Self-reported Concussion History Research Articles

University Club Sport Student-Athlete Concussion Profiles Differ by Sport and Sex

Athletes’ history of concussions is an important indicator of risk potential in organized sports. The purpose of this project was to explore differences by sport classification (contact vs. noncontact) and sex on concussion history among university club sports participants. This was a cross-sectional quality improvement study ( n = 593). The outcomes were self-reported answers to: (1) How many times have you been diagnosed with a concussion? and (2) How many times have you had your “bell rung”/“dinged”? Multivariable logistic regression models examined the association of contact club sport participation and sex on the history of concussion and prior experience of having their bell rung. Models were adjusted for age, race, participation in multiple sports, and years of participation in sports, and years in college. When compared to those in non-contact club sports, the adjusted odds of reporting ever having a concussion were 2.29 times higher for those participating in contact club sports (OR = 2.29; 95% CI: 1.49, 3.53). In the model for having a bell rung, those participating in a contact sport had 1.90 times greater odds of reporting having their bell rung in the past compared to those in noncontact sports (OR = 1.90; 95% CI: 1.25, 2.88). Whereas males and females did not differ in their self-reported concussion history, females had significantly lower odds of reporting having their bell rung in the past than males (OR = 0.46; 95% CI: 0.30, 0.69). Female athletes have a higher reporting of concussion incidence than that of male athletes. The use of terminology and variance in slang versus medical terms has the potential to affect reporting outcomes. Reporting of concussion incidents has the potential to be influenced by the nature of sport culture and sport participation in contact versus noncontact sports. Club sport athletes could benefit from tailored education related to concussions based on these results.

Preseason Measures of Cervical Spine Function, Vestibulo-Ocular Reflex, Dynamic Balance, and Divided Attention in Youth Ice Hockey Players.

OBJECTIVES: Report typical scores and examine preseason cervical spine, vestibulo-ocular reflex, dynamic balance, and divided attention measures in competitive youth ice hockey players aged 10 to 18 years with and without a previous concussion history. DESIGN: Cross-sectional secondary analysis. METHODS: The exposure of interest was self-reported history of concussion. The main outcomes were cervical spine measures (Cervical Flexor Endurance [CFE; seconds], Cervical Flexion-Rotation Test [normal/abnormal], Anterolateral Cervical Spine Strength [kilograms], Head Perturbation Test (/8), and Joint Position Error [JPE; centimeters]), vestibulo-ocular reflex (Dynamic Visual Acuity [logMAR], Head Thrust Test [Positive/Negative]), dynamic balance (Functional Gait Assessment [/30]) and divided attention (Walking While Talking Test [seconds]). Multivariable linear or logistic regression, adjusted for age-group, sex, level of play, and clustered by team, were used to assess potential differences by concussion history. RESULTS: We included data from 2311 participants in this study (87.2% male, 12.8% female, 39.0% reported a previous concussion). No differences by concussion history were found across any of the measures (P values range: 0.17-0.99). Measures of cervical spine function and divided attention differed by age group (eg, Median Left Anterolateral Cervical Spine Strength [kilograms] for males: U13 = 7.46, U15 = 9.10, U18 = 9.67). CONCLUSION: Clinical outcomes scores in youth ice hockey players did not differ by concussion history. Performance on cervical spine strength, CFE, and JPE test outcomes may improve with age, highlighting the importance of developmental considerations when interpreting test scores. J Orthop Sports Phys Ther 2024;54(3):1-11. Epub 30 November 2023. doi:10.2519/jospt.2023.11958.

