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The aim of this study was to compare the neuropsychological functioning and symptoms of female and male high school athletes following a single concussion during the school year. The baseline test scores of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) of 309 concussed athletes (169 females, 221 males) in varied sports were obtained. After a sport-related concussion, the athletes were re-administered the ImPACT, on the average, 7.25 days after the injury. MANCOVA compared the ImPACT baseline scores, post-concussion scores, and baseline-to-post-concussion changes of the female and male athletes, with p set at 0.01. The only significant sex comparison found females performing better on baseline visual motor speed (p < 0.001). Otherwise, no sex differences were found in baseline test scores, post-concussion scores, and baseline-to-post-concussion changes. The findings tentatively suggest that there are insignificant sex differences in the consequences of sport-related concussion after a week post-injury. Future studies on sex comparisons after a concussion are needed focusing on the acute and sub-acute phases of the recovery period.

Concussions have become a public health issue. This public health concern has drawn the attention of many states in which laws were created to address concussions safety, recognition of signs and symptoms, immediate removal, medical clearance, and return-to-play protocols. Most state legislation focused on student athletes participating in organized sports. However, the rise in concussion can be directly attributed to children, youth, and adolescents participating in nonsports-related events. Maximizing recovery from a concussion involves implementing education programs that focus on recognition of symptoms, treatment, and return-to-learn options. Treatment strategies used to address concussed youth include physical and cognitive rest and minimizing external stimuli that can increase symptoms. Because learning is a direct outcome for all youth, a return-to-learn protocol based on a collaborative school-based team approach is suggested.

Objective This study was designed to determine concussion incidence, risk, and relative risk among middle and high school athletes participating in various sports. Method Data were retrospectively obtained from 10,334 athletes of 12 different sports in Hawaii. In addition to determining the overall concussion incidence, comparisons of incidence, risk, and relative risk were made according to age, sex, concussion history, sport, and football position. Results The overall incidence of concussion among youth athletes was 1,250 (12.1%). The relative risk for a concussion was almost two times greater in 18-year olds than in 13-year-old athletes. In comparable sports, girls had a 1.5 times higher concussion risk than boys. Athletes with a prior concussion had 3-5 times greater risk to sustain a concussion than those with no history of a concussion. Among varied sports, wrestling and martial arts had the highest relative risk of a concussion, followed by cheerleading, football, and track and field. No differences in concussion risks were found among the football players in different positions. Conclusions Older youths, females, those with a history of concussion, and those participating in high contact sports were found to have higher risks of sustaining a concussion. The findings increase awareness of concussion patterns in young athletes and raise concerns regarding protective strategies and concussion management in youth sports.

Objective The aim of this research was to examine the role of native language in the performance of youth athletes on a computerized neuropsychological test battery, the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). Method The study compared the baseline test scores of 5545 participants whose native language was English versus 195 whose native language was not English. The mean age of the participants was 15.06 years. Results A multivariate analysis of variance revealed no differences in the five ImPACT Composite scores of the two language groups. Conclusion Contrary to prior research, one cannot simply expect that non-native English speakers will do more poorly on ImPACT than native English speakers. Further research on the use of ImPACT with other non-native English-speaking youth athletes is recommended.

The aim of this study was to examine the effects of head impact frequency on the neuropsychological test results of football players who participate in different positions on the team. Based on the biomechanical measures of head impact frequency reported in high school football, a High Contact group (n = 480) consisting of offensive and defensive linemen was compared with a Low Contact group (n = 640) comprised of receivers and defensive backs. The results revealed that the High Contact group obtained poorer performances on the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) on three Composite scores (Verbal Memory, Visual Motor Speed, Impulse Control) and the Total Symptom score compared to the Low Contact group. The present study is the first, to date, to report differences in the neuropsychological test performances of athletes who participate in high and low contact football positions. The findings raise tentative concerns that youth football players exposed to repetitive head trauma, including subconcussive impacts, may be at risk for lowered neuropsychological functioning and increased symptoms.

