SPORT	TYPE AND BASELINE NEUROCOGNITIVE SCORES AMONG HEALTHY HIGH SCHOOL ATHLETES

Background: Athletes who participate in collision sports may experience more repetitive head impacts than other sport types. These repetitive head impacts have been theorized as a potential catalyst for cognitive problems later in life. It is unknown, however, if sport type influences neurocognitive performance. Hypothesis/Purpose: Our purpose was to investigate the association between sport type and baseline neurocognitive scores in a high school athletic population. We hypothesized that athletes participating in collision sports would demonstrate worse scores on baseline neurocognitive tests compared to those in contact or non-contact sports. Methods: We conducted a cross-sectional, observational study using baseline computerized neurocognitive scores of 186,117 high school student-athletes (age: 15.47±2.28 years, height: 168.53±10.77 cm, weight: 63.02±14.83 kg, 45% female) in the state of Massachusetts. The dependent variables were five composite scores (verbal memory, visual memory, visual motor, reaction time, and impulse control) and total symptom score. The independent variables included sport type (collision, contact, non-contact), age, sex, and concussion history. We used univariable one-way ANOVAS to compare composite scores between sport type. We conducted a series of multivariable regression models, controlling for age, sex, and number of previous concussions, to examine the independent association between sport type and composite scores. Results: There was a minimal but statistically significant association between sport type and composite scores, with collision sport athletes performing slightly worse than other athletes on most composite scores. Collision sport athletes had a slightly lower symptom burden. (Tables 1 and 2) Conclusion: While statistically significant, the differences in neurocognitive function and symptom burden between sport type are of questionable clinical significance. In fact, all of them fall within the reliable change index values of each respective score. As participants were in high school at the time of the study, we cannot determine the potential for associations later in life. Tables/Figures: [Table: see text][Table: see text]

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One-Year Test-Retest Reliability of the Online Version of ImPACT in High School Athletes

The American Journal of Sports Medicine ◽

10.1177/0363546511417173 ◽

2011 ◽

Vol 39 (11) ◽

pp. 2319-2324 ◽

Cited By ~ 118

Author(s):

R.J. Elbin ◽

Philip Schatz ◽

Tracey Covassin

Keyword(s):

High School ◽

Verbal Memory ◽

Visual Memory ◽

Online Version ◽

Neurocognitive Performance ◽

High School Athletes ◽

Stable Measure ◽

Motor Processing ◽

Test Retest Reliability ◽

The Impact

Background: The ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) neurocognitive testing battery is a popular assessment tool used for concussion management. The stability of the baseline neurocognitive assessment is important for accurate comparisons between postconcussion and baseline neurocognitive performance. Psychometric properties of the recently released online version of ImPACT have yet to be established; therefore, research evaluating the reliability of this measure is warranted. Purpose: The authors investigated the 1-year test-retest reliability of the ImPACT online version in a sample of high school athletes. Study Design: Case series; Level of evidence, 4 Methods: A total of 369 varsity high school athletes completed 2 mandatory preseason baseline cognitive assessments approximately 1 year apart as required by their respective athletics program. No diagnosed concussion occurred between assessments. Results: Intraclass correlation coefficients (ICCs) for ImPACT online indicated that motor processing speed (.85) was the most stable composite score, followed by reaction time (.76), visual memory (.70), and verbal memory (.62). Unbiased estimates of reliability were consistent with ICCs: motor processing speed (.85), reaction time (.76), visual memory (.71), and verbal memory (.62). Conclusion: The online ImPACT baseline is a stable measure of neurocognitive performance across a 1-year time period for high school athletes. These reliability data for online ImPACT are higher than the 2-year ICCs previously reported from the desktop version. Clinical Relevance: It is recommended that the ImPACT baseline assessment (both desktop and online) continue to be updated every 2 years. The online version of ImPACT appears to be a stable measure of neurocognitive performance over a 1-year period, and systematic evaluation of its stability over a 2-year period is warranted.

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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.

