Symptom recovery and the relationship between post-injury symptom scores and neurocognitive performance in athletes with sport-related concussion

Introduction A multi-domain approach to concussion assessment has been recommended that includes self-reported symptom severity in addition to neurocognitive tests and measures of postural stability. The relationship between subjective self-reported symptoms and objective measures of cognitive function in the post-injury state is not well understood. The aims of the study were to determine symptom severity throughout the post-injury continuum of care and the association between symptom severity and performance on measures of neurocognitive function. Methods An observational cohort study was conducted on 1257 high school and collegiate athletes (67% male and 33% female) who had sustained a concussion. Student-athletes were included in the study if they had a healthy baseline assessment and at least one follow-up injury assessment utilizing the Cleveland Clinic Concussion Application (C3 App). Symptom severity was assessed during the acute (0–7 days post-injury), subacute (8–20 days post-injury), and post-concussive (≥21 days post-injury) phases. Neurocognitive performance was assessed using the following measures: Simple Reaction Time (SRT), Choice Reaction Time (CRT), Processing Speed Test (PST), Trail Making Test A (TMT-A), and Trail Making Test B (TMT-B). To determine the relationship between symptom severity and neurocognitive test performance, athletes were stratified into two groups for comparison: symptom score ≤7 or >7, utilizing the 27-item graded symptom checklist within the C3 App. Neurocognitive performance was analyzed with separate linear mixed effect models for each module to compare within-phase differences. Significance for each module at each phase was tested at P < .05 and adjusted for multiple comparisons. Results Median symptom severity during the acute post-injury phase was 10 declining to 2 during the subacute and post-concussive phases. Performance on each of the C3 App modules (SRT, CRT, PST, Trails A, and Trails B) were significantly better in athletes reporting a symptom score of ≤7 compared to those reporting a symptom score >7 at each of the post-injury phases (P < 0.05 on all comparisons). Conclusions Symptomatic athletes performed worse on all measures of neurocognitive function, regardless of time from injury. While symptoms alone should not be used to determine recovery, our data indicate that symptom severity may aide in deciding when to initiate post-injury neurocognitive testing to determine readiness for treatment progression.

Download Full-text

Effects of Persistent Concussion Symptoms on Executive Function in Working-aged Adults using a Novel Sensorimotor Assessment Tool

Neurology ◽

10.1212/01.wnl.0000719996.56412.9a ◽

2020 ◽

Vol 95 (20 Supplement 1) ◽

pp. S13.3-S14

Author(s):

Kelsey Bryk ◽

Scott Passalugo ◽

Thomas A. Buckley

Keyword(s):

Severity Score ◽

Assessment Tool ◽

Neurocognitive Function ◽

Group Differences ◽

Trail Making Test ◽

Dominant Hand ◽

Neurocognitive Deficits ◽

Neurocognitive Performance ◽

Trail Making ◽

Sensorimotor Assessment

ObjectiveTo examine neurocognitive performance of persistent concussion symptom patients using a novel sensorimotor technology.BackgroundIn patients with persistent concussion symptoms, neurocognitive deficits have been routinely identified; however, most of the current literature focuses on athletes and military veterans. Middle aged community members face unique challenges related to jobs, family, and transportation which can all be adversely affected by neurocognitive deficits.Design/MethodsThirteen adults (44.3 ± 12.6 years) with self-reported persistent-concussion symptoms (PCS) at least 3 months post-injury, and thirteen sex and age matched healthy controls (37.5 ± 8.8 years) were recruited. Participants performed the Trail-Making Test A (TMT-A) and Trail-Making Test B (TMT-B) on a novel sensorimotor assessment tool, the KINARM (BKIN Technologies, Kingston, ON, Canada). Using their dominant hand, TMT-A required participants to connect numbered dots in ascending order as quickly as possible. TMT-B required connecting dots with either a number or letter inside, in an alternating number-letter fashion (i.e.,: 1-A-2-B-3-C…). Total number of symptoms and a symptom severity score were assessed using the Rivermead Post Concussion Symptoms Questionnaire (RPQ). An independent samples t-test was used to analyze group differences of total time to completion, dwell time, and number of errors.ResultsAs expected, PCS patients had a significantly higher number of symptoms and severity score (PCS: 13.4 ± 2.3 and 36.2 ± 14.5, respectively; Controls: 3.4 ± 3.7 and 5.3 ± 5.6, respectively, p < 0.001). PCS patients were significantly slower on TMT-A (46.3 ± 20.1 sec; and 34.7 ± 6.5 sec respectively, p = 0.047). There were no group differences in TMT-B.ConclusionsOur results suggest that neurocognitive function may remain unaffected by persistent concussion symptoms in working-aged adults. The lack of task performance differences may be a result of neurocognitive function recovery, or the need for a more sensitive task to assess neurocognitive function in this population.