OBJECTIVE 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. DESIGN A retrospective records review. SETTING Middle and high school athletic departments. PARTICIPANTS 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. INDEPENDENT VARIABLES Age, sex, ethnicity, and sport. MAIN OUTCOME MEASURES ImPACT Composite scores (Verbal Memory, Visual Memory, Visual Motor Speed, Reaction Time, and Impulse Control) and Total Symptom score from baseline testing. RESULTS The results indicated statistically significant differences between age and sex groups, as well as between ethnic and sport groups. CONCLUSIONS 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.

The aim of this study was to examine the neuropsychological test results of non-concussed high school athletes playing at three different levels of contact sports. Based on the concussion risk data of 12 different sports, a High Contact group (n=2819; wrestling/martial arts, cheerleading, track and field, football), a Moderate Contact group (n=2323; softball, basketball, soccer), and a Low Contact group (n=1580; baseball, volleyball, water polo, tennis, cross-country) were formed and compared in terms of their scores on the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). The results revealed that the High Contact group obtained small but statistically poorer performances in ImPACT Visual Memory, Visual Motor Speed, Impulse Control, and Total Symptom scores compared to the Moderate and Low Contact groups. The High Contact group also had poorer Reaction Time scores compared to the Low Contact group. No differences between the Moderate and Low Contact groups were noted. The findings, along with prior similar results, tentatively raise concerns that participant in high contact sports, exposed to repetitive subconcussive head trauma, may be at greater risk for lowered neuropsychological functioning and increased symptoms, compared to other high school athletes. In view of the preliminary nature of this investigation, more research into the effects of frequent head impacts in high school sports is strongly recommended.

This replication study re-examined the neuropsychological effects of participation in high and low contact youth sports. Modeled after a recently published investigation, two contact sport groups of participants ages 12 to 18 were formed based on the rate of concussion in their respective sport, with the assumption that more head impacts and neuropsychological effects occur in high contact sports that have a greater number of reported concussions as compared with low contact sports. The preseason baseline ImPACT neuropsychological test scores and symptom scores of non-concussed youth athletes in a High Contact Sport (football, n = 139) and a Low Contact Sport (basketball, baseball, soccer, wrestling, volleyball, paddling, and cheerleading, n = 57) were compared. The results revealed significantly poorer ImPACT test performances in visual motor speed and reaction time among high contact sport athletes compared to low contact sport athletes. No differences were found between the two groups in Verbal Memory, Visual Memory, and Total Symptom. These findings were identical to a recent study in which nonconcussed youth athletes in a high contact sport, that is, football, exhibited poorer neuropsychological test performance than their peers in low contact sports, that is, basketball, baseball, soccer, wrestling, and judo. This research replication verified the results of the prior study, and raises concerns that youth athletes exposed to repetitive head trauma may be at risk for lowered neuropsychological functioning, even without a reported concussive event.

The effects of forensic examiner role on validity scores have rarely been studied empirically. We used a repeated measures design to examine the association between examiner role (plaintiff- and defense-selected neuropsychologists) and scores on eight Minnesota Multiphasic Inventory-2 validity scores (MMPI-2-VRIN, -TRIN, -L, -K, -F, -Fb, -Fp, and -FBS) of the same 80 individuals. All 80 were involved in litigation following mostly minor neurological injuries. We found no significant within-group differences on any of the MMPI-2 validity scales. Concordance of pass/fail rates between examinations was above 80%, except for MMPI-2-Fb. For example, the Symptom Validity Scale (MMPI-2-FBS) showed equivalently high failure rates (70%) during both examinations. This study does not support the view that examiner role affects symptom validity scores in forensic settings.

