scholarly journals The Influence of Hormonal Contraceptives on Cognitive Recovery in Concussed Collegiate Athletes: Data from the NCAA-DoD CARE Consortium

Neurology ◽  
2019 ◽  
Vol 93 (14 Supplement 1) ◽  
pp. S14.3-S15
Author(s):  
Jacob Kay ◽  
Andrew Lapointe ◽  
Thomas McAllister ◽  
Michael McCrea ◽  
Steven Broglio ◽  
...  
Keyword(s):  
Verbal Memory ◽  
Female Athletes ◽  
Clinical Symptoms ◽  
Collegiate Athletes ◽  
Neurological Status ◽  
Return To Play ◽  
Hormonal Contraceptives ◽  
Cognitive Efficiency ◽  
Concussion Recovery ◽  
The Impact

ObjectiveTo longitudinally examine the relation between hormonal contraceptives and concussion recovery. We hypothesized that female athletes using hormonal contraceptives would exhibit faster recovery times and smaller post-injury alterations in neurological status, cognition, and clinical symptoms than female athletes not using hormonal contraceptives.BackgroundResearch indicates sex may moderate concussion outcomes, with some females experiencing protracted recovery relative to males. It is hypothesized that fluctuations of sex hormones lead to poorer outcomes in these females. Thus, female athletes taking hormonal contraceptives may exhibit better recovery than their un-medicated counterparts, as their hormone levels are artificially stabilized.Design/MethodsData from the NCAA-DOD Grand Alliance: Concussion Assessment, Research, and Education (CARE) Consortium were used to evaluate female athletes who were (n = 50) and were not (n = 50) taking hormonal contraceptives. Baseline assessments were completed prior to athletes’ sport season. Athletes were re-assessed 24–48 hours post-concussion, and again at the unrestricted return-to-play. Length of recovery was defined as days between injury and the unrestricted return-to-play. Neurological status was measured using the Standardized Assessment of Concussion (SAC). Cognitive function and clinical symptoms were measured using the ImPACT test. Participants were matched on age, sex, body mass index, sport, and concussion history.ResultsNo group differences in length of recovery were observed (p > 0.05). Across all timepoints, analyses revealed main effects of group for concentration (SAC; p = 0.04), verbal memory (ImPACT; p = 0.03), and cognitive efficiency (ImPACT; p = 0.01). No differences in change scores (relative to baseline) were observed between groups.ConclusionsThe current results suggest that hormonal contraceptives do not influence concussion recovery. However, irrespective of injury status, our findings indicate that females on hormonal contraceptives may exhibit better concentration, working memory, and cognitive efficiency.

scholarly journals The Influence of Psycho-Stimulant Medication on Concussion Recovery in Athletes with ADHD: Findings from the NCAA-DOD Concussion Consortium

Neurology ◽  
2019 ◽  
Vol 93 (14 Supplement 1) ◽  
pp. S22.2-S23
Author(s):  
Brett Gunn ◽  
Michael McCrea ◽  
Steven Broglio ◽  
R. Davis Moore
Keyword(s):  
Repeated Measures ◽  
Stimulant Medication ◽  
Collegiate Athletes ◽  
Return To Play ◽  
Adhd Group ◽  
Post Injury ◽  
Stimulant Medications ◽  
Multiple Variables ◽  
Concussion Recovery ◽  
The Impact

ObjectiveWe sought to longitudinally evaluate concussion recovery in collegiate athletes with ADHD who were and were not taking psycho-stimulant medication.BackgroundPsycho-stimulant medication is commonly prescribed to individuals with ADHD. Some have posited that psycho-stimulant medications may mitigate impairments following sport-related concussion. However, no studies longitudinally evaluated the influence of psycho-stimulant medications on concussion recovery in collegiate athletes.Design/MethodsData from the NCAA-DOD Grand Alliance: Concussion Assessment, Research, and Education (CARE) Consortium were used to evaluate athletes with ADHD who were not taking psycho-stimulant medications (Rx-ADHD; n = 20), athletes with ADHD who were taking psycho-stimulant medications (Rx+ADHD; n = 20), and controls (n = 80). Athletes with ADHD were double-matched to controls on biological sex, age, and body mass index. All athletes were assessed prior to their sporting season, 24-48 hours post-injury, and again upon unrestricted return-to-play (RTP). Cognition and clinical symptoms were evaluated using the ImPACT test.ResultsAthletes in the Rx-ADHD (10.4 ± 1.5 days) and Rx + ADHD (11.9 ± 1.7) groups exhibited prolonged symptom durations compared to controls (4.2 ± .8; p’s ≤ 0.05). Repeated-measures analyses of covariance (baseline scores = covariate) group × time interactions for multiple variables (p’s ≤ 0.05). Univariate analyses revealed that both groups with ADHD demonstrated poorer verbal memory, and greater total symptoms at 24–48 hours post-injury than controls (p’s ≤ 0.01). Additionally, athletes in the Rx-ADHD group demonstrated poorer cognitive efficiency at 24–48 hours post-injury, and at RTP than controls (p’s ≤ 0.05). Lastly, athletes in the Rx+ADHD group demonstrated slower visual motor speed at 24–48 hours post-injury, and at RTP than controls (p’s ≤ 0.05).ConclusionsT Our findings suggest that following concussion athletes with ADHD may experience longer recovery than controls, regardless of medicated status. Interestingly, athletes with ADHD who were taking medication did not appear to have different recovery time relative to un-medicated athletes with ADHD.