Download Full-text

Rehabilitation of Persistent Symptoms and Neurocognitive Deficits Following Sports-Related Concussion in a Professional Hockey Player: Case Study

Neurology ◽

10.1212/01.wnl.0000801980.87446.22 ◽

2021 ◽

Vol 98 (1 Supplement 1) ◽

pp. S26-S26

Author(s):

Shaun Kornfeld ◽

Emily Kalambaheti ◽

Matthew Michael Antonucci

Keyword(s):

Reaction Time ◽

Simple Reaction Time ◽

Trail Making Test ◽

Neurocognitive Performance ◽

Test Part ◽

Hockey Player ◽

Trail Making ◽

Professional Hockey ◽

Functional Neurology

ObjectiveTo demonstrate decreased post-concussive symptomatology and neurocognitive improvements in a professional hockey player following a multimodal, functional neurology approach to neurorehabilitation.BackgroundHockey is one of the top 3 sports in which concussions occur and has one of the top 10 highest participation numbers of sports in the northern hemisphere. The investigation of treatment modalities is warranted given the prevalence of hockey throughout society. This case study presents a 31-year-old male professional hockey athlete who had sustained 5 diagnosed concussions with additional suspected concussions throughout his career. His symptoms remained after independently receiving physical therapy and vestibular rehabilitation, causing an inability to continue playing hockey at a professional level.Design/MethodsThe patient was prescribed 10 treatment sessions over 5 contiguous days at an outpatient neurorehabilitation center specializing in functional neurology. The C3Logix neurocognitive assessment and graded symptom checklist were utilized at intake and discharge. Multimodal treatment interventions included transcranial photobiomodulation, non-invasive neuromodulation of the lingual branch of the trigeminal nerve, hand-eye coordination training, vestibular rehabilitation utilizing a three-axis whole-body off-axis rotational device, and cognitive training.ResultsOn intake, their composite symptom score was reported as 16/162, Trail Making Test Part B was 24.1 seconds, Simple Reaction Time was 274 milliseconds, and Choice Reaction Time was 496 milliseconds. On discharge, the patient experienced an 81% in self-reported symptoms, Trail Making Test Part B improved to 17 seconds (+29.46%), Simple Reaction Time was 252 milliseconds (8% faster), and Choice Reaction Time was 465 milliseconds (24% faster).ConclusionsThe present case study results demonstrated meaningful improvements in both self-rated concussion symptoms and neurocognitive performance for this patient. The Press suggest further investigation into functional neurology-based, multimodal, intensive approaches to decrease chronic post-concussion symptoms and improve neurocognitive performance in athletes that engage in hockey.

Download Full-text

B-70 The Effect of Bilingualism on Trail Making Test Performance in Traumatic Brain Injury Survivors and Healthy Adults

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acz034.153 ◽

2019 ◽

Vol 34 (6) ◽

pp. 1018-1018

Author(s):

P Litvin ◽

R Rugh-Fraser ◽

W Lopez-Hernandez ◽

J Knight ◽

R Cervantes ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Executive Functioning ◽