18 Measurement Invariance of ImPACT in Bilingual and Monolingual High School Athletes

Objective:Previous studies have found differences between monolingual and bilingual athletes on ImPACT, the most widely used sport-related concussion (SRC) assessment measure. Most recently, results suggest that monolingual English-Speaking athletes outperformed bilingual English- and Spanish-speaking athletes on Visual Motor Speed and Reaction Time composites. Before further investigation of these differences can occur, measurement invariance of ImPACT must be established to ensure that differences are not attributable to measurement error. The current study aimed to 1) replicate a recently identified four-factor model using cognitive subtest scores of ImPACT on baseline assessments in monolingual English-Speaking athletes and bilingual English- and Spanish-speaking athletes and 2) to establish measurement invariance across groups.Participants and Methods:Participants included high school athletes who were administered the ImPACT as part of their standard pre-season athletic training protocol in English. Participants were excluded if they had a self-reported history of concussion, Autism, ADHD, learning disability or treatment history of epilepsy/seizures, brain surgery, meningitis, psychiatric disorders, or substance/alcohol use. The final sample included 7,948 monolingual English-speaking athletes and 7,938 bilingual English- and Spanish-speaking athletes with valid baseline assessments. Language variables were based on self-report. As the number of monolingual athletes was substantially larger than the number of bilingual athletes, monolingual athletes were randomly selected from a larger sample to match the bilingual athletes on age, sex, and sport. Confirmatory factor analysis (CFA) was used to test competing models, including one-factor, two-factor, and three-factor models to determine if a recently identified four-factor model (Visual Memory, Visual Reaction Time, Verbal Memory, Working Memory) provided the best fit of the data. Eighteen subtest scores from ImPACT were used in the CFAs. Through increasingly restrictive multigroup CFAs (MGCFA), configural, metric, scalar, and residual levels of invariance were assessed by language group.Results:CFA indicated that the four-factor model provided the best fit in the monolingual and bilingual samples compared to competing models. However, some goodness-of-fit-statistics were below recommended cutoffs, and thus, post-hoc model modifications were made on a theoretical basis and by examination of modification indices. The modified four-factor model had adequate to superior fit and met criteria for all goodness-of-fit indices and was retained as the configural model to test measurement invariance across language groups. MGCFA revealed that residual invariance, the strictest level of invariance, was achieved across groups.Conclusions:This study provides support for a modified four-factor model as estimating the latent structure of ImPACT cognitive scores in monolingual English-speaking and bilingual English- and Spanish-speaking high school athletes at baseline assessment. Results further suggest that differences between monolingual English-speaking and bilingual English- and Spanish-speaking athletes reported in prior ImPACT studies are not caused by measurement error. The reason for these differences remains unclear but are consistent with other studies suggesting monolingual advantages. Given the increase in bilingual individuals in the United States, and among high school athletics, future research should investigate other sources of error such as item bias and predictive validity to further understand if group differences reflect real differences between these athletes.

Use of Biostatistical Models to Manage Replicate Error in Concussion Biomarker Research

Advancing research on fluid biomarkers associated with sport-related concussion (SRC) highlights the importance of detecting low concentrations using ultrasensitive platforms. However, common statistical practices may overlook replicate errors and specimen exclusion, emphasizing the need to explore robust modeling approaches that consider all available replicate data for comprehensive understanding of sample variation and statistical inferences. To evaluate the impact of replicate error and different biostatistical modeling approaches on SRC biomarker interpretation. This cross-sectional study within the Surveillance in High Schools to Reduce the Risk of Concussions and Their Consequences study used data from healthy youth athletes (ages 11-18 years) collected from 3 sites across Canada between September 2019 and November 2021. Data were analyzed from November 2022 to February 2023. Demographic variables included age, sex, and self-reported history of previous concussion. Outcomes of interest were preinjury plasma glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase-L1 (UCH-L1), neurofilament-light (NFL), total tau (t-tau) and phosphorylated-tau-181 (p-tau-181) assayed in duplicate. Bland-Altman analysis determined the 95% limits of agreement (LOAs) for each biomarker. The impact of replicate error was explored using 3 biostatistical modeling approaches assessing the associations of age, sex, and previous concussion on biomarker concentrations: multilevel regression using all available replicate data, single-level regression using the means of replicate data, and single-level regression with replicate means, excluding specimens demonstrating more than 20% coefficient variation (CV). The sample included 149 healthy youth athletes (78 [52%] male; mean [SD] age, 15.74 [1.41] years; 51 participants [34%] reporting ≥1 previous concussions). Wide 95% LOAs were observed for GFAP (-17.74 to 18.20 pg/mL), UCH-L1 (-13.80 to 14.77 pg/mL), and t-tau (65.27% to 150.03%). GFAP and UCH-L1 were significantly associated with sex in multilevel regression (GFAP: effect size, 15.65%; β = -0.17; 95% CI, -0.30 to -0.04]; P = .02; UCH-L1: effect size, 17.24%; β = -0.19; 95% CI, -0.36 to -0.02]; P = .03) and single-level regression using the means of replicate data (GFAP: effect size, 15.56%; β = -0.17; 95% CI, -0.30 to -0.03]; P = .02; UCH-L1: effect size, 18.02%; β = -0.20; 95% CI, -0.37 to -0.03]; P = .02); however, there was no association for UCH-L1 after excluding specimens demonstrating more than 20% CV. Excluding specimens demonstrating more than 20% CV resulted in decreased differences associated with sex in GFAP (effect size, 12.29%; β = -0.14; 95% CI, -0.273 to -0.004]; P = .04) and increased sex differences in UCH-L1 (effect size, 23.59%; β = -0.27; 95% CI, -0.55 to 0.01]; P = .06), with the widest 95% CIs (ie, least precision) found in UCH-L1. In this cross-sectional study of healthy youth athletes, varying levels of agreement between SRC biomarker technical replicates suggested that means of measurements may not optimize precision for population values. Multilevel regression modeling demonstrated how incorporating all available biomarker data could capture replicate variation, avoiding challenges associated with means and percentage of CV exclusion thresholds to produce more representative estimates of association.

