recorded at intake through last appointment. Descriptive analysis, including frequencies, means, and standard deviations were performed as well as paired T-test to compare mean scores for first and last visit. Statistical significance was determined by two-sided p-values &lt;.05. Results Twenty out of 69 participants (29%) reported a previous concussion. Concussion symptom severity scores at participants’ first clinic visit averaged 56.19 (SD=26.56) compare with 39.51 (SD=25.53) at their final clinic visit. When comparing ImPACT data, all scores improved comparatively from Visit 1 to Last Visit (P values =0.000-0.014); all VOMS total scores improved as well (P =0.00-0.047). The most frequent primary profile among participants was Vestibular (31.9%). Conclusion Older adults diagnosed with concussion showed improvement on ImPACT scores and their symptom severity scores decreased. The most frequent primary concussion profile at initial visit was Vestibular. Further research with this at-risk population is needed.

Etiology and Clinical Presentation of Concussion: An Age- and Sex-matched Case Series

Abstract Purpose Differential patterns of clinical presentation in concussion have been explored previously based on etiology (e.g., sport vs. non-sport) and may be affected by biomechanical, pathophysiological, and psychological factors. The purpose of the study was to compare neurocognitive performance and symptom presentation across different etiologies in concussed patients. Methods 36 concussion patients, 12 slip-and-fall (SNF) were age- and sex-matched with motor vehicle accident (MVA) and sport-related concussions (SRC) (20.3±1.5 years; 4 males; 8 females per group). They were evaluated ≤ 2 weeks (7.2±3.7 days) after their injury. Patients completed medical history, an Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), and Post-Concussion Symptom Scale (PCSS) at initial visit. Descriptive statistics, a series of Kruskal-Wallis H Tests, χ² tests and one-way ANOVAs were performed using SPSS 24. Results The three groups exhibited no differences in verbal memory (p=0.11), visual memory (p=0.10), visual motor speed (p=0.19), or reaction time (p=0.19) composites. There were no differences in symptom severity (p=0.69) or symptom count (p=0.99) or the cognitive-migraine-fatigue (p=0.69), somatic (p=0.26), affective (p=0.92), or sleep (p=0.73) symptom clusters. Comorbidities (i.e., learning disorder, previous concussion, migraine, seizure, psychological condition, or motion sickness) were not significantly different across groups. Conclusion No significant differences were found on ImPACT or PCSS across etiologies. When controlling for comorbidities and demographic variables, these groups appear similar at the initial evaluation. Future research will focus on practice patterns and clinical outcomes.