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High Baseline Postconcussion Symptom Scores and Concussion Outcomes in Athletes

Journal of Athletic Training ◽

10.4085/1062-6050-51.2.12 ◽

2016 ◽

Vol 51 (2) ◽

pp. 136-141 ◽

Cited By ~ 17

Author(s):

Aimee Custer ◽

Alicia Sufrinko ◽

R. J. Elbin ◽

Tracey Covassin ◽

Micky Collins ◽

...

Keyword(s):

High School ◽

Verbal Memory ◽

Repeated Measures ◽

Visual Memory ◽

Collegiate Athletes ◽

Cognitive Test ◽

Symptom Scale ◽

Symptom Scores ◽

High Level ◽

Composite Scores

Some healthy athletes report high levels of baseline concussion symptoms, which may be attributable to several factors (eg, illness, personality, somaticizing). However, the role of baseline symptoms in outcomes after sport-related concussion (SRC) has not been empirically examined.Context: To determine if athletes with high symptom scores at baseline performed worse than athletes without baseline symptoms on neurocognitive testing after SRC.Objective: Cohort study.Design: High school and collegiate athletic programs.Setting: A total of 670 high school and collegiate athletes participated in the study. Participants were divided into groups with either no baseline symptoms (Postconcussion Symptom Scale [PCSS] score = 0, n = 247) or a high level of baseline symptoms (PCSS score > 18 [top 10% of sample], n = 68).Patients or Other Participants: Participants were evaluated at baseline and 2 to 7 days after SRC with the Immediate Post-concussion Assessment and Cognitive Test and PCSS. Outcome measures were Immediate Post-concussion Assessment and Cognitive Test composite scores (verbal memory, visual memory, visual motor processing speed, and reaction time) and total symptom score on the PCSS. The groups were compared using repeated-measures analyses of variance with Bonferroni correction to assess interactions between group and time for symptoms and neurocognitive impairment.Main Outcome Measure(s): The no-symptoms group represented 38% of the original sample, whereas the high-symptoms group represented 11% of the sample. The high-symptoms group experienced a larger decline from preinjury to postinjury than the no-symptoms group in verbal (P = .03) and visual memory (P = .05). However, total concussion-symptom scores increased from preinjury to postinjury for the no-symptoms group (P = .001) but remained stable for the high-symptoms group.Results: Reported baseline symptoms may help identify athletes at risk for worse outcomes after SRC. Clinicians should examine baseline symptom levels to better identify patients for earlier referral and treatment for their injury. Additional investigation of baseline symptoms is warranted to help delineate the type and severity of premorbid symptoms.Conclusions:

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Baseline Neurocognitive Performance and Clearance for Athletes to Return to Contact

Journal of Athletic Training ◽

10.4085/1062-6050-51.12.27 ◽

2017 ◽

Vol 52 (1) ◽

pp. 51-57 ◽

Cited By ~ 2

Author(s):

Breton M. Asken ◽

James R. Clugston ◽

Aliyah R. Snyder ◽

Russell M. Bauer

Keyword(s):

Cognitive Decline ◽

Verbal Memory ◽

Visual Memory ◽

Sport Participation ◽

Collegiate Athletes ◽

Composite Score ◽

Cognitive Test ◽

Motor Speed ◽

Neurocognitive Performance ◽

Composite Scores

Context: Computerized neurocognitive assessments are commonly used to manage sport-related concussion. Variations in baseline performance may influence neurocognitive performance after injury as well as the amount of time needed for an athlete to be cleared for return to sport participation.Objective: To investigate the relationship between mean baseline Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) scores and postconcussion reliable decline as well as the association between postconcussion cognitive decline and days missed after injury.Design: Cross-sectional study.Setting: University concussion databank.Patients or Other Participants: A total of 84 collegiate athletes who sustained a concussion between 2008 and 2015 were studied. For each ImPACT composite score (verbal memory, visual memory, visual motor speed, reaction time), athletes were grouped based on the presence or absence of reliable decline and on the presence of reliable decline in 0, 1, 2, 3, or 4 cognitive domains.Main Outcome Measure(s): Outcome measures were baseline ImPACT composite scores and days missed due to concussion.Results: Athletes with a reliable decline in visual memory scored higher on baseline visual memory than did athletes with no decline or an improvement (t82 = −2.348, P = .021, d = 0.65). When comparing athletes who displayed a reliable decline with those who showed no change or an improvement in any composite score, days missed did not differ. The number of composite scores with a reliable decline demonstrated no main effect on days missed (P = .530).Conclusions: Athletes who exhibited cognitive decline in most or all of the composite scores did not miss more days after injury than athletes with a decline in fewer or none of the composite scores. Athletes should be educated regarding the lack of association between baseline neurocognitive scores and the presence or absence of a reliable decline after concussion, as well as the fact that, on average, individuals with a reliable decline across multiple domains did not miss more time after concussion.