Validity scales of the Minnesota Multiphasic Personality Inventory—2 (MMPI-2) are widely used for the detection of exaggerated psychological complaints, although little is known about the results of these scales with racial or ethnic minority individuals. Five validity scales derived from the MMPI-2, including the F Scale, the Back Infrequency Scale, the Symptom Validity Scale, the Infrequency-Psychopathology Scale, and the Dissimulation Scale-MMPI-2, were evaluated in 157 medical patients—109 Caucasian Americans and 48 Asian Americans. All patients were involved in personal injury litigation or seeking compensation for alleged psychological conditions. Analyses of variance (ANOVAs) conducted on the five validity scales revealed no significant group effects for race. The results were consistent with the limited available data on the MMPI-2 validity scales with minority group samples. Further research with other racial minorities, including relevant extra-test criteria for malingering, is encouraged.

This research evaluated the 2-year test-retest reliability of the Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) neuropsychological battery, and clarified the need for biennial updated baseline testing of high school athletes. This study compared the baseline test scores of 212 non-concussed athletes that were obtained in Grade 9 and again 2 years later when they were in Grade 11. Regression-based methods indicated that 4 of the 5 ImPACT scores were stable over 2 years, as they fell within the 80% and 95% confidence intervals (CIs). The results suggested that updating baseline testing for high school athletes after 2 years is not necessary. Further research into the consistency of computerized neuropsychological tests over 2 years with high school athletes is recommended.

The effect of depression and anxiety upon neuropsychological test scores of candidates for coronary artery bypass graft (CABG) surgery was examined. Sixty patients were administered the Beck Depression Inventory II and the State-Trait Anxiety Inventory, along with a battery of neuropsychological tests. Regression analyses were conducted in which the neuropsychological test scores were predicted using age, education, depression, anxiety, and combined depression-anxiety scores. While age and education were significant predictors of several neuropsychological test measures, no significant regression analysis results were obtained for the depression, anxiety and combined depression-anxiety scores. Similarities and discrepancies between this research and previous studies are discussed. It appears that low levels of preoperative depression and anxiety states do not affect neuropsychological functioning among CABG candidates.

Five MMPI-2 validity scales were evaluated with 120 personal injury litigation patients (LP) and 208 clinical patients (CP) along with 43 normal participants (NP). The validity measures included the Fake Bad Scale (FBS), Infrequency scale (F), Back Infrequency scale (Eb), Infrequency-Psychopathology scale (F[p]), and the Dissimulation scale-2 (DA2). Results showed that only the FBS significantly differentiated the LP and CP, whereas the LP and CP scored significantly higher than the NP on FBS, F, Fb, and Ds2. The content of the FBS, with several items from the Hypochondriasis (Hs) and Hysteria (Hy) Scales, appears to enhance the FBS' ability to detect the somatic overreporting often observed with personal injury claimants. The authors suggest that the FBS may be a useful index of symptom magnification when employed within a comprehensive assessment of malingering in personal injury plaintiffs.

An effective, user-friendly neurocognitive test to diagnose minimal hepatic encephalopathy (MHE) is needed. Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) is a brief, validated, Web-based, neuropsychological test battery resulting in four composite scores [Verbal Memory (VrbM), Visual Memory, Visual Motor Speed (VMS), Reaction Time (RT)]. We compared ImPACT to traditional paper-and-pencil tests in patients at risk for MHE versus controls.Ninety cirrhotic patients with no history of overt hepatic encephalopathy were compared with 131 controls on standard psychometric tests (SPT) [Trail Making Test-A, Trail Making Test-B, Digit Symbol Test], 4 ImPACT composite scores, and the Sickness Impact Profile (SIP). MHE+ was defined by a score 2 SD below the normative mean on at least one of the SPT. ImPACT (ImP+) scores of patients were defined as 2 SD from the control mean.Cirrhotic patients scored more poorly than controls on 3/4 of ImPACT scores: VrbM (78.88 vs. 71.37, p0.001), VMS (26.47 vs. 22.68, p0.001) and RT (0.89 vs. 1.00, p0.01), as well as on all 3 SPT. Of the 90 cirrhotics, 16 (18%) were MHE+, who performed more poorly (p0.001) than patients without MHE on VrbM (58.13 vs. 74.19), VMS (16.77 vs. 23.95) and RT (1.24 vs. 0.95). Of the 90 cirrhotics, 25 (27.8%) were ImP+. MHE+ and ImP+ patients had increased SIP scores versus controls (p0.001).Compared to paper-and-pencil testing, ImPACT provides a brief, user-friendly, neuropsychological evaluation of MHE. ImPACT could become a new standard for MHE diagnosis.