The Longitudinal Relationship Between Concussion History, Years of American Football Participation, and Alcohol Use Among Former National Football League Players: an NFL-LONG Study.

Investigate the relationships between concussion history and years of football participation (repetitive head impact proxy) with alcohol use across multiple decades in former professional football players. Participants (n= 348; mean age = 49.0 ± 9.4) completed health questionnaires in 2001 and 2019, which included self-reported concussion history and years of participation. Alcohol use frequency and amount per occasion were reported for three timepoints: during professional career, 2001, and 2019. Ordinal logistic regression models were fit to test associations of concussion history and years of participation with alcohol use at each timepoint. There were no significant associations between either concussion history or years of football participation with alcohol use (frequency and amount per occasion) at any timepoint. Effect estimates for concussion history and years of football participation with alcohol use were generally comparable across timepoints. Later life alcohol use by former American football players is not associated with concussion history or years of exposure to football.

Youth intentions to provide social support to a peer with a concussion

ABSTRACT Objectives 1) To describe demographic factors, concussion knowledge, attitudes, subjective norms, self-efficacy and intentions to provide social support to a peer with a concussion and 2) to examine if demographic factors and concussion knowledge are associated with components of the Theory of Planned Behavior. Methods The survey was completed between October 2018 and February 2019 by 200 youth (M = 15.30 years, SD = 1.52). Questions were designed for athletes and non-athletes and inquired about various types of social support. Data analysis included descriptive statistics, Wilcoxon Rank Sum Tests and Spearman’s Rank-Order Correlation Coefficients. Results More favorable attitudes and intentions to provide social support were observed among females (W = 2576, p ≤ 0.001; W = 2411, p ≤ 0.001), older youth (rho = 0.32, p ≤ 0.001; rho = 0.41, p ≤ 0.001) and those with higher concussion knowledge (rho = 0.29, p ≤ 0.001; rho = 0.22; p ≤ 0.001). Participating in sports with a high-risk of concussion was associated with lower attitudes and intentions to provide social support (W = 6677; p ≤ 0.001; W = 6721; p ≤ 0.001). Self-reported concussion history or knowing someone with a concussion history was not significantly associated with social support intentions. Conclusion This study identified characteristics of youth who had positive intentions to provide social support. These findings identify individuals who may model providing social support to a peer, as well as opportunities for future concussion education.

NZ-RugbyHealth Study: Current Postural Control Ability of Former Rugby Union and Non-contact Sport Players.

Players in contact sports frequently experience mild traumatic brain (concussion) injuries (TBI). While there are known disruptions to balance following acute head trauma, it is uncertain if sport-related concussion injuries have a lasting impact on postural control. To assess postural control in retired rugby players in comparison to retired non-contact sport players, and to evaluate any association with self-reported sport-related concussion history. Using a cross-sectional design, 75 players in the NZ-RugbyHealth study from three sports groups (44 ± 8years; 24 elite rugby, 30 community rugby, 21 non-contact sport) took part in this study. The SMART EquiTest® Balance Master was used to assess participant's ability to make effective use of visual, vestibular and proprioceptive information using standardised tests. Postural sway was also quantified using centre of pressure (COP) path length. The relationship among sports group, sport-related concussion history and postural control was evaluated using mixed regression models while controlling for age and body mass index. Limited significant differences in balance metrics were found between the sports groups. A statistically significant (p < 0.001) interaction indicated a relationship between COP path length and sport-related concussion history in the most challenging balance condition, such that path length increased as the number of previous sport-related concussions increased. There was some evidence for a relationship between sport-related concussion recurrence in sports players and postural stability in challenging balance conditions. There was no evidence of impaired balance ability in retired rugby players compared with non-contact sport athletes.