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Concussion History and Cognitive Function in a Large Cohort of Adolescent Athletes

The American Journal of Sports Medicine ◽

10.1177/0363546518798801 ◽

2018 ◽

Vol 46 (13) ◽

pp. 3262-3270 ◽

Cited By ~ 4

Author(s):

Kathryn M. Taylor ◽

Marianthi-Anna Kioumourtzoglou ◽

Jim Clover ◽

Brent A. Coull ◽

Jack T. Dennerlein ◽

...

Keyword(s):

High School ◽

Cognitive Function ◽

Verbal Memory ◽

Impulse Control ◽

Visual Memory ◽

Test Battery ◽

Cognitive Test ◽

Effect Estimate ◽

Cognitive Score ◽

And Performance

Background: The incidence of reported concussions in the adolescent population is increasing, yet research on the effects of concussions in this population is minimal and inconclusive. Purpose: To assess the association between concussion and performance on a cognitive test battery. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Using multivariate models, the authors assessed the association between concussion and performance on a cognitive test battery among 5616 high school and junior high school athletes. The researchers utilized a global cognitive score and scores for 5 domains: verbal memory, visual memory, visual motor, reaction time, and impulse control. Each cognitive score was converted to a z score with the mean and SD of the nonconcussed population. Results from each model were then interpreted as change in the standardized unit score. In the models, concussion was evaluated as ever having a concussion, number of concussions, time since last concussion, and age at first concussion. Results: Ever having a concussion was associated with a mean decrease of 0.11 standardized units (95% CI, −0.20 to −0.01) on the global cognitive score and lower scores in all cognitive domains. Each additional concussion was associated with lower scores on global cognitive function (effect estimate, −0.06; 95% CI, −0.11 to −0.02), verbal memory, visual memory, and impulse control. Concussion in early childhood was associated with lower global cognition (effect estimate, −0.05; 95% CI, −0.08 to −0.01), visual memory, and motor visual scores as compared with concussions in later childhood. The associations between time since last concussion and cognitive test scores were nonlinear, and on all tests, lower scores were observed even ≥1 year after the concussion. Conclusion: On the basis of objective performance metrics for cognitive function, concussions had a more persistent effect on cognitive function than previously thought. The age at which an individual has his or her first concussion may be an important factor in determining long-lasting cognitive effects.

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Addressing the ``Replication Crisis'' in Sports Neuropsychology: Validation of the Two-Factor Theory of ImPACT

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acz026.28 ◽

2019 ◽

Vol 34 (5) ◽

pp. 758-758 ◽

Cited By ~ 1

Author(s):

P Schatz ◽

K Bogar ◽

R J Elbin

Keyword(s):

