Relationship Between Concussion and Neuropsychological Performance in College Football Players

Collins, Michael W.

doi:10.1001/jama.282.10.964

Cited by 714 publications

(452 citation statements)

References 19 publications

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“…These results are similar to those reported following sequential mild fluid-percussion brain injury in rats 45 and to clinical reports of exacerbation of behavioral deficits in cases of multiple concussions. 15,56 These findings, taken together with reports of increased neurological impairment and histological damage after TBI and posttraumatic ischemia and hypoxia, 14,40,41 are suggestive of an increased vulnerability of the brain after mild TBI. Although a number of mechanisms are likely to contribute to this impairment and dysfunction following mild TBI, the exact mechanism for this increased vulnerability and an understanding of this posttraumatic pathobiology remain speculative.…”

Section: J Neurosurg / Volume 95 / November 2001mentioning

confidence: 62%

Mild head injury increasing the brain's vulnerability to a second concussive impact

Laurer¹,

Bareyre²,

Lee³

et al. 2001

Journal of Neurosurgery

288

234

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Object. Mild, traumatic repetitive head injury (RHI) leads to neurobehavioral impairment and is associated with the early onset of neurodegenerative disease. The authors developed an animal model to investigate the behavioral and pathological changes associated with RHI. Methods. Adult male C57BL/6 mice were subjected to a single injury (43 mice), repetitive injury (two injuries 24 hours apart; 49 mice), or no impact (36 mice). Cognitive function was assessed using the Morris water maze test, and neurological motor function was evaluated using a battery of neuroscore, rotarod, and rotating pole tests. The animals were also evaluated for cardiovascular changes, blood—brain barrier (BBB) breakdown, traumatic axonal injury, and neurodegenerative and histopathological changes between 1 day and 56 days after brain trauma. No cognitive dysfunction was detected in any group. The single-impact group showed mild impairment according to the neuroscore test at only 3 days postinjury, whereas RHI caused pronounced deficits at 3 days and 7 days following the second injury. Moreover, RHI led to functional impairment during the rotarod and rotating pole tests that was not observed in any animal after a single impact. Small areas of cortical BBB breakdown and axonal injury, observed after a single brain injury, were profoundly exacerbated after RHI. Immunohistochemical staining for microtubule-associated protein—2 revealed marked regional loss of immunoreactivity only in animals subjected to RHI. No deposits of β-amyloid or tau were observed in any brain-injured animal. Conclusions. On the basis of their results, the authors suggest that the brain has an increased vulnerability to a second traumatic insult for at least 24 hours following an initial episode of mild brain trauma.

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Section: J Neurosurg / Volume 95 / November 2001mentioning

confidence: 62%

Mild head injury increasing the brain's vulnerability to a second concussive impact

Laurer¹,

Bareyre²,

Lee³

et al. 2001

Journal of Neurosurgery

288

234

View full text Add to dashboard Cite

show abstract

“…26,73 Studies in Division I college football players have shown that those experiencing 3 or more prior concussions had a triple incidence of subsequent concussions and that those with multiple concussions had more symptoms and took longer to recover. 13,30,46,47 As noted previously, Talavage et al discovered a new category of injured athletes: those with no readily observable symptoms but who instead exhibited functional impairment as measured by neuropsychological testing and fMRI studies. 79 This "third group" in which abnormal neurological performance occurred despite a lack of symptoms typically associated with a clinically diagnosed concussion may shed light on the issue of subconcussive impacts and their relationship to chronic neurological syndromes (Fig.…”

Section: Discussionmentioning

confidence: 88%

Role of subconcussion in repetitive mild traumatic brain injury

Bailes

Petraglia

Omalu

et al. 2013

JNS

432

340

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Research now suggests that head impacts commonly occur during contact sports in which visible signs or symptoms of neurological dysfunction may not develop despite those impacts having the potential for neurological injury. Recent biophysics studies utilizing helmet accelerometers have indicated that athletes at the collegiate and high school levels sustain a surprisingly high number of head impacts ranging from several hundred to well over 1000 during the course of a season. The associated cumulative impact burdens over the course of a career are equally important. Clinical studies have also identified athletes with no readily observable symptoms but who exhibit functional impairment as measured by neuropsychological testing and functional MRI. Such findings have been corroborated by diffusion tensor imaging studies demonstrating axonal injury in asymptomatic athletes at the end of a season. Recent autopsy data have shown that there are subsets of athletes in contact sports who do not have a history of known or identified concussions but nonetheless have neurodegenerative pathology consistent with chronic traumatic encephalopathy. Finally, emerging laboratory data have demonstrated significant axonal injury, blood-brain barrier permeability, and evidence of neuroinflammation, all in the absence of behavioral changes. Such data suggest that subconcussive level impacts can lead to significant neurological alterations, especially if the blows are repetitive. The authors propose “subconcussion” as a significant emerging concept requiring thorough consideration of the potential role it plays in accruing sufficient anatomical and/or physiological damage in athletes and military personnel, such that the effects of these injuries are clinically expressed either contemporaneously or later in life.

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“…Evidence exists that some aspects of neurocognitive function do not recover as quickly in those who have experienced multiple concussions, and some studies suggest a permanent reduction in cognitive performance [14][15]. One recent study showed greater reduction in neurological activity among persons with two concussions, with reduced time between concussive events acting as an important mediator [16].…”

Section: Traumatic Brain Injury (Tbi) Is One Of the Predominant Injurmentioning

confidence: 99%

Repeated concussion among U.S. military personnel during Operation Iraqi Freedom

MacGregor¹,

Dougherty²,

Morrison³

et al. 2011

JRRD

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Abstract-Concussions are a predominant injury of the conflicts in Iraq and Afghanistan. The aims of this study were to describe repeated concussive events among U.S. military personnel injured in Operation Iraqi Freedom and examine subsequent healthcare utilization. We reviewed clinical records from the Expeditionary Medical Encounter Database to identify servicemembers with repeat concussions. We abstracted demographic and injury-specific variables, calculated time between events, and identified healthcare utilization from electronic medical databases. Overall, 113 personnel experienced more than one concussion between 2004 and 2008. A majority of these incidents were blast related. The median time between events was 40 days, with 20% experiencing a second event within 2 weeks of the first and 87% within 3 months. Time between events was not associated with severity of the second event. Greater severity of the second concussive event was associated with higher postinjury utilization of mental health and neurology services. This study is one of the first to describe repeated concussions in a combat setting. We found that repeated concussions occur within a short interval among deployed personnel, although the effects of the first event are unclear. Further research is needed to define the effect of repeated concussions on the health of combat veterans.

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Relationship Between Concussion and Neuropsychological Performance in College Football Players

Cited by 714 publications

References 19 publications

Mild head injury increasing the brain's vulnerability to a second concussive impact

Mild head injury increasing the brain's vulnerability to a second concussive impact

Role of subconcussion in repetitive mild traumatic brain injury

Repeated concussion among U.S. military personnel during Operation Iraqi Freedom

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