Neck Strength Assessment Offers No Clinical Value in Predicting Concussion in Male Professional Rugby Players: A Prospective Cohort Study.

OBJECTIVE: To determine if neck muscle strength and endurance are associated with concussion injuries in professional, male rugby players. Playing position, history of previous concussion, and age were also considered. DESIGN: Prospective cohort study METHODS: One hundred thirty-six male, professional rugby players completed neck strength testing that comprised a peak isometric test, an endurance test, and a concussion screening questionnaire. Electronic medical records were analyzed for head injury data. RESULTS: Out of 136 players (mean age, 25.3 ± 3.4 years; height, 186 ± 7 cm; weight, 103 ± 13.2 kg), 40 players suffered from 51 concussions in the 2017/18 playing season. A history of concussion was reported by 65% of the cohort. Multiple logistic regression analysis found that peak isometric flexion strength was not associated with concussion risk. Increased peak isometric extension strength was associated with significantly greater odds of sustaining a concussion (odds ratio [OR] = 1.01; 95% CI: 1.00, 1.01, does not include 1; P = .04) that is likely too small to be clinically relevant. Players with a self-reported history of concussion had over 2 times greater odds of sustaining a concussion (OR = 2.25; 95% CI: 0.73, 6.22). More than 2 concussions in the past 12 months was associated with almost tenfold greater odds of concussion (OR = 9.51; 95% CI: 1.66, 54.55). Age, playing position, and neck muscle endurance were not associated with concussion. CONCLUSION: The strongest predictor of concussion injury was previous concussion. Players who sustained concussions in season had similar neck muscle strength to players who had not sustained a concussion. J Orthop Sports Phys Ther 2023;53(5):1-7. Epub: 5 April 2023. doi:10.2519/jospt.2023.11723.

Investigation of Factors Contributing to Racial Differences in Sport-Related Concussion Outcomes

Following sport-related concussion (SRC), early studies have demonstrated racial differences in time to clinical recovery; however, these differences have not been fully explained. We sought to further explore these associations by considering possible mediating/moderating factors. Data from patients aged 12-18 years diagnosed with SRC from November 2017 to October 2020 were analyzed. Those missing key data, lost to follow-up, or missing race were excluded. The exposure of interest was race, dichotomized as Black/White. The primary outcome was time to clinical recovery (days from injury until the patient was either deemed recovered by an SRC provider or symptom score returned to baseline or zero.) RESULTS: A total of 389 (82%) White and 87 (18%) Black athletes with SRC were included. Black athletes more frequently reported no SRC history (83% vs. 67%, P= 0.006) and lower symptom burden at presentation (median total Post-Concussion Symptom Scale 11 vs. 23, P < 0.001) than White athletes. Black athletes achieved earlier clinical recovery (hazard ratio [HR]= 1.35, 95% CI 1.03-1.77, P=0.030), which remained significant (HR= 1.32, 95% CI 1.002-1.73, P= 0.048) after adjusting for confounders associated with recovery but not race. A third model adding the initial Post-Concussion Symptom Scale score nullified the association between race/recovery (HR=1.12, 95% CI 0.85-1.48, P= 0.410). Adding prior concussion history further reduced the association between race/recovery (HR= 1.01, 95% CI 0.77-1.34, P= 0.925). Overall, Black athletes initially presented with fewer concussion symptoms than White athletes, despite no difference in time to clinic. Black athletes achieved earlier clinical recovery following SRC, a difference explained by differences in initial symptom burden and self-reported concussion history. These crucial differences may stem from cultural/psychologic/organic factors.

A systematic review and meta-analysis of factors influencing ImPACT concussion testing in high school and collegiate athletes with self-reported ADHD and/or LD.