Test Performance ◽

Control Group ◽

Trail Making Test ◽

Neurocognitive Performance ◽

Post Injury ◽

Trail Making ◽

Main Effects

Abstract Objective Traumatic brain injury (TBI) is associated with a number of cognitive deficits. Language factors also impact neurocognitive performance. We examined the effects of TBI and bilingualism/monolingualism on a test of attention and executive functioning (Trail Making Test; TMT). Method The sample (N = 96) consisted of 36 healthy controls (19 bilingual; 17 monolingual), 34 acute TBI participants (12 bilingual; 21 monolingual), and 27 chronic TBI participants (16 bilingual; 11 monolingual). Acute TBI participants were tested 6 months post-injury and chronic TBI participants were tested 12 months or more post-injury. 3X2 ANOVAs were conducted to determine the effect of TBI and bilingualism/monolingualism on TMT part A and B. Results Main effects were found between groups (i.e., control and TBI groups) on TMT A, p < .001, ηp² = .17 and TMT B, p < .05, ηp² = .09. Pairwise comparisons revealed a difference only between the control group and the 6-month TBI group, with the latter performing worse. Main effects were found for bilingualism/monolingualism on TMT A, p < .05, ηp² = .04 and TMT B, p < .05, ηp² = .05; monolingual participants performed better than bilingual participants. No interactions emerged. Conclusion Relative to monolinguals, bilingual participants demonstrated worse attention and executive functioning performances 6 months post-TBI; however, 12 months post-TBI, the difference was negligible.

Download Full-text

A-31 Association Between Cognitive Activity and Recovery Outcomes in College Students Following Concussion

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acaa036.31 ◽

2020 ◽

Vol 35 (5) ◽

pp. 627-627

Author(s):

K M Petit ◽

A J Zynda ◽

M Anderson ◽

C P Tomczyk ◽

T Covassin

Keyword(s):

College Students ◽

Symptom Severity ◽

Recovery Time ◽

Cognitive Activity ◽

Symptom Reporting ◽

Future Research ◽

Symptom Scale ◽

Post Injury ◽

Medical Clearance ◽

The Relationship

Abstract Objective To evaluate the relationship between self-reported cognitive activity and recovery outcomes (symptom reporting, recovery time) in college students following concussion. Method Cognitive activity was defined as self-reported minutes spent in class and studying during the first 5 days following concussion. Self-reported symptoms were reported at day 5 post-injury using the Post-Concussion Symptom Scale (PCSS). The PCSS evaluates 22 symptoms on a 7-point Likert Scale from 0 (none) to 6 (severe). Recovery time was defined as total days from injury to unrestricted medical clearance. Separate Spearman’s rank correlations assessed the relationship between total cognitive activity (minutes in class and studying) and recovery outcomes (symptom total (22), symptom severity (132), and recovery time). Alpha level set a priori at 0.05. Results Twenty-one participants (14 female, 7 male, 19.5 ± 1.3 years) averaged a total of 653[IQR = 348] minutes of cognitive activity during the first 5 days after concussion (334[IQR = 149] minutes in class, 273[IQR = 313] minutes studying). Five days after injury, participants self-reported 3[IQR = 8] total symptoms yielding a severity of 4[IQR = 12]. Participants took 15 [IQR = 8] days to reach unrestricted medical clearance. No associations were found between total cognitive load and any post-concussion recovery outcomes (symptom total: Rs = −.299, p = .19; symptom severity: Rs = −.230, p = .32; recovery time: Rs = −.041, p = .86). Conclusions Preliminary analyses suggest that concussed college students can be encouraged to gradually return to normal levels of cognitive activity, as it may not be associated with future symptom reporting or recovery time. Future research is needed to assess specific cognitive activities immediately influence on post-concussion symptom reporting.

Download Full-text

S47. A MULTICENTER STUDY OF COGNITIVE RESERVE IN FIRST-EPISODE PYCHOSIS

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa031.113 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S50-S50

Author(s):

Silvia Amoretti ◽

Gerard Anmella ◽

Ana Meseguer ◽

Cristina Saiz ◽

Sonia Canals ◽

...

