Search

Background Athletes who are diagnosed with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of concussion compared to other athletes. Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a widely used concussion tool, but it relies on pre-injury baseline testing that can be affected by psychiatric conditions. This research aims to determine if there are differences in pre-injury testing composite scores in student-athletes with ADHD compared to those without ADHD diagnosis. Methods We obtained 11,563 pre-season ImPACT assessments of 7,454 student-athletes (ages: 12–22) from 2009 to 2019. After exclusions, there were 6,920 control and 276 ADHD subjects. Multivariable linear regression analyses compared the independent effect of ADHD on the six ImPACT composite score metrics with Bonferroni correction for multiple comparisons with a = 0.008. Results Univariate analyses indicated ADHD is associated with more symptoms as measured by the Post-Concussion Symptom Scale (PCSS) (β = 2.67, 95% CI: 1.47–3.87, p  < .0001) and worse Impulse Control scores (β = 0.93, 95% CI: 0.33–1.53, p  = .002). In multivariate analysis, this association was the same for symptom score (β = 2.48, 95% CI: 1.22–3.74, p  < .0001), but Impulse Control was not significantly different after multiple comparison adjustment (β = 0.87, 95% CI: 0.22–1.15, p  = .009). Conclusions The ADHD subjects reported worse symptoms at baseline and had worse Impulse Control in univariate analysis, but not multivariate analysis. These results can further guide clinicians in concussion diagnosis and test interpretations for student-athletes with ADHD, considering the symptom burden at baseline. [ABSTRACT FROM AUTHOR]

Introduction: Gender differences in neurocognitive function have been reported over the past few decades. However, multiple studies that report gender differences in Immediate Post-Concussion Assessment and Cognitive Tests composite scores ignore potential confounders which may lead to inaccurate results. Methods: A total of 4829 male and 2477 female baseline Immediate Post-Concussion Assessment and Cognitive Tests from 2009 to 2019 of subjects ages 12–18 years were used to evaluate gender differences in baseline neurocognitive scores and symptom severity ratings. Regression analyses were used to assess the effects of gender on neurocognitive performance at baseline while controlling for a number of potential confounders including symptom burden at the time of testing. Results: Differences in 3 of 5 composite scores as well as severity rating scores were maintained in multivariate analysis. Females had increased Post-Concussion Symptom Scale (β = 3.54, 95% confidence interval, 2.91 to 4.16, P <.0001) along with higher verbal memory (β = 1.82, 95% confidence interval, 1.15 to 2.50, P <.0001) and visual motor (β = 1.29, 95% confidence interval, 0.85–1.72, P <.0001) scores. Conclusions: Statistically significant gender differences were found in baseline neurocognitive function. This study clarifies for the first time that gender differences in these neurocognitive domains are not simply an artifact of differences in symptom burden. However, the small effect sizes call into question the clinical relevance of these differences. [ABSTRACT FROM AUTHOR]

Concussions are the leading cause of injury among youth athletes, and antibiotics are the most prescribed pediatric medication in the United States. Antibiotics have shown to exert neuroprotective effects in animal models of traumatic brain injury, but to date, no human studies exist. Between 2009 and 2019, 6,343 adolescent athletes with differential antibiotic use at baseline were administered Immediate Post-concussion Assessment and Cognitive Testing at baseline and twice postinjury. Chronic antibiotic use was associated with a reduced risk for concussion (odds ratio 0.54), increased postconcussive symptomology and neurocognitive burden, and improved recovery by follow-up, a median of 7 days after concussion. This preliminary retrospective analysis suggests antibiotic use may impart neuroprotection up to a certain severity threshold, leading to fewer, yet more severe concussions that tend to recover faster. [ABSTRACT FROM AUTHOR]

Introduction Neurocognitive tests are an integral component of sport-related concussion (SRC) workup. A history of psychiatric illness (HPI) is common among young athletes. Investigations of factors that influence athletes' baseline neurocognitive function are crucial for an accurate assessment of SRC. Objective In this study, we aim to elucidate the effect of HPI and selective-serotonin reuptake inhibitor (SSRI) medication use on baseline neurocognitive performance in young athletes. Methods We conducted a retrospective cross-sectional study of Immediate Post-Concussion Assessment and Cognitive Testing assessments. A total of 268 athletes with HPI and a control group of 6,364 athletes were included. The outcomes were total symptom score based on post-concussion symptom scale, verbal memory, visual memory, visual motor, reaction time, and impulse control scores with self-reported HPI status and SSRI use. Results Athletes with HPI had an elevated symptom score in both univariate analysis (p  < .0001) and multivariate analysis (p  < .0001). HPI influence on visual memory score was not robust to multivariate analysis (p  = .24). Athletes with HPI who reported SSRI medication use had the same baseline neurocognitive performance as other athletes with HPI. HPI influences athletes' baseline neurocognitive performance by elevating symptom scores. HPI does not alter any of the objective neurocognitive composite scores in contrast to previous work. Conclusions Clinicians should consider the impact of HPI on baseline neurocognitive performance during the assessment of a suspected SRC. Additional research is required to bolster our findings on SSRI use and ascertain the effects of other drug classes on baseline neurocognitive performance. [ABSTRACT FROM AUTHOR]

Objective Contact level affects the incidence of sports-related concussion. However, the effects of contact level on injury severity and recovery are less clear and are the focus of this study. Method Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) for athletes aged 12–22 was performed at baseline (n  = 10,907 for 7,058 athletes), after suspected concussion determined by physicians or athletic trainers (n  = 5,062 for 4,419 athletes), and during follow-up visits (n  = 3,264 for 2,098 athletes). Athletes played contact/collision (CC), limited contact (LC), and noncontact (NC) sports. Injury incidence, severity, and recovery were measured using raw and change from baseline neurocognitive test scores. Comparisons between groups used univariate analysis and multivariable regression controlling for demographic variables. Results Compared to CC athletes, LC and NC athletes showed decreased suspected concussion incidence. At initial post-injury testing, all neurocognitive test scores were similar between groups except changes from baseline for processing speed were improved for LC compared to CC athletes. Upon follow-up testing, raw neurocognitive scores were better for NC compared to the contact collision athletes in verbal memory, processing speed, total symptom score, migraine cluster, cognitive cluster, and neuropsychiatric cluster scores. For change from baseline scores, LC athletes exhibited better performance on verbal memory, processing speed, and reaction time but also showed higher neuropsychiatric scores than CC athletes. Conclusion Neurocognitive scores between contact levels were similar at the first post-injury test. However, follow up showed many improved scores and symptoms for limited and NC sports compared to CC sports, which may indicate faster recovery. [ABSTRACT FROM AUTHOR]

Sport-related concussion has gained increasing recognition as a result of recent legislation, public health initiatives and media coverage. Moreover, there have been substantial paradigm shifts in the management of concussion. This article will discuss the variables that affect the use of diagnostic rating scales such as ImPACT and SCAT in the current management of concussed individuals. Specifically, patient-specific modifying factors affecting test interpretation, including age, gender, fitness level, psychiatric conditions, learning disorders and other components of medical history will be addressed, as well as methodological concerns with baseline testing. [ABSTRACT FROM AUTHOR]