Sport concussion is a common injury, and athletes with attention-deficit/hyperactivity disorder (ADHD) and/or learning disorder (LD) are at increased risk and require specialized attention in clinical settings. Although systematic reviews of the relationship between ADHD/LD and concussion are reported in the literature, these reviews do not include quantitative syntheses. Additionally, no reviews have focused on the most commonly utilized concussion assessment, Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). The current review provides an update of sport concussion assessment in athletes with ADHD and/or LD from 2000 to 2021 on these topics: baseline and postconcussion performance on ImPACT, baseline and postconcussion symptom reporting using the Postconcussion Symptom Scale, invalid baseline classification on ImPACT, and self-reported history of concussion. Meta-analyses were conducted on baseline ImPACT performance, symptom reporting, invalid baseline classification, and concussion rates. Thirty-four studies were included in systematic review and 19 were included in meta-analyses. Decreased baseline performance was found for athletes with ADHD (trivial to small effects), LD (small-to-medium effects), and ADHD/LD (small-to-medium effects). Increased baseline symptom reporting was found for athletes with ADHD (small effect). Increased odds of invalid baseline performance (trivial effect) and self-reported concussion history (small effect) were found in ADHD. These results provide the first quantitative synthesis of the literature in this area. It is recommended that future research further examines these topics in athletes with LD and co-occurring ADHD/LD (given the focus on ADHD), as well as the effects that all of these conditions may have on concussion recovery and return-to-play decision-making. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Subtle impairments of perceptual-motor function and well-being are detectable among military cadets and college athletes with self-reported history of concussion.

A lack of obvious long-term effects of concussion on standard clinical measures of behavioral performance capabilities does not preclude the existence of subtle neural processing impairments that appear to be linked to elevated risk for subsequent concussion occurrence, and which may be associated with greater susceptibility to progressive neurodegenerative processes. The purpose of this observational cohort study was to assess virtual reality motor response variability and survey responses as possible indicators of suboptimal brain function among military cadets and college athletes with self-reported history of concussion (HxC). The cohort comprised 75 college students (20.7 ± 2.1 years): 39 Reserve Officer Training Corp (ROTC) military cadets (10 female), 16 football players, and 20 wrestlers; HxC self-reported by 20 (29.2 ± 27.1 months prior, range: 3-96). A virtual reality (VR) test involving 40 lunging/reaching responses to horizontally moving dots (filled/congruent: same direction; open/incongruent: opposite direction) was administered, along with the Sport Fitness and Wellness Index (SFWI) survey. VR Dispersion (standard deviation of 12 T-scores for neck, upper extremity, and lower extremity responses to congruent vs. incongruent stimuli originating from central vs. peripheral locations) and SFWI response patterns were the primary outcomes of interest. Logistic regression modeling of VR Dispersion (range: 1.5-21.8), SFWI (range: 44-100), and an interaction between them provided 81% HxC classification accuracy (Model χ 2[2] = 26.03, p < .001; Hosmer & Lemeshow χ 2[8] = 1.86, p = .967; Nagelkerke R 2 = .427; Area Under Curve = .841, 95% CI: .734, .948). Binary modeling that included VR Dispersion ≥3.2 and SFWI ≤86 demonstrated 75% sensitivity and 86% specificity with both factors positive (Odds Ratio = 17.6, 95% CI: 5.0, 62.1). Detection of subtle indicators of altered brain processes that might otherwise remain unrecognized is clearly important for both short-term and long-term clinical management of concussion. Inconsistency among neck, upper extremity, and lower extremity responses to different types of moving visual stimuli, along with survey responses suggesting suboptimal well-being, merit further investigation as possible clinical indicators of persisting effects of concussion that might prove to be modifiable.

Self-reported concussion history among midwestern skiers and snowboarders.

To assess the rate of self-reported concussion in midwestern skiers and snowboarders. Recreational skiers and snowboarders between the ages of 14 and69 yearsduring a single winter ski season (2020-2021) at a ski area in Wisconsin, USA. Survey study. Among this survey population (n=161), 9.32 and 19.25% reported one or more diagnosed concussion and suspected concussion respectively as a result of a skiing- or snowboarding-related incident. Skiers and snowboarders that self-identified as advanced, those who utilized terrain park features, and those that participated in freestyle competition had significantly higher self-reported rates of concussion. Self-reported concussion history indicates a concussion prevalence that is higher than expected based on previous studies. Participants reported significantly more suspected concussions than diagnosed concussions, indicating a possible issue with underreporting in this population.