Sex differences in outcome following sports-related concussion

2005 ◽  
Vol 102 (5) ◽  
pp. 856-863 ◽  
Author(s):  
Donna K. Broshek ◽  
Tanya Kaushik ◽  
Jason R. Freeman ◽  
David Erlanger ◽  
Frank Webbe ◽  
...  
Keyword(s):  
Sex Differences ◽  
Subjective Experience ◽  
Female Athletes ◽  
Collegiate Athletes ◽  
Cognitive Change ◽  
Return To Play ◽  
Cognitive Test ◽  
Content Type ◽  
Baseline Levels ◽  
Fine Print

Object. Females comprise an increasing percentage of the athlete population across all age groups, and analysis of recent literature reveals that they sustain more concussions in collegiate sports. Results of human and animal studies indicate that females may have poorer outcomes after traumatic brain injury; however, no return-to-play guideline takes sex or other individual differences into account. In the present study the authors evaluated the influence of patient sex on objective neurocognitive performance and subjective reporting of symptoms following sports-related concussion. Methods. According to preseason baseline neurocognitive computerized testing in 2340 male and female high school and collegiate athletes, individuals who sustained sports-related concussions (155 persons) were reevaluated using an alternate form of the cognitive test. Sex differences in the magnitude of cognitive change from baseline levels and the subjective experience of symptoms were analyzed. To account for the possible protective effects of helmets, comparisons were performed among females, males with helmets, and males without helmets; none of the female athletes wore helmets. Female athletes had significantly greater declines in simple and complex reaction times relative to preseason baseline levels, and they reported more postconcussion symptoms compared with males. As a group, females were cognitively impaired approximately 1.7 times more frequently than males following concussions. Furthermore, females experienced more objective and subjective adverse effects from concussion even after adjusting for the use of helmets by some groups of male athletes (for example, in football). Conclusions. Return-to-play decisions and concussion management must be objective and made on an individual basis, including consideration of factors such as patient sex rather than relying on a one-size-fits-all guideline.

scholarly journals Reconsidering Return-to-Play Times: A Broader Perspective on Concussion Recovery

2018 ◽  
Vol 6 (3) ◽  
pp. 232596711876085 ◽  
Author(s):  
Christopher D’Lauro ◽  
Brian R. Johnson ◽  
Gerald McGinty ◽  
C. Dain Allred ◽  
Darren E. Campbell ◽  
...  
Keyword(s):  
Recovery Time ◽  
Time Window ◽  
Collegiate Athletes ◽  
Return To Play ◽  
Sample Population ◽  
Intercollegiate Athletes ◽  
Level Of Evidence ◽  
Athletic Status ◽  
Recovery Times ◽  
Concussion Recovery

Background: Return-to-play protocols describe stepwise, graduated recoveries for safe return from concussion; however, studies that comprehensively track return-to-play time are expensive to administer and heavily sampled from elite male contact-sport athletes. Purpose: To retrospectively assess probable recovery time for collegiate patients to return to play after concussion, especially for understudied populations, such as women and nonelite athletes. Study Design: Cohort study; Level of evidence, 3. Methods: Medical staff at a military academy logged a total of 512 concussion medical records over 38 months. Of these, 414 records included complete return-to-play protocols with return-to-play time, sex, athletic status, cause, and other data. Results: Overall mean return to play was 29.4 days. Sex and athletic status both affected return-to-play time. Men showed significantly shorter return to play than women, taking 24.7 days (SEM, 1.5 days) versus 35.5 days (SEM, 2.7 days) ( P < .001). Intercollegiate athletes also reported quicker return-to-play times than nonintercollegiate athletes: 25.4 days (SEM, 2.6 days) versus 34.7 days (SEM, 1.6 days) ( P = .002). These variables did not significantly interact. Conclusion: Mean recovery time across all groups (29.4 days) showed considerably longer return to play than the most commonly cited concussion recovery time window (7-10 days) for collegiate athletes. Understudied groups, such as women and nonelite athletes, demonstrated notably longer recovery times. The diversity of this sample population was associated with longer return-to-play times; it is unclear how other population-specific factors may have contributed. These inclusive return-to-play windows may indicate longer recovery times outside the population of elite athletes.

