Influence of Test Environment, Age, Sex, and Sport on Baseline Computerized Neurocognitive Test Performance

Abstract

Background: Baseline computerized testing is a common component of concussion assessments, and the testing environment has been suggested to influence test performance and validity. Purpose: To compare concussion baseline computerized neurocognitive test performance and validity among adolescent athletes based on testing environment (group, individual), age group (10-12, 13-15, 16-18 years), sex (male, female), and sport type (collision/combat, contact, noncontact). Study Design: Cohort study; Level of evidence, 3. Methods: Through a concussion community outreach program, participants completed baseline computerized neurocognitive testing using Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). A total of 2845 athletes aged 10 to 18 years completed the baseline assessment. A total of 2241 (79%) athletes completed baseline testing in a group environment, and 604 (21%) completed testing in an individual environment. A random subsample of 500 athletes from each group was selected for statistical comparison. Results: No significant differences were supported in baseline computerized neurocognitive test performance between the group and individual administration environments. Test validity was statistically similar across testing environment, age group, and sex. However, patients of older age (16-18 years), female sex, and collision/combat and contact sports performed better on ImPACT. There were differences in total symptom severity scores ( t = 2.19, df = 998, P = .03), with participants in the group testing environment reporting lower total symptom severity scores than those in the individual testing environment. The rates of invalid tests were low across all age groups, averaging from 4.0% in the 10- to 12-year age group to 4.8% in the 13- to 15-year age group. Conclusion: The findings indicated that concussion baseline neurocognitive test performance is similar when administered in group and individual testing environments. However, differences based on age group, sex, and sport type should be considered when interpreting baseline computerized neurocognitive test scores. The finding of higher symptom scores in older adolescents in the individual testing environment suggests that they may be less forthcoming about symptoms in a group setting.

Neurocognitive functioning and symptoms across levels of collision and contact in male high school athletes

“…Previous studies of adolescent12 and collegiate10 11 athletes found no association between sport and neurocognitive test performance and no significant differences for sport type on composite scores during baseline preseason evaluations. A similar large scale investigation of male NCAA athletes undergoing preseason testing found that football players had lower (worse) visual motor processing speed and slower (worse) reaction time compared with non-contact sport athletes, however, the authors reported small effect sizes and minimal clinical relevance, similar to our study 9.…”

“…Others have examined the influence of sport on cognition across an athletic season and found small but measurable short-term differences in neurocognitive outcomes between collision, contact and non-contact high school and collegiate athletes,13 although the magnitude of the differences between sport type did not reach the thresholds deemed to be clinically significant and did not persist across subsequent athletic seasons 13. Similarly, previous studies have found lower symptom scores in adolescent12 and collegiate athletes10 associated with collision sport participation. It is not known as to why collision sport athletes report fewer symptoms, but it is possibly due, at least in part, to collision sports being predominantly male, as sex has been associated with baseline symptom reporting in a number of studies 26 27 34.…”

“…Moreover, high school football players may potentially sustain upwards of 1800 collisions over the course of a single season, while some studies suggest that fewer than 3000 repetitive head impacts may be associated with an elevated risk of later life impairments in executive functioning 5 8. Other studies, however, suggest that collision and contact sport participation does not necessarily result in worse neurocognitive outcomes 9–13. Furthermore, recent studies suggest that collision and contact sport athletes have fewer anxiety and depression symptoms compared with non-contact sport athletes,10 14 and they are not more likely to have depression or cognitive deficits long term 15 16.…”

A Systematic Review of Telehealth and Sport-Related Concussion: Baseline Testing, Diagnosis, and Management

“…Computer-based neurocognitive testing could be performed at an athlete’s home but administered or proctored using telehealth to ensure proper testing procedure. French et al found that although environment did not affect test performance, those who tested in an individual testing environment had, on average, a higher concussion symptom severity score than those who underwent testing in a group [11]. Other tests that may be used in baseline testing such as the Vestibular Ocular-Motor Screen would require another examiner to be physically present with the athlete [22].…”

Interaction between Age, Sex, and Mental Health Status as Precipitating Factors for Symptom Presentation in Concussed Individuals

“…All participants were separated into one of the six age groupings: ages 12 and under, 13-15, 16-19, 20-29, 30-39, and 40+. e younger age group clusters were chosen based on previous reports showing differences in concussion symptomology [25,26]. A total of 1,577 participants were included in the study for the experimental data (see Table 1 for number of participants per category).…”