Influence of Self-Reported Concussion History and a Dual-Task Paradigm on Multidirectional Gait and Cognitive Performance of Athletes

Single-task assessments may not identify lingering effects following a concussion that may be detected under dual-task (DT) paradigms. The purpose of this study was to determine the effects of a novel DT paradigm and concussion history on gait and cognitive performance. Hockey and rugby club college athletes (n = 26) completed a box drill and the color and word Stroop test under single task and DT. Distance ambulated around the box, response rate, and accuracy were recorded to calculate dual-task cost. Mean comparisons and linear mixed-effects regression models were performed. Compared to athletes with no concussion history, those with a history had a greater motor than cognitive dual-task cost and were 3.15% less accurate in Stroop responses (p &lt; .01). Athletes walked 0.72-m shorter distance under DT compared to single task (p = .04). A multidirectional, low-tech DT assessment may highlight long-term motor and cognitive deficits among athletes with a concussion history, which will provide valuable information to prepare and track performance within an athletic season.

Gender and Workplace Stress Affect the Association Between Concussion History and Depression Symptoms in Professional Jockeys.

Professional jockeys experience high rates of concussion, workplace stress, and poor mental health. The present cross-sectional study, for the first time, concurrently assessed the potential interplay between concussion history and workplace stress with current depression symptoms. Seventy-two professional flat-track jockeys (male = 49, female = 23) were grouped based on self-reported concussion history (CG; n = 56) and those who did not report a concussion history (NCG; total n = 16). Analyses featured both between (CG vs NCG) and within group (CG only) assessment on self-reported measures of workplace stress and depression symptoms (affect, daily functioning). Jockeys in the CG had more symptoms of negative affect than the NCG. This association, however, was nonsignificant after covarying for age, gender, and workplace stress. Higher workplace stress (p = .005) and gender (p= .001) were associated with poorer daily functioning after controlling for concussion history (CG vs. NCG) and age. Gender moderated the association between concussion group and poorer daily functioning (β = -18.739, t (71) = -2.924, p = .005), with the difference between CG and NCG significant for females, but not males (β = 33.648, t (71) = 3.420, p = .001). The findings provide preliminary evidence that previously concussed females may be more likely to report poorer daily functioning than males with a history of concussion, and that workplace stress may reduce the association between a history of concussion and depression symptoms. Prospective studies are required to validate and extend these findings.

Associations of lifetime concussion history and repetitive head impact exposure with resting-state functional connectivity in former collegiate American football players: An NCAA 15-year follow-up study.

The objective of this study was to examine associations of lifetime concussion history (CHx) and an advanced metric of lifetime repetitive head impact exposure with resting-state functional connectivity (rsFC) across the whole-brain and among large-scale functional networks (Default Mode; Dorsal Attention; and Frontoparietal Control) in former collegiate football players. Individuals who completed at least one year of varsity collegiate football were eligible to participate in this observational cohort study (n = 48; aged 36-41 years; 79.2% white/Caucasian; 12.5±4.4 years of football played; all men). Individuals were excluded if they reported history/suspicion of psychotic disorder with active symptoms, contraindications to participation in study procedures (e.g., MRI safety concern), or inability to travel. Each participant provided concussion and football playing histories. Self-reported concussion history was analyzed in two different ways based on prior research: dichotomous "High" (≥3 concussions; n = 28) versus "Low" (<3 concussions; n = 20); and four ordinal categories (0-1 concussion [n = 19]; 2-4 concussions [n = 8]; 5-7 concussions [n = 9]; and ≥8 concussions [n = 12]). The Head Impact Exposure Estimate (HIEE) was calculated from football playing history captured via structured interview. Resting-state fMRI and T1-weighted MRI were acquired and preprocessed using established pipelines. Next, rsFC was calculated using the Seitzman et al., (2020) 300-ROI functional atlas. Whole-brain, within-network, and between-network rsFC were calculated using all ROIs and network-specific ROIs, respectively. Effects of CHx and HIEE on rsFC values were examined using separate multivariable linear regression models, with a-priori α set to 0.05. We observed no statistically significant associations between rsFC outcomes and either CHx or HIEE (ps ≥ .12). Neither CHx nor HIEE were associated with neural signatures that have been observed in studies of typical and pathological aging. While CHx and repetitive head impacts have been associated with changes in brain health in older former athletes, our preliminary results suggest that associations with rsFC may not be present in early midlife former football players.