The Effects of Concussion on Quantity and Quality of Sleep in Football Athletes

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S22.1-S22
Author(s):  
Taren Bone ◽  
Suzanne M. Konz ◽  
William Garrett ◽  
Charles Andrew Gilliland
Keyword(s):  
Sleep Disturbances ◽  
Collegiate Athletes ◽  
Return To Play ◽  
Quality Of Sleep ◽  
Time In Bed ◽  
Study Results ◽  
Sleep Parameters ◽  
Concussion Recovery ◽  
Initial Measurement

ObjectiveThe objective was to observe the quantity and quality of sleep of collegiate athletes following a concussion.BackgroundPatients diagnosed with a concussion report a disruption or change in their sleep with 46% of patients still having sleep disturbances 3 months after the event. Research is lacking on the sleep disruption or sleep changes in athletes who have experienced a concussion.Design/MethodsThis IRB-approved convenient cohort study involved athletes from 2 local universities. 27 (20 non-concussed and 7 concussed) male collegiate football players (19.93 ± 1.14 years old, 1.82 ± 0.08 m, and 96.42 ± 21.26 kg) wore a Readiband device for 7–10 days or throughout concussion recovery. Concussed participants completed a symptom score sheet each day. Participants returned the Readiband device and completed the Pittsburgh Sleep Quality Index Questionnaire (PSQIQ) after 7–10 days or on return to play. The sleep parameters, and PSQIQ scores were analyzed using non-parametric & independent t-tests with the alpha level set at 0.05.ResultsThe t-tests indicated a difference between the total minutes in bed at the initial measurement (F = 11.839, df = 1, p = 0.037) between the concussed (353.29 ± 110.48 minutes) and non-concussed (471.5 ± 125.09 minutes) groups. There was also a difference between the total minutes asleep at the initial measurement (F = 12.662, df = 1, p = 0.032) between the concussed (286.43 ± 86.73) and non-concussed groups (383.7 ± 104.86). The last measurement that indicated a difference was the calculated minutes in bed at the initial measurement (F = 11.916, df = 1, p = 0.023) between the concussed (326.4 3 ± 97.01) and non-concussed groups (441.60 ± 110.55).ConclusionsThe study results indicate that concussion affects the quantity of sleep, with concussed athletes spending less time in bed and fewer minutes asleep. Changes in sleep occur post-concussion, which may delay concussion recovery.

Differences in sport-related concussion for female and male athletes in comparable collegiate sports: a study from the NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium

2020 ◽  
pp. bjsports-2020-103316
Author(s):  
Christina L Master ◽  
Barry P Katz ◽  
Kristy B Arbogast ◽  
Michael A McCrea ◽  
Thomas W McAllister ◽  
...  
Keyword(s):  
Sex Differences ◽  
Collegiate Athletes ◽  
Return To Play ◽  
Extrinsic Factors ◽  
Contact Sports ◽  
Recovery Times ◽  
Division Ii ◽  
Concussion Recovery ◽  
Research And Education ◽  
Assessment Research

ObjectivesTo examine sex differences in sport-related concussion (SRC) across comparable sports.MethodsProspective cohort of collegiate athletes enrolled between 2014 and 2017 in the Concussion Assessment, Research and Education Consortium study.ResultsAmong 1071 concussions (females=615; 57.4%), there was no difference in recovery (median days to full return to play) (females=13.5 (IQR 9.0, 23.1) vs males=11.8 (IQR 8.1, 19.0), p=0.96). In subgroup analyses, female recovery was longer in contact (females=12.7 days (IQR 8.8, 21.4) vs males=11.0 days (IQR 7.9, 16.2), p=0.0021), while male recovery was longer in limited contact sports (males=16.9 days (IQR 9.7, 101.7) vs females=13.8 days (IQR 9.1, 22.0), p<0.0001). There was no overall difference in recovery among Division I schools (females=13.7 (IQR 9.0, 23.1) vs males=12.2 (IQR 8.2 19.7), p=0.5), but females had longer recovery at the Division II/III levels (females=13.0 (IQR 9.2, 22.7) vs males=10.6 (IQR 8.1, 13.9), p=0.0048).ConclusionOverall, no difference in recovery between sexes across comparable women’s and men’s sports in this collegiate cohort was found. However, females in contact and males in limited contact sports experienced longer recovery times, while females had longer recovery times at the Division II/III level. These disparate outcomes indicate that, while intrinsic biological sex differences in concussion recovery may exist, important, modifiable extrinsic factors may play a role in concussion outcomes.