High School ◽

Reaction Time ◽

Factor Structure ◽

Verbal Memory ◽

Visual Memory ◽

Impact Testing ◽

Memory Factor ◽

Speed Factor ◽

Replication Crisis ◽

Visual Motor

Abstract Purpose The "replication crisis" in psychology and across the broader field of social sciences raises criticism due to a lack of data to show that esoteric research findings can be replicated. The present study replicated and validated the two-factor “memory” and “speed” structure of ImPACT (Schatz & Maerlender, 2013). Methods High school aged athletes (N=18,918, Mean age=15.4, SD=1.2) who completed pre-season baseline ImPACT testing were randomly assigned to one of 5 independent samples of approximately 3,780 athletes. Exploratory factor analyses (FA) for a two-factor solution were conducted with ImPACT composite scores within each of the five groups. Post-Concussion Symptom Scale (PCSS) scores were included, with the expectation they would load on a third, unique factor. Results All five samples met assumptions for FA (KMO Measure of Sampling Adequacy above .600), and all five analyses yielded the same “memory” and “speed” two-factor structure. Visual Motor Speed and Reaction Time loaded on the first "Speed" factor and Verbal and Visual Memory loaded on a second "Memory" factor. The PCSS scores loaded on a third, unique “symptom” factor. Conclusion Replication of the two-factor structure for ImPACT in a five large high school sample further validates the model. Given that both visual and verbal memory involve encoding of information presented visually, use of a “memory” factor may improve interpretation of ImPACT scores. Similarly, similarities between constructs measuring speed of responding (Reaction Time) and speed of processing (Visual Motor Processing Speed) may be best explained using a “speed” factor.

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Late contributions of repetitive head impacts and TBI to depression symptoms and cognition

Neurology ◽

10.1212/wnl.0000000000010040 ◽

2020 ◽

Vol 95 (7) ◽

pp. e793-e804 ◽

Cited By ~ 1

Author(s):

Michael L. Alosco ◽

Yorghos Tripodis ◽

Zachary H. Baucom ◽

Jesse Mez ◽

Thor D. Stein ◽

...

Keyword(s):

Geriatric Depression Scale ◽

Depression Scale ◽

Later Life ◽

Depression Symptoms ◽

Neurocognitive Performance ◽

Contact Sport ◽

Cross Sectional ◽

Head Impacts ◽

Repetitive Head Impacts ◽

History Of

ObjectiveTo test the hypothesis that repetitive head impacts (RHIs), like those from contact sport play and traumatic brain injury (TBI) have long-term neuropsychiatric and cognitive consequences, we compared middle-age and older adult participants who reported a history of RHI and/or TBI with those without this history on measures of depression and cognition.MethodsThis cross-sectional study included 13,323 individuals (mean age, 61.95; 72.5% female) from the Brain Health Registry who completed online assessments, including the Ohio State University TBI Identification Method, the Geriatric Depression Scale (GDS-15), and the CogState Brief Battery and Lumos Labs NeuroCognitive Performance Tests. Inverse propensity-weighted linear regressions accounting for age, sex, race/ethnicity, and education tested the effects of RHI and TBI compared to a non-RHI/TBI group.ResultsA total of 725 participants reported RHI exposure (mostly contact sport play and abuse) and 7,277 reported TBI (n = 2,604 with loss of consciousness [LOC]). RHI (β, 1.24; 95% CI, 0.36–2.12), TBI without LOC (β, 0.43; 95% CI, 0.31–0.54), and TBI with LOC (β, 0.75; 95% CI, 0.59–0.91) corresponded to higher GDS-15 scores. While TBI with LOC had the most neuropsychological associations, TBI without LOC had a negative effect on CogState Identification (β, 0.004; 95% CI, 0.001–0.01) and CogState One Back Test (β, 0.004; 95% CI, 0.0002–0.01). RHI predicted worse CogState One Back Test scores (β, 0.02; 95% CI, −0.01 to 0.05). There were RHI × TBI interaction effects on several neuropsychological subtests, and participants who had a history of both RHI and TBI with LOC had the greatest depression symptoms and worse cognition.ConclusionsRHI and TBI independently contributed to worse mid- to later-life neuropsychiatric and cognitive functioning.