Keyword(s):

Working Memory ◽

Executive Function ◽

Processing Speed ◽

Cognitive Reserve ◽

Leisure Activities ◽

First Episode ◽

Trail Making Test ◽

Neurocognitive Performance ◽

Adult Intelligence Scale ◽

Trail Making

Abstract Background The cognitive reserve (CR) refers to the brain’s capacity to cope with pathology in order to minimize the symptoms. In the field of first episode psychosis (FEP), the CR was able to predict functional and neurocognitive performance. Nevertheless, CR has been estimated using heterogeneous methods, which, in term, difficult to compare studies. Therefore, there is a need to create a specific scale for the assessment of this relevant construct. The Cognitive Reserve Assessment Scale in Health (CRASH) is the first measure developed specifically for patients with severe mental illness with optimal psychometric properties, facilitating reliable and valid measurement of CR. The study of the internal structure of the CRASH determined a four-factor structure (Education, Occupation, Leisure activities and Sociability) that can be analyzed separately to know what kind of relationship they might have with other variables. The aim of this study was to analyze the effects of CR measured with CRASH scale on functioning and neurocognitive performance and to explore the relationship of each factor with the outcome in an adult sample of subjects with FEP. Methods The sample of this study came from a multicentre, naturalistic and longitudinal research project financed by a catalan grant (“Pla Estratègic de Recerca i Innovació en Salut” - PERIS 2016–2018). Expedient Nº: SLT006/17/00345; entitled “Identificación y caracterización del valor predictivo de la reserva cognitiva en el curso evolutivo y respuesta en terapéutica en personas con un primer episodio psicótico”. 23 FEP patients and 72 healthy control (HC) were enrolled. The premorbid IQ was estimated with the Wechsler Adult Intelligence Scale (WAIS-IV) vocabulary subtest. To assess processing speed, Trail Making Test-part A was used. Sustained attention was tested with the Continuous Performance Test–II. The working memory was assessed with the Letters and Numbers Subtest of the WAIS-IV. Finally, the executive functions tested set shifting, planning and cognitive flexibility using the Tower of London task and the Trail Making Test (TMT) part B. Results Significant differences between the total CRASH score of patients and HC groups have been found. The patient group obtained lower scores compared to the HC group (36.66±16.01 vs 49.83±11.08, p<0.001). After performing a logistic regression to assess the predictive power of CRASH for each group, the model correctly classified 83.2% of the cases (B=0.091; p<0.001; Exp(B)=1.095). In FEP patients, the CRASH score was associated with premorbid IQ (p<0.001), processing speed (p=0.005), executive function (TMT-B, p=0.005; London Tower task, p=0.039) and attention (CPT Hit SE ISI change, p=0.004). Specifically, the Education factor was associated with premorbid IQ, processing speed, working memory and executive function. The Occupation was only associated with executive function. Leisure activities factor was correlated with premorbid IQ and functioning. Finally, Sociability was correlated with psychosocial functioning and duration of untreated psychosis. In HC, CRASH was associated with premorbid IQ (p<0.001) and attention (p=0.015). Education and Occupation factors were associated with premorbid IQ and attention; Leisure activities with processing speed; and sociability with attention. Discussion FEP patients were shown to have lower CR than HC, and CRASH correctly classified 83.2% of the sample. Each CRASH factor was associated with different outcome, which is why it can be interesting to analyze the total CRASH score and each factor separately. Patients with higher CR showed a better cognitive performance. Therefore, enhancing each factor involved in cognitive reserve may improve outcomes in FEP.

Download Full-text

Association of Negative Symptoms of Schizophrenia Assessed by the BNSS and SNS Scales With Neuropsychological Performance: A Gender Effect

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.797386 ◽

2021 ◽

Vol 12 ◽

Author(s):

Paweł Wójciak ◽

Klaudia Domowicz ◽

Marta Zabłocka ◽

Michał Michalak ◽

Janusz K. Rybakowski

Keyword(s):