Optimizing Concussion Care Seeking: The Influence of Previous Concussion Diagnosis Status on Baseline Assessment Outcomes

Background: The prevalence of unreported concussions is high, and undiagnosed concussions can lead to worse postconcussion outcomes. It is not clear how those with a history of undiagnosed concussion perform on subsequent standard concussion baseline assessments. Purpose: To determine if previous concussion diagnosis status was associated with outcomes on the standard baseline concussion assessment battery. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Concussion Assessment, Research, and Education (CARE) Consortium participants (N = 29,934) self-reported concussion history with diagnosis status and completed standard baseline concussion assessments, including assessments for symptoms, mental status, balance, and neurocognition. Multiple linear regression models were used to estimate mean differences and 95% CIs among concussion history groups (no concussion history [n = 23,037; 77.0%], all previous concussions diagnosed [n = 5315; 17.8%], ≥1 previous concussions undiagnosed [n = 1582; 5.3%]) at baseline for all outcomes except symptom severity and Brief Symptom Inventory–18 (BSI-18) score, in which negative binomial models were used to calculate incidence rate ratios (IRRs). All models were adjusted for sex, race, ethnicity, sport contact level, and concussion count. Mean differences with 95% CIs excluding 0.00 and at least a small effect size (≥0.20), and those IRRs with 95% CIs excluding 1.00 and at least a small association (IRR, ≥1.10) were considered significant. Results: The ≥1 previous concussions undiagnosed group reported significantly greater symptom severity scores (IRR, ≥1.38) and BSI-18 (IRR, ≥1.31) scores relative to the no concussion history and all previous concussions diagnosed groups. The ≥1 previous concussions undiagnosed group performed significantly worse on 6 neurocognitive assessments while performing better on only 2 compared with the no concussion history and all previous concussions diagnosed groups. There were no between-group differences on mental status or balance assessments. Conclusion: An undiagnosed concussion history was associated with worse clinical indicators at future baseline assessments. Individuals reporting ≥1 previous undiagnosed concussions exhibited worse baseline clinical indicators. This may suggest that concussion-related harm may be exacerbated when injuries are not diagnosed.

A-185 Influence of Improved Lifetime TBI History Ascertainment on Clinical Outcomes

Abstract Objective: History of TBI/concussion earlier in life may have implications for long-term health. It is important to understand factors that influence retrospective reports of TBI/concussion history in the clinic. We examined whether providing a formal TBI/concussion definition affected self-reported TBI/concussion history and evaluated association of TBI/concussion history with current mood symptoms. Methods: Participants were 12 individuals (5 M, 7 F, average age = 40.4) seen in an interdisciplinary TBI/concussion clinic. Non-parametric Mann-Whitney-Wilcoxon tests compared the total number of reported TBI/concussions before and after providing patients a formalized definition for TBI/concussion in the overall sample and then separately for males and females. A secondary analysis used Pearson’s correlation to examine the relationship between total number of TBI/concussions and self-reported anxiety using Generalized Anxiety Disorder (GAD-7) total score. Results: Participants reported an average of 3.1 more concussions after being informed of the definition of a TBI/concussion. This result was primarily seen in men, who reported 5.8 more TBI/concussions (women = 0.5 more TBI/concussions) after the definition was provided (W = 1.5, p = 0.05). Further, there was a positive, strong correlation between total number of reported lifetime concussions post TBI/concussion definition and anxiety severity (r = 0.67, p = 0.05). Conclusions: Providing a definition of TBI/concussion increases reports of lifetime concussion, primarily in males. Higher trait anxiety may also be associated with self-reported concussion history. Larger sample sizes are needed to better understand factors that drive retrospective injury reports in those who seek concussion care.

