A case matched study examining the reliability of using ImPACT to assess effects of multiple concussions

Abstract

BackgroundApproximately 3.8 million sport and recreational concussions occur per year, creating a need for accurate diagnosis and management of concussions. Researchers and clinicians are exploring the potential dose-response cumulative effects of concussive injuries using computerized neuropsychological exams, however, results have been mixed and/or contradictory. This study starts with a large adolescent population and applies strict inclusion criteria to examine how previous mild traumatic brain injuries affect symptom reports and neurocognitive performance on the Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) computerized tool.MethodsAfter applying exclusion criteria and case matching, 204 male and 99 female participants remained. These participants were grouped according to sex and the number of previous self-reported concussions and examined for overall differences on symptoms reported and scores obtained on the ImPACT neurocognitive battery composites. In an effort to further reduce confounding factors due to the varying group sizes, participants were then case matched on age, sex, and body mass index and analyzed for differences on symptoms reported and scores obtained on the ImPACT neurocognitive battery composites.ResultsCase matched analysis demonstrated males with concussions experience significantly higher rates of dizziness (p = .027, η2 = .035), fogginess (p = .038, η2 = .032), memory problems (p = .003, η2 = .055), and concentration problems (p = .009, η2 = .046) than males with no reported previous concussions. No significant effects were found for females, although females reporting two concussions demonstrated a slight trend for experiencing higher numbers of symptoms than females reporting no previous concussions.ConclusionsThe results suggest that male adolescent athletes reporting multiple concussions have lingering concussive symptoms well after the last concussive event; however, these symptoms were found to be conflicting and better explained by complainer versus complacent attitudes in the population examined. Our results conflict with a significant portion of the current literature that uses relatively lenient inclusion and exclusion criteria, providing evidence of the importance of strict inclusion and exclusion criteria and examination of confounding factors when assessing the effects of concussions.Electronic supplementary materialThe online version of this article (doi:10.1186/s40359-017-0184-1) contains supplementary material, which is available to authorized users.

Research on the changes in balance motion behavior and learning, as well as memory abilities of rats with multiple cerebral concussion-induced chronic traumatic encephalopathy and the underlying mechanism

“…Cerebral concussion caused by traumatic biological force can produce complex effects on the brain, causing a series of pathophysiological reactions and leading to rapid and transient neurological impairment. With the increasing number of trauma, it will further lead to severe damage to learning and memory abilities and balance motion behavior ( 9 , 10 ). Benson et al ( 11 ) studied and found that when cerebral concussion in patients has not restored, the stimulation of cerebral concussion once again can lead to learning and memory and neurological disorders in patients.…”

Cognitive and personality assessment in applied sport psychology: Evidence-based test selection.

“…In one validation of the ImPACT neurocognitive screen, the authors carefully selected a sample of 303 athletes from a pool of 26,240 athletes, ages 10 to 19 years. The authors identified baseline data and delineated patterns of postconcussion symptom expression (Barker et al, 2017). In a separate study, the sensitivity and specificity of the ImPACT screen had only minimally acceptable discriminant function analysis results.…”

Cognitive Disorders Among Incoming College Football Athletes: Legal and Medical Implications of Undisclosed Inclusion in Concussion Research

“…10,11 Recent research has continued to emphasize that accounting for such concussion co-morbidities is critical to the proper interpretation of neuropsychological test results. 12 Nuwer et al explain that "Concussion symptoms can be difficult to separate from ADHD baseline symptoms… Many postconcussion symptoms present as a clinical picture similar to ADHD itself." 13 The Institute of Medicine and National Research Council of the National Academies ("IOM-NRC") report titled Sports-Related Concussion in Youth: Improving the Science, Changing the Culture, identifies ADHD and learning disabilities as co-morbid conditions in neuropsychological testing and recommends collection of such data in concussion evaluation, noting that the presence of these factors may affect test outcomes.…”