Five validity scales derived from the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), the Infrequency Scale (F), Infrequency-Psychopathology Scale (F[p]), Symptom Validity Scale (FBS), Henry-Heilbronner Index (HHI), and Response Bias Scale (RBS) were evaluated in 118 litigation patients (LPs) and 163 clinical patients (CPs). Varied statistical methods, including hierarchical logistic regression analyses, Receiver Operating Characteristic (ROC) curve, Area Under the Curve (AUC) values, and sensitivity/specificity analyses, showed that RBS performed better than the other four scales in identifying LPs. The regression analyses found RBS to be the most significant predictor of LP and CP group membership (p

The Luria-Nebraska Neuropsychological Battery (LNNB) and the Minnesota Multiphasic Personality Inventory (MMPI) were administered to 184 head injury patients with varying degrees of headache activity. A multiple regression analysis, controlling for neurological status, compared the 11 LNNB scores of patients with Daily Headaches, Frequent Headaches, Infrequent Headaches, and No Headaches and found that the Arithmetic Scale was the only significant predictor, with the Daily Headache patients performing more poorly than the Infrequent Headache patients. A similar analysis of the 13 MMPI scores indicated that the K, Hs, and Pt Scales were significant predictors. However, post hoc Tukey tests revealed that K and Pt scores did not vary significantly among the four headache groups and only showed that Daily Headaches and Frequent Headaches patients had significantly higher Hs scores than the No headaches group. Subsequent comparisons of patients with and without headaches at the time of testing revealed no differences between the two groups on the LNNB and MMPI, after controlling for age, duration of symptoms, and neurological status. Overall, the results suggested that the relation between headache symptoms and neuropsychological functioning was insignificant.

Primary objective: To investigate possible sex differences in neuropsychological functioning among patients following mild traumatic brain injury (TBI).Methods and procedures: Retrospective records analysis of the neuropsychological test results of 102 participants with head injury, including 62 males and 40 females.Main outcome and results: A multivariate analysis of variance indicated that females and males performed similarly on neuropsychological tests, on average, ∼2 years after minor head trauma. A sex-by-age interaction effect was found on the Category and Trail Making A Tests, with a pattern similar to those obtained in a previous research.Conclusions: Although past research has found that females develop more TBI-related neuropsychological deficits than males in the immediate post-injury period, the present study found that, overall, sex differences in the performance of patients with mild TBI on a variety of neuropsychological tests were insignificant. More investigation into the sex-by-age inte...

Establishing normative data of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) performance of high school athletes in Hawai'i.Pre-season ImPACT testing was performed on 751 participants in football, baseball, basketball, soccer, volleyball, softball, and track from 4 Oahu public high schools. The ImPACT composite scores included measures of Verbal Memory, Visual Memory Processing Speed, and Reaction Time. The descriptive statistical data collected were the group means, standard deviations, standard errors of measurement, distribution of scores and percentile ranks of (1) 262 boys ages 13 to 15; (2) 297 boys ages 16 to 18; and (3) 192 girls ages 13 to 18.The means and standard deviations of the 4 ImPACT composite scores for the 751 student-athletes in Hawai'i were similar to the ImPACT scores obtained from a master database of ImPACT test results. Although differences between the Hawai'i and mainland data were nonsignificant, there appeared to be a trend revealing somewhat lower scores in the Hawai'i sample of athletes.The similarity in ImPACT test performance of Hawai'i high school athletes as compared to the mainland normative data provides support for the applicability of this computerized neuropsychological battery in Hawai'i. However in view of a trend reflecting slightly lower ImPACT scores among Hawai'i participants, the use of the normative data produced by this study may be desirable in assessing Hawai'i high school athletes.