Negative Symptoms ◽

Color Word ◽

Gender Effect ◽

Neuropsychological Performance ◽

Trail Making Test ◽

Female Patients ◽

Interference Test ◽

Trail Making ◽

Male Patients ◽

The Relationship

Objective: The relationship between negative symptoms and neurocognitive performance in schizophrenia is well documented, but the mechanism of these connections remains unclear. The study aims to measure the relationship between the results on the new scales for the assessment of negative symptoms such as Brief Negative Symptom Scale (BNSS) and Self-evaluation of Negative Symptoms (SNS), and the results of some neurocognition tests. The second aim is to assess a possible gender effect on these associations.Methods: The study included 80 patients (40 men, 40 women) with schizophrenia, aged 19–63 (mean 38 years), during the improvement period (total PANSS score <80, unchanged pharmacological treatment in the last 3 weeks). They were assessed using the BNSS, SNS, Personal and Social Performance (PSP) scales, and the tests for neuropsychological performance such as the Trail Making Test (TMT-A, TMT-B), Stroop Color-Word Interference Test, Verbal fluency tests (VFT), Category fluency test (CFT), and Digit Symbol Substitution Test (DSST).Results: Male patients obtained higher scores than females on some PANSS and BNSS items. No gender differences were observed for the SNS scale. Female patients scored better in the PSP and CFT. In male patients, a significant positive correlation between the intensity of negative symptoms measured by the BNSS and the results of PSP with the Trail Making Test was observed. In female patients, we found a positive correlation between the results of BNSS and PSP with the Stroop Color-Word Interference Test.Conclusion: The obtained results confirm the relationship between negative symptoms and neurocognition in schizophrenia patients. However, in male and female patients such association was observed for different cognitive domains. Further research is needed to explain the nature of these differences.

Download Full-text

Age of First Exposure to Contact Sports and Neurocognitive Performance in U.S. Service Academy Athletes

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acz026.23 ◽

2019 ◽

Vol 34 (5) ◽

pp. 753-753

Author(s):

J B Caccese ◽

G L Iverson ◽

K L Cameron ◽

M N Houston ◽

G T McGinty ◽

...

Keyword(s):

Reaction Time ◽

Symptom Severity ◽

Sports Participation ◽

Ice Hockey ◽

Motor Speed ◽

Neurocognitive Performance ◽

Contact Sports ◽

Visual Motor ◽

Service Academy ◽

The Impact

Abstract Purpose To examine the association between estimated age of first exposure (eAFE) to contact sports and neurocognitive performance and symptom ratings in collegiate U.S. Military Service Academy athletes. We hypothesized that contact-sports participation before the age of 12 would not be associated with worse neuropsychological test performance or greater symptom reporting. Methods Male cadets (N=891) who participated in contact sports [i.e., in lacrosse (n=211), wrestling (n=170), ice hockey (n=81), soccer (n=119), rugby (n=10)], or non-contact sports (n=298), completed the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) test before the season. Generalized linear modeling was used to predict each cognitive domain score and the symptom severity score. Predictor variables were entered in the following order: group (contact vs. non-contact), eAFE (eAFE<12 vs. eAFE≥12), group-by-eAFE, and covariates for learning accommodation status, concussion history, and age. Results The group-by-eAFE interaction was not significant for any of the ImPACT composite scores (Verbal Memory, Wald Χ2=.073, p=.788; Visual Memory, Wald Χ2=2.71, p=.100; Visual Motor Speed, Wald Χ2=.078, p=.780; Reaction Time, Wald Χ2=.003, p=.955; Symptom Severity, Wald Χ2=2.87, p=.090). Learning accommodation history was associated with lower scores on Visual Motor Speed (Χ2=6.19, p=.013, B=-2.97). Older age was associated with faster reaction time (Χ2=4.40, p=.036, B=-.006) and lesser symptom severity (Χ2=5.55, p=.019, B=-.068). No other parameters were significant. Conclusion We observed no association between eAFE, contact-sport participation, cognitive functioning, or subjectively-experienced symptoms in this cohort. Earlier eAFE to RHI is not related to worse neurocognitive performance or greater subjectively-experienced symptoms in collegiate student-athletes enrolled in military academies.

Download Full-text

A Multivariable Analysis to Evaluate the Presence or Absence of Gender Differences in Baseline ImPACT Composite Scores and Symptom Severity Ratings in Student-Athletes Ages 12–18 Years

Pediatric Exercise Science ◽

10.1123/pes.2021-0010 ◽

2021 ◽

pp. 1-8

Author(s):

Theodore C. Hannah ◽

Oranicha Jumreornvong ◽

Naoum F. Marayati ◽

Zachary Spiera ◽

Muhammad Ali ◽

...