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THE RELATIONSHIP BETWEEN ACUTE MOOD, SLEEP, AND SEX ON NEUROCOGNITIVE PERFORMANCE POST-CONCUSSION IN ADOLESCENTS

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00191 ◽

2020 ◽

Vol 8 (4_suppl3) ◽

pp. 2325967120S0019

Author(s):

Sara Stremlau ◽

Richard Cameron Allred ◽

Richard Gerkin ◽

Steven Erickson ◽

Jamie Pardini

Keyword(s):

Reaction Time ◽

Verbal Memory ◽

Visual Memory ◽

Cognitive Testing ◽

Motor Speed ◽

Neurocognitive Performance ◽

Symptom Report ◽

Mood Symptoms ◽

Visual Motor ◽

And Performance

Background: Both sleep disturbance and mood changes are common symptoms post-concussion (Sell & Rubeor, 2017). Studies have found these symptoms are correlated with poorer performance on neurocognitive testing (Kontos et al., 2012 and Kostyun et al., 2015). In addition, Brown et al., (2015) showed that females report more symptoms at both baseline and post-concussion compared to males on the Post-Concussion Scale and the Sport Concussion Assessment Tool 2. Hypothesis/Purpose: The purpose of this study is to investigate how a patient’s sex, as well as self-reported acute mood and sleep symptoms are related to neurocognitive performance in individuals with concussion. Methods: Data were acquired through IRB-approved retrospective chart review. Composite scores from the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) computerized evaluation and self-reported symptom scores on the Post-Concussion Symptom Scale were gathered for 1619 adolescents age 12-18 (49.3% female) who presented to a large metropolitan outpatient clinic for treatment of concussion. Results: Females endorsed higher overall symptoms (x=19.52, SD 19.37, median 13.0 for females; x=12.88, SD 15.89, median 7.0 for males; Mann-Whitney U Test p<0.001). This same pattern emerged for the mood and sleep symptom clusters (female mood mean=2.92, SD 4.51; male mood mean=1.64, SD 3.34; female sleep mean=1.59, SD 2.0; male sleep mean=1.11, SD 1.84; both Independent Samples Mann-Whitney U Tests ps<0.001). There were significant but modest negative correlations between mood symptoms and performance on verbal memory (r=-0.174), visual memory (r=-0.213), and visual motor speed (r=-0.146) composites (all ps<0.01). There was positive correlation between reaction time composite and mood symptoms (r=0.191). There were significant but modest negative correlations between sleep symptoms and performance on verbal memory (r=-0.171), visual memory (r=-0.184), and visual motor speed (r=-0.161) composites (all ps<0.01). There was a positive correlation between reaction time composite and sleep symptoms (r=0.196, p<0.01). Conclusion: Consistent with prior research, adolescent females reported more symptoms post-concussion, including total symptom score, mood symptoms, and sleep symptoms. Adolescents presenting with more mood and sleep symptoms demonstrated poorer performance on neurocognitive testing. However, given the modest nature of the correlation, a significant amount of variation in test performance is not explained by symptom report. Results from this study underscore the importance of a multidimensional concussion assessment that includes both symptom report and cognitive testing when working with pediatric athletes. This study also reinforces the importance of understanding potential effects of sleep, mood, and sex on concussion.

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The stability of ImPACT baseline test performance over a 3-year period in high school athletes

Neurology ◽

10.1212/01.wnl.0000550636.18771.12 ◽

2018 ◽

Vol 91 (23 Supplement 1) ◽

pp. S7.2-S7

Author(s):

Nicholas Erdman ◽

Samuel Walton ◽

Jeremy Eith ◽

Lizzie Leitch ◽

Joanna Shutzer ◽

...

Keyword(s):

