Sex Differences in Neuropsychological Function and Post-Concussion Symptoms of Concussed Collegiate Athletes

Abstract

OBJECTIVE:Our purpose was to determine whether sex differences exist with respect to post-concussion symptoms and neurocognitive function in concussed collegiate athletes. METHODS: A prospective dependent-sample cohort design was used to compare baseline and post-concussion neuropsychological test scores and endorsed symptoms as functions of serial post-concussion assessment with respect to time and sex. The Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) battery was administered to a multicenter analysis group of 79 concussed athletes. This computerized neuropsychological test was given to the athletes during the preseason and, on average, 2 and 8 days postinjury. RESULTS: Multivariate analyses revealed no significant between-group differences on baseline test performance with respect to sex on any of the ImPACT composite scores or on the total symptom score. Multivariate analyses of post-concussion data revealed a significant main effect of time on ImPACT scores, but no main effect of sex was identified, and no time-by-sex interaction existed. Post hoc analysis revealed that concussed female athletes performed significantly worse than concussed male athletes on visual memory tasks (P ϭ 0.001), and analysis of endorsed post-concussion symptoms revealed that concussed men were significantly more likely than concussed women to report post-concussion symptoms of vomiting (P ϭ 0.001) and sadness (P ϭ 0.017). Athletes' scores were examined individually using the reliable-change methodology. At 2 days post-injury, 58% of concussed athletes had one or more reliable incidents of performance decline or increases in symptom reporting. At 8 days post-concussion, 30% of concussed athletes were still showing one or more reliable change from preseason values. CONCLUSIONS: College athletes exhibit differences on visual memory composite scores and symptoms post-concussion as a function of sex. These data support the importance of evaluating neuropsychological status and post-concussion symptoms in concussed athletes. In addition, these data illustrate the importance of analyzing an individual athlete's recovery pattern, because individual differences in recovery trajectories may be overshadowed by global norm-group comparisons. A pproximately 300,000 sport-related concussions are reported each year (40). To date, literature reporting concussions in athletes has been primarily concentrated on men's sports such as football, ice hockey, boxing, and soccer, with few comparisons with regard to sex in concussed athletes (2, 3, 10, 37). However, female athletes have been found to be at a greater risk for concussion in basketball and soccer than male athletes (10). Broshek et al. (6) reported significant declines on measures of simple and complex reaction times relative to preseason baseline values in female athletes. Because women's sports participation has expanded significantly during the last decade and brain function differs between the sexes, a comparison of baseline neuropsychological function and post-concu...

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“…However, most investigators have studied collegiate athletes, and whether high school athletes will behave similarly is uncertain. Covassin et al 21 reported differences in visual memory composite scores in collegiate athletes and suggested a relationship between postconcussive symptoms and sex. In a mixed sample of collegiate and high school athletes, Broshek et al 22 found that females tended to be more cognitively impaired after a sport-related concussion.…”

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