The impact of cognitive reserve, cognition and clinical symptoms on psychosocial functioning in first-episode psychoses

2020 ◽  
pp. 1-12 ◽  
Author(s):  
Silvia Amoretti ◽  
Adriane R Rosa ◽  
Gisela Mezquida ◽  
Bibiana Cabrera ◽  
María Ribeiro ◽  
...  
Keyword(s):  
Cognitive Performance ◽  
Verbal Memory ◽  
Negative Symptoms ◽  
Cognitive Reserve ◽  
Clinical Symptoms ◽  
First Episode ◽  
Cognitive Domains ◽  
The Impact ◽  
The Relationship

Abstract Background Functional impairment is a defining feature of psychotic disorders. A range of factors has been shown to influence functioning, including negative symptoms, cognitive performance and cognitive reserve (CR). However, it is not clear how these variables may affect functioning in first-episode psychosis (FEP) patients. This 2-year follow-up study aimed to explore the possible mediating effects of CR on the relationship between cognitive performance or specific clinical symptoms and functional outcome. Methods A prospective study of non-affective FEP patients was performed (211 at baseline and 139 at follow-up). CR was entered in a path analysis model as potential mediators between cognitive domains or clinical symptoms and functioning. Results At baseline, the relationship between clinical variables or cognitive performance and functioning was not mediated by CR. At follow-up, the effect of attention (p = 0.003) and negative symptoms (p = 0.012) assessed at baseline on functioning was partially mediated by CR (p = 0.032 and 0.016), whereas the relationship between verbal memory (p = 0.057) and functioning was mediated by CR (p = 0.014). Verbal memory and positive and total subscales of PANSS assessed at follow-up were partially mediated by CR and the effect of working memory on functioning was totally mediated by CR. Conclusions Our results showed the influence of CR in mediating the relationship between cognitive domains or clinical symptoms and functioning in FEP. In particular, CR partially mediated the relationship between some cognitive domains or clinical symptoms and functioning at follow-up. Therefore, CR could improve our understanding of the long-term functioning of patients with a non-affective FEP.

scholarly journals The Impact of Genetics and Hormonal Contraceptives on the Steroid Profile in Female Athletes

2014 ◽  
Vol 5 ◽  
Author(s):  
Jenny J. Schulze ◽  
Jenny E. Mullen ◽  
Emma Berglund Lindgren ◽  
Magnus Ericsson ◽  
Lena Ekström ◽  
...  
Keyword(s):  
Female Athletes ◽  
Hormonal Contraceptives ◽  
Steroid Profile ◽  
The Impact

SEX DIFFERENCES IN NEUROPSYCHOLOGICAL FUNCTION AND POST-CONCUSSION SYMPTOMS OF CONCUSSED COLLEGIATE ATHLETES

Neurosurgery ◽  
2007 ◽  
Vol 61 (2) ◽  
pp. 345-351 ◽  
Author(s):  
Tracey Covassin ◽  
Philip Schatz ◽  
C. Buz Swanik
Keyword(s):  
Sex Differences ◽  
Visual Memory ◽  
Female Athletes ◽  
Multivariate Analyses ◽  
Neuropsychological Test ◽  
Collegiate Athletes ◽  
Reliable Change ◽  
Main Effect ◽  
Composite Scores ◽  
The Impact

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 = 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 = 0.001) and sadness (P = 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.

scholarly journals The Influence of Hormonal Contraceptives on Baseline ImPACT Performance

2019 ◽  
Vol 34 (5) ◽  
pp. 784-784
Author(s):  
H W Carrington ◽  
D K Broshek ◽  
N K Erdman ◽  
X D Thompson ◽  
S R Walton ◽  
...  
Keyword(s):  
Medical History ◽  
Visual Memory ◽  
Female Athletes ◽  
Collegiate Athletes ◽  
Demographic Variables ◽  
Hormonal Contraceptives ◽  
Motor Speed ◽  
Impact Performance ◽  
Outcome Scores ◽  
Female Collegiate Athletes

Abstract Purpose Our study examined the influence of hormonal contraceptives (HC) on pre-injury (baseline) ImPACT performance in female collegiate athletes. Methods Participants in our cross-sectional study consisted of 304 NCAA Division I female athletes who self-reported taking (HC+ [n=154]) or not taking (HC- [n=154]) HC. HC+ participants were matched to HC- participants for height, weight, sport, and position. HC+ participants had an average age of 19.0±1.33 years, height of 170.5–8.70 cm, and mass of 64.2–10.58 kg. HC- participants had an average age of 19.0±1.24 years, height of 170.3–9.19 cm, and mass of 64.2–9.75 kg. Participants completed ImPACT as part of their preseason