A-48 The Relationship Between Concussion History and Emotional and Behavioral Dyscontrol Domains of Health-Related Quality of Life in College-Aged Individuals

Abstract Purpose: The purpose of this study was to determine the relationship between concussion history and emotional and behavioral dyscontrol domains of health-related quality of life (HRQoL) in college-aged individuals. Methods: A cross-sectional survey study of individuals ages 18–25 years was conducted. Participants completed demographics, medical history, and the Neuro-QOL Emotional and Behavioral Dyscontrol Short Form (Neuro-QOL). A t-score &amp;gt; 50 on the Neuro-QOL indicated better outcomes for emotional and behavioral dyscontrol. A Mann–Whitney U Test compared scores on the Neuro-QOL between individuals with and without self-reported concussion history. Logistic regression was used to analyze the relationship between concussion history on the probability of higher or lower Neuro-QOL scores. Statistical significance was set at p &amp;lt; 0.05. Results: Two hundred fifty-two participants (155 female; age = 19.95 years; SD = 1.53 years) were included, 76 (30.2%) with concussion history and 176 (69.8%) without concussion history. No significant difference in Neuro-QOL t-scores was noted between groups (concussion history: t = 49.4, SE = 2.4; no concussion history; t = 49.4, SE = 2.4; p = 0.47). Individuals with reported concussion history were 1.16 times more likely to score higher on the Neuro-QOL than those without concussion history when controlling for gender (95% CI [0.66, 2.04]); however, this was not significant (p = 0.61). Conclusions: Preliminary findings suggest that emotional and behavioral dyscontrol domains are not influenced by prior concussion history. Future research should continue to explore HRQoL domains (e.g., physical health, psychological health, social relationships, environment) most impacted by concussion, as well as the influence of prior mental health conditions or behavioral dysfunction following a subsequent injury.

Measurement implications on the association between self-reported concussion history and depression: An NFL-LONG study

ObjectiveThis study examined how associations of self-reported concussion history and depression vary based on different variable characterizations. Methods Former NFL players (n = 1,697) completed a General Health Survey, indicating the number of concussions they sustained during their football career and whether a physician had diagnosed them with depression, and the PROMIS 4-item Depression scale. Self-reported concussion history was characterized as: a 3-category variable (0, 1–2, 3+) with (1) indicator variables and (2) as an ordinal variable; a 5-category variable (0, 1–2, 3–5, 6–9, 10+) with (3) indicator variables and (4) as an ordinal variable; and (5) the original interval scale (0, 1, 2,…, 10, 10+). Depression was characterized as: (1) physician diagnosis (yes/no); and the PROMIS 4-item Depression scale treated as: (2) the original T-score variable and (3) using a cut-off of a T-score >60 versus ≤60. Regression models with various combinations of the characterizations, while adjusting for age, race/ethnicity, education, pain interference, and stress level, estimated prevalence ratios and mean differences for binary and continuous outcomes, respectively. Concussion history-related effect estimates were compared across all models. Results Self-reported concussion history emerged as a significant predictor of each depression measure. With a higher number of concussions reported, be it via the categories or the interval scale, stronger associations between self-reported concussion history and depression were observed. Conclusions The various approaches to characterize self-reported concussion history and depression provided evidence of significant associations between the two variables, with the degree of association varying based on characterization of each construct.

The stability of self-reported professional football concussion history among former players: A longitudinal NFL-LONG study

ABSTRACT Objectives To examine the stability of former National Football League (NFL) players’ recall of professional football concussion. Methods Two-hundred-and-nine former NFL players (ceasing football participation before/in 2001) completed surveys in 2001, 2010, and 2019 and reported the number of concussions sustained during their professional careers (0, 1 … 10, >10). Participants were categorized into four ‘recall stability’ groups, based upon concussion recall [e.g., ‘Same’ (same number recalled), ‘Increased’ (more recalled than in prior time point)]. In 2019, participants completed measures of functioning (e.g., PROMIS Cognitive Function, Anxiety, Depression). Fleiss Kappa and generalized linear mixed models (GLMM)-based ordinal measures Kappa assessed stability across time points. ‘Recall stability group’ functioning scores were compared. Results Overall, 45.9% recalled more concussions over time; 14.8% reported the same number. Fleiss Kappa and GLMM-based ordinal measures Kappa suggested fair (0.22, 95% CI: 0.26, 0.38) and moderate stability (0.41, 95% CI: 0.35, 0.46), respectively. Higher cognitive functioning (P = 0.002), lower anxiety (P = 0.003), and lower depression (P = 0.007) were observed in the ‘Same’ vs ‘Increased’ groups. Conclusions Despite subtle time-based variations in reporting, professional football concussion history recall was relatively stable. Better cognitive and psychological functioning was associated with greater stability in concussion recall.