A psychological assessment is critical for morbidly obese patients seeking Roux-en-Y gastric bypass (RYGBP) surgery. The Minnesota Multiphasic Personality Inventory (MMPI) has been widely used in past psychological studies of bariatric surgery patients, but, to date, there is no published research on the more recent version of the MMPI, the Minnesota Multiphasic Personality Inventory-2 (MMPI2), and its relation to RYGBP outcome. This investigation was designed to evaluate the predictive validity of the MMPI-2 with respect to outcome of RYGBP for morbid obesity.The research involved a retrospective analysis of MMPI-2 scores of 2 groups of patients 1 year following RYGBP: 1). those who lostor= 50% of their excess weight and 2). those who lost50% of their excess weight. Subjects were 52 morbidly obese patients (mean age 44 years, mean BMI 56 kg/m2). The measurement of psychological variables consisted of the MMPI-2 scores of 3 validity scales, 10 clinical scales, and 3 Content Scales, and BMI.Those who lost50% excess weight scored significantly higher than those who lost50% excess weight on the F,Hysteria, Paranoia, and Health Concerns scales of the MMPI-2, and significantly lower on the Masculinity-femininity scale. Stepwise regression analysis found that a combination of the Health Concerns and Masculinity-femininity scales was the most accurate predictor model for 1-year post-surgery weight loss.A standard personality measure, the MMPI-2, appears to be associated with weight loss outcome 1 year after RYGBP. Psychological traits such as anxiety and excessive health concerns are likely to influence bariatric surgical outcome.

Although the MMPI-2 has been employed since 1989, to date no study has been reported on its use with patients with insomnia. The MMPI-2 was administered to 104 insomnia patients. The T scores of all the MMPI-2 scales fell below the cut-off score of T = 65. Although the group profile was within the normal range, the percentages of patients who had MMPI-2 scores above T = 65 for each scale indicated that a substantial portion of the insomnia patients obtained elevated scores, particularly in the Hs, D, Hy, and Pt scales. Thus, the results suggest that many of the insomnia patients exhibit psychological distress and would benefit from brief psychological interventions, such as sleep hygiene education and relaxation training. In view of the large number of insomnia patients who obtained abnormal MMPI-2 scores, a psychological measure such as the MMPI-2 remains an important assessment tool in identifying insomnia patients who may need extensive psychotherapeutic intervention.

The Luria-Nebraska Neuropsychological Battery (LNNB) and the Minnesota Multiphasic Personality Inventory (MMPI) were administered to 37 mild head injury patients, whose headache activity was rated at the time of testing. A one-way analysis of variance (ANOVA) compared each of the 11 LNNB scores of patients with severe headache, mild headache, and no headache. The results revealed no significant differences on varied neuropsychological tests between the three headache groups. Similar analyses of the 13 MMPI scores also indicated no significant differences between the three headache groups across various psychoemotional measures. The results are consistent with previous research and suggest that headaches do not affect the performance of mild head injury patients on varied neuropsychological tests requiring concentration and immediate memory, but because of the small number of patients in this study the findings should be considered tentative.

Although the relationship between smoking and its harmful effects on health has been long known to the medical profession, relatively few medical institutions have taken serious measures to control smoking within their premises. This study focused on the effects of a smoking ban at a large private medical center, specifically its impact on smoking attitudes and behavior of the employees. A questionnaire was administered to more than 800 (over 50%) of the medical center employees before and after the implementation of a total ban on smoking on the worksite. The results revealed, after 1 year of the no-smoking policy, an increased acceptance of the smoking ban at work and a greater willingness to consider smoking cessation in the future. An important trend was noted in the decreased number of cigarettes smoked per day among the employees.

Dichotic-listening tests were conducted with 23 male and 23 female Asian-American college students. The mean correct responses for the men were right ear 54.7 and left ear 48.7, whereas the mean correct for the women were for the right ear 53.4 and the left ear 54.8. Among the men 60.9% did better with the right ear than with the left, while 43.5% of the women showed a right-ear superiority. The male-female differences, however, did not teach statistical significance. Clearly, larger samples are needed.