Keyword(s):

Gender Differences ◽

Confidence Interval ◽

Verbal Memory ◽

Symptom Severity ◽

Multivariable Analysis ◽

Symptom Burden ◽

Neurocognitive Function ◽

Cognitive Tests ◽

Neurocognitive Performance ◽

Composite Scores

Introduction: Gender differences in neurocognitive function have been reported over the past few decades. However, multiple studies that report gender differences in Immediate Post-Concussion Assessment and Cognitive Tests composite scores ignore potential confounders which may lead to inaccurate results. Methods: A total of 4829 male and 2477 female baseline Immediate Post-Concussion Assessment and Cognitive Tests from 2009 to 2019 of subjects ages 12–18 years were used to evaluate gender differences in baseline neurocognitive scores and symptom severity ratings. Regression analyses were used to assess the effects of gender on neurocognitive performance at baseline while controlling for a number of potential confounders including symptom burden at the time of testing. Results: Differences in 3 of 5 composite scores as well as severity rating scores were maintained in multivariate analysis. Females had increased Post-Concussion Symptom Scale (β = 3.54, 95% confidence interval, 2.91 to 4.16, P < .0001) along with higher verbal memory (β = 1.82, 95% confidence interval, 1.15 to 2.50, P < .0001) and visual motor (β = 1.29, 95% confidence interval, 0.85–1.72, P < .0001) scores. Conclusions: Statistically significant gender differences were found in baseline neurocognitive function. This study clarifies for the first time that gender differences in these neurocognitive domains are not simply an artifact of differences in symptom burden. However, the small effect sizes call into question the clinical relevance of these differences.

Download Full-text

A-109 Examining Relationship of Brain Injury, Anxiety and Workload on Trail Making Test Performances

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acab062.127 ◽

2021 ◽

Vol 36 (6) ◽

pp. 1158-1158

Author(s):

Kristina E Smith ◽

Daniel W Lopez-Hernandez ◽

Winter Olmos ◽

Pavel Y Litvin ◽

Bethany A Nordberg ◽

...

Keyword(s):

Brain Injury ◽

Interactive Effects ◽

Trail Making Test ◽

Future Studies ◽

Trail Making ◽

Severe Tbi ◽

Perceived Workload ◽

Relationship Of ◽

The Relationship ◽

Larger Sample

Abstract Objective Both anxiety and traumatic brain injury (TBI) are both related to poorer Trail Making Test (TMT) performances. TBI survivors exhibit a greater incidence of anxiety in contrast to the general population. We evaluated the relationship between TBI and anxiety on TMT and perceived workload ratings. Method The sample consisted of 39 moderate-to-severe TBI [(21 with normal symptoms of anxiety (NSA) and 18 with abnormal symptoms of anxiety (ASA)] and 51 healthy comparison (HC; 26 NSA and 25 ASA) participants. Results ANCOVA’s, controlling for age, revealed the HC group outperformed the TBI group on TMT part A and TMT part B (TMT-B). An interaction emerged on TMT-B, with TBI-ASA participants outperformed TBI-NSA participants and HC-NSA participants outperformed their counterparts with ASA. Ratings of physical demand and frustration were reported higher in TBI participants compared to the HC participants. Moreover, TBI and anxiety symptoms had interactive effects on NASA-TLX temporal demand and frustration ratings, were TBI-ASA participants reported higher scores in contrast to TBI-NSA. Lastly, an interaction emerged with HC participants with ASA reporting better performances in contrast to HC-NSA. Conclusions As expected, TBI participants did worse on both TMT tasks. Next, we found that TBI-ASA participants impacted their TMT-B performance and their perceived workload (i.e., frustration, temporal demand) more than TBI-NSA participants. In the future, studies with a larger sample size should examine if anxiety influences TMT performance and perceived workload in person with mild TBI.

Download Full-text