High School ◽

Verbal Memory ◽

Repeated Measures ◽

Visual Memory ◽

Intraclass Correlation ◽

Baseline Assessment ◽

Motor Speed ◽

Group Setting ◽

The Stability ◽

Subject Differences

PurposeAnnual baseline assessment using computerized neurocognitive tests have been recommended by governing healthcare bodies for the management of sport-related concussion but is supported by limited evidence. The current study examined the stability of ImPACT performance across three-successive years in adolescent athletes.MethodThis prospective cohort included 229 (117 male, 112 female) high school student-athletes from 2 private high schools. ImPACT was administered in a controlled group setting (1–17 participants) at years 1 (T1; n = 229), 2 (T2; n = 101) and 3 (T3; n = 47). Repeated measures analyses of variance (ANOVA 4 × 3) were used to examine performance on ImPACT's Verbal Memory (VEM), Visual Memory (VIS), Visual Motor Speed (VMS), and Reaction Time (RT) composite scores. Paired t-tests were used for post-hoc analyses. Two-way mixed intraclass correlation coefficients (ICC [3,1]) with 95% confidence intervals (CI) were calculated between time points. Group mean and within-subject differences between each time point for ImPACT scores were analyzed using manufacturer provided reliable change indices (RCI). All analyses were performed with alpha = 0.05.ResultsA significant main effect was observed for VMS (F [2,92] = 27.90, p = 0.001) across time. Participants significantly improved on VMS between T2 and T1 (t [100] = 4.15, p = 0.001), T3 and T2 (t [46] = 7.19, p = 0.001), and T3 and T1 (t [46] = 3.85, p < 0 .001). Weak (VEM: ICC = 0.37, CI = 0.19, 0.55) to strong (VMS: ICC = 0.83, CI = 0.74, 0.90) ICCs were observed for ImPACT scores. No group mean differences exceeded the 80% CI for ImPACT's RCI, although within-subject differences for at least 1 score exceeded the 80% CI between T2 and T1 (24%–39%), T3 and T2 (26%–45%), and T3 and T1 (32%–51%).ConclusionsOverall, statistically significant improvement was observed for VMS, however, the magnitude of the change may not be clinically meaningful. Similar to previous research, reliability of ImPACT scores ranged from weak to strong. Our results support annual baseline assessment of young athletes for progression of neurocognitive functioning.

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Reduced cognitive resiliency ofattention-deficit/hyperactivity disorder against subconcussive head impacts

Neurology ◽

10.1212/01.wnl.0000581116.83066.44 ◽

2019 ◽

Vol 93 (14 Supplement 1) ◽

pp. S29.1-S29

Author(s):

Madeleine Nowak ◽

Patrick Quinn ◽

Keisuke Ejima ◽

Timothy Mickelborough ◽

Sharlene Newman ◽

...

Keyword(s):

Verbal Memory ◽

Visual Memory ◽

Neurocognitive Function ◽

Significant Decline ◽

Cognitive Testing ◽

Soccer Players ◽

Post Intervention ◽

Significant Group ◽

Head Impacts ◽

Hyperactivity Disorder

ObjectiveThe purpose of this study was to determine the subconcussive head impacts (SHI) effects on neurocognitive function in individuals diagnosed with attention-deficit/hyperactivity disorder (ADHD).BackgroundAthletes diagnosed with ADHD have a heightened risk (2 to 4-fold) for sustaining concussion. However, their response to repetitive SHI remain unclear.Design/MethodsIn this case-control intervention study, 17 soccer players clinically diagnosed with ADHD who take their prescribed medication daily, were assigned a heading intervention (ADHD-Heading group),individuals who met the ADHD criteria but were non-soccer players, were assigned into a kicking group, (ADHD-Kicking group, n = 15). Whereas 34 soccer players without ADHD diagnosis were randomized into either a heading or kicking intervention, yielding Non-ADHD-Heading group (n = 17) or Non-ADHD-Kicking group (n = 17). To implement SHI, the heading groups executed 10 headers with a standard soccer ball projected at a velocity of 25 mph (equivalent to a long throw-in) over 10 minutes by a JUGS soccer machine, while the kicking groups performed 10 kicks. Neurocognitive function was measured via the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) at pre-intervention baseline, 0h, 2h, and 24h post-intervention.ResultsThe vulnerability to SHI was notable in subjects diagnosed with ADHD particularly in memory, as illustrated by a significant group × time interaction, F(6,96) = 3.796, p = 0.002. Both Kicking groups improved verbal memory over time indicating the brain’s ability to learn, whereas the Non-ADHD-Heading group showed no improvement. The ADHD-Heading group showed a significant decline at 0h and 2h post-heading compared to other groups. As for visual memory, the ADHD-Heading group showed a significant decline at 24h post; however, all other groups displayed improvement. There were no group differences in remaining domains.ConclusionsData suggests neurocognitive vulnerability in athletes diagnosed with ADHD after experiencing SHI, specifically in memory performance. These outcomes can better inform clinicians; overall, promoting a better personalized care in athletes diagnosed with ADHD.

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