Return-to-play decisions and concussion management must be objective and made on an individual basis, including consideration of factors such as patient sex rather than relying on a one-size-fits-all guideline.

This paper represents the first documentation of empirically derived indicators of the clinical course of postconcussion symptom resolution. Self-reported memory problems apparent 24 hours postconcussion were robust indicators of the severity of sports-related concussion and should be a primary consideration in determining an athlete's readiness to return to competition. A decline on neurocognitive testing was the only objective measure significantly related to the duration of symptoms. Neither a brief LOC nor a history of concussion was a useful predictor of the duration of postconcussion symptoms.

An Internet-based system holds promise for applying complex statistical models for routine monitoring of cognitive function.

The Concussion Resolution Index (CRI) is an online assessment tool designed to track resolution of symptoms following sports-related concussion. The CRI is composed of six subtests measuring reaction time, visual recognition, and speed of information processing. Three factors are derived from the subtests: Simple Reaction Time (SRT), Complex Reaction Time (CRT), and Processing Speed (PS). Multiple alternate forms within subtests afford simple, reliable, assessment of change, relative to a baseline test completed by an athlete. The test also assesses self-reported neurophysiological symptoms at the time of injury and tracks resolution of these symptoms. The data demonstrate the CRI is a valid and reliable measure of cognitive performance in a relatively heterogeneous group of athletes aged 13-35. Two methods of statistical analysis for assessing change from baseline were compared to establish a psychometric basis for return-to-play decision-making: the Reliable Change Index (RCI) and multiple regression. Multiple regression was more accurate than the RCI in determining a decline in performance relative to the baseline.

The MS-COG is a reliable, repeatable measure of MS cognitive functioning that is sensitive to cognitive impairment in SP MS and RR MS patients and feasible for multicenter clinical trials. Further development is warranted.

Defects in processing speed and memory are common in multiple sclerosis (MS) patients. In other populations, amphetamines have been shown to enhance cognition, but their use is limited by adverse behavioral effects. The L-isomer may have equivalent cognition enhancement with less adverse effects due to decreased potency in subcortical areas. The aim of this study was to assess the safety and efficacy of L-amphetamine sulfate in the treatment of cognitive dysfunction in MS. This was a 2:1 randomized, placebo-controlled, double-blind trial, involving 33 MS clinics across the USA. One hundred and fifty-one clinically definite MS patients with documented cognitive dysfunction who were relapse free for >or=90 days, with an Expanded Disability Status Scale (EDSS)

Cognitive screening measures for age-related cognitive impairment have been found to have only fair validity, and the risks of harm even may outweigh the benefits at this time (U.S. Preventative Service Task Force, 2003). A large-scale project designed to assess elder care in Primary Care Physician offices noted that dementia evaluation and treatment was one of the most overlooked aspects of care. Taken together, these studies cited the lack of time and technical expertise in test administration as the most prominent barriers to the accurate detection of dementia in Primary Care Physician offices. It was for these reasons that the Cognitive Screening Test (CST) was created. The CST requires no physician time or training to administer or interpret it. The current study investigated the clinical utility of this cognitive screening system by comparing the results of 102 patients to those of expert geriatricians, using consensus conference methods for diagnosis. Overall clinical utility demonstrated scores at .80 or above for sensitivity, specificity, and positive and negative predictive power. In contrast, the MMSE had only a .38 sensitivity. A Receiver Operating Curve (ROC) analysis indicated a .863 accuracy rating for the predetermined cut score on the CST.

Background: Memory impairment is prevalent in multiple sclerosis (MS), but no drugs are approved to treat these memory problems. Objective: The objective of the study was to examine the effect of l-amphetamine versus placebo on auditory/verbal memory and visual/spatial memory in MS patients with and without baseline memory impairment. Methods: We conducted a re-analysis of a previously published clinical trial in which MS patients were randomly assigned to treatment (30 mg l-amphetamine, N ¼ 99) or placebo (N ¼ 37) in a four-week, double-blind, parallel-group, dose titration trial. Auditory/verbal memory (CVLT-II: Long Delay Free Recall) and visual/spatial memory (BVMT-R: Delayed Recall) were assessed at baseline and follow-up across subgroups of patients with intact baseline memory (mean ¼ 50th percentile) or impaired baseline memory (mean ¼ 2nd percentile). Primary analyses: 2 (l-amphetamine, placebo) Â 2 (baseline, follow-up), Â 2 (baseline memory intact, baseline memory impaired) ANOVAs performed separately for auditory/verbal and visual/spatial memory. Results: For both auditory/verbal and visual/spatial memory, we observed significant 2 Â 2 Â 2 interactions whereby l-amphetamine improved memory more than placebo, and this effect was specific to patients with baseline memory impairment. Conclusions: Among memory-impaired patients, memory improved about 48.5% for those on l-amphetamine, but only 1.0% on placebo. Treatment with l-amphetamine produced large memory gains among memory-impaired MS patients.