Baseline memory and speed scores are significantly influenced by history of neurodevelopmental disorder, age, and race. In football players, specifically, maternal SES independently predicted baseline memory scores, but concussion history and years exposed to sport were not predictive. SES, race, and medical history beyond exposure to brain injury or subclinical brain trauma are important factors when interpreting variability in cognitive scores among collegiate athletes. Additionally, sport-specific differences in the proportional representation of various demographic variables (e.g., SES and race) may also be an important consideration within the broader biopsychosocial attributional model. (JINS, 2018, 24, 1-10).
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.
Objectives: To describe multivariate base rates (MBRs) of low scores and reliable change (decline) scores on Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) in college athletes at baseline, as well as to assess MBR differences among demographic and medical history subpopulations. Methods: Data were reported on 15,909 participants (46.5% female) from the NCAA/DoD CARE Consortium. MBRs of ImPACT composite scores were derived using published CARE normative data and reliability metrics. MBRs of sex-corrected low scores were reported at <25th percentile (Low Average), <10th percentile (Borderline), and ≤2nd percentile (Impaired). MBRs of reliable decline scores were reported at the 75%, 90%, 95%, and 99% confidence intervals. We analyzed subgroups by sex, race, attention-deficit/hyperactivity disorder and/or learning disability (ADHD/LD), anxiety/depression, and concussion history using chi-square analyses. Results: Base rates of low scores and reliable decline scores on individual composites approximated the normative distribution. Athletes obtained ≥1 low score with frequencies of 63.4% (Low Average), 32.0% (Borderline), and 9.1% (Impaired). Athletes obtained ≥1 reliable decline score with frequencies of 66.8%, 32.2%, 18%, and 3.8%, respectively. Comparatively few athletes had low scores or reliable decline on ≥2 composite scores. Black/African American athletes and athletes with ADHD/LD had higher rates of low scores, while greater concussion history was associated with lower MBRs (p < .01). MBRs of reliable decline were not associated with demographic or medical factors. Conclusions: Clinical interpretation of low scores and reliable decline on ImPACT depends on the strictness of the low score cutoff, the reliable change criterion, and the number of scores exceeding these cutoffs. Race and ADHD influence the frequency of low scores at all cutoffs cross-sectionally.
ObjectiveTo examine the association between estimated age of first exposure (eAFE) to American football and clinical measures throughout recovery following concussion.MethodsParticipants were recruited across 30 colleges and universities as part of the NCAA–DoD Concussion Assessment, Research and Education (CARE) Consortium. There were 294 NCAA American football players (age = 19 ± 1 years) evaluated 24–48 hours following concussion with valid baseline data and 327 (age = 19 ± 1 years) evaluated at the time they were asymptomatic with 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, Balance Error Scoring System (BESS) total score, and Brief Symptom Inventory 18 (BSI-18) sub-scores. The eAFE was defined as participant's age at the time of assessment minus self-reported number of years playing football.ResultsIn unadjusted regression models, younger eAFE was associated with lower (worse) ImPACT Visual Motor Speed (R2 = 0.031, p = 0.012) at 24–48 hours following injury and lower (better) BSI-18 Somatization sub-scores (R2 = 0.014, p = 0.038) when the athletes were asymptomatic. The effect sizes were very small. The eAFE was not associated with the number of days until asymptomatic, other ImPACT composite scores, BESS total score, or other BSI-18 sub-scores.ConclusionEarlier eAFE to American football was not associated with longer symptom recovery, worse balance, worse cognitive performance, or greater psychological distress following concussion. In these NCAA football players, longer duration of exposure to football during childhood and adolescence appears to be unrelated to clinical recovery following concussion.
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