Enduring effects of concussion in youth athletes

Archives of Clinical Neuropsychology 17 (2002) 91 – 100 Enduring effects of concussion in youth athletes Rosemarie Scolaro Mosera,*, Philip Schatzb a RSM Psychology Center, LLC, 3131 Princeton Pike, Building 5, Lawrenceville, NJ 08648, USA b Saint Joseph’s University, Philadelphia, PA 19131, USA Accepted 2 January 2001 Abstract The purpose of this study was to explore the mild, enduring effects of concussion in otherwise healthy youth athletes. Reported history of concussion and cognitive functioning was examined in an initial sample of 35 youth athletes, 21 of whom were considered healthy volunteers (No Recent Concussion within the past 6 months) with no identified medical or neuropsychological difficulties related to concussion. The remaining 14 volunteers had each sustained a concussion within 1 week of testing (Recent Concussion). Significant differences in performances on a general cognitive measure, and specifically in the area of attention, were found as a function of number of concussions reported by the No Recent Concussion athletes. Furthermore, on some of the measures, No Recent Concussion athletes with a history of two or more concussions appeared to resemble Recent Concussion athletes more so than No Recent Concussion athletes with a history of one or no concussion. The importance of assessment of youth concussion and the use of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) for this purpose are discussed. D 2001 National Academy of Neuropsychology. Published by Elsevier Science Ltd. Keywords: Concussion; Youth sports; Neuropsychological testing; Baseline screening; Mild head injury 1. Introduction Sports-related head injury has received significantly more attention over the past few years. The effects of repeated concussions have been demonstrated in a number of high-profile athletes (Grady, 1998; LaPointe, 1998). With multimillion dollars and careers at stake, * Corresponding author. Tel.: +1-609-895-1070; fax: +1-609-896-2030. E-mail address: (R.S. Moser). 0887-6177/01/$ – see front matter D 2001 National Academy of Neuropsychology. 0887-6177(01)00108-1 Downloaded PII: from Shttps://academic.oup.com/acn/article-abstract/17/1/91/2197 by guest on 14 May 2018 92 R.S. Moser, P. Schatz / Archives of Clinical Neuropsychology 17 (2002) 91–100 professional athletic associations have supported the implementation of preseason baseline testing and neuropsychological evaluation to assist in return-to-play decision making and to assess the cognitive sequelae of concussive head injuries (Lovell, 1999). Such comprehensive programs are infiltrating college athletics (Lovell & Collins, 1998) and most recently have begun to manifest themselves in high school athletics (Echemendia, 1999). It is clear that mild head injury is a growing concern in the popular high school contact sports (Powell & Barber-Foss, 1999). Barth’s (1998) and Barth et al.’s (1989) groundbreaking research focused on college athletes in the 1980s and evaluated the cognitive effects of mild concussion where there was no loss of consciousness. Tested at three postconcussion time intervals (24 h, 5 and 10 days), Barth discovered that recently concussed athletes demonstrated significant increases in memory difficulties, dizziness, and headaches, as well as significant decreases in attention and problem solving abilities, as measured by the Trail Making Test A and B, from the Halstead–Reitan Neuropsychological Test Battery, the Symbol Digit Test, and the Paced Auditory Serial Addition Task (PASAT). He further noted that within 5–10 days after the injuries, these athletes returned to their preseason baseline abilities. Typically, research has focused on immediate and short-term effects of sports concussion, some of which include alteration in consciousness, amnesia, confusion, delayed cognitive responses, memory and learning difficulties, headache, and irritability (Macciocchi, Barth, & Littlefield, 1998; Moser, 1998). Long-term follow-up of sports concussion sequelae has been limited. More recent research on adult soccer players has documented the persisting cognitive effects of concussions. In amateur soccer players, concussions were related to poorer performance on a number of neuropsychological measures including Digit Span, Facial Recognition, Complex Figures, Digit Symbol, and Logical Memory (Wechsler Memory Scale; Matser, Kessels, Lezak, Jordan, & Troost, 1999). Weaker planning and memory abilities were also observed in these soccer players when compared to control athletes. In an earlier study in which professional soccer players were compared to elite noncontact sport athletes, impaired memory, planning, and visuospatial abilities were related to frequency of heading the ball and number of concussions (Matser, Kessels, Jordan, Lezak, & Troost, 1998). Research on adults has revealed some possible long-term sequelae of repeated mild head injury, such as an association with the development of Alzheimer’s disease. A link between Apolipoprotein 4, a factor associated with Alzheimer’s disease, and exposure to contact sports has been posited (Jordan et al., 1997). Biochemical and genetic factors are receiving greater attention in recent research (Kutner & Barth, 1998). Concussion is now understood in terms of ionic influx that suddenly activates or increases glycolysis in the brain (Hovda et al., 1999). Metabolic dysfunction appears to be important in understanding the vulnerability of the brain during recovery. Recently, research has documented deficits in the neuropsychological performance of college football players and a link to concussion and the synergistic effects of learning disability (Collins et al., 1999). In this research, male college football players were assessed regarding their histories of concussion and learning disorder. Of 393 players, 208 had a history of one or more concussions, approximately 53%. The authors suggested that having a history of learning disorder further compromised those individuals who had a history of two R.S. Moser, P. Schatz / Archives of Clinical Neuropsychology 17 (2002) 91–100 93 or more concussions. These findings echo that of Gronwell (1976) who over 20 years prior suggested that premorbid intelligence might mitigate the effects of concussion. In this study, concussed university students (in active academic study) performed better than concussed nonstudents on measures of vocabulary and verbal fluency after a period of recovery, even though there was no significant difference between the groups on measures immediately after concussion. The bulk of neuropsychological research has focused on the college or professional athlete rather than adolescent youth. The prevalence of traumatic brain injury in high school athletes has only recently been comprehensively documented. Powell and BarberFoss (1999) noted that of 23,566 reported sports injuries in 235 high schools during the period of 1995–1997, 5.5% were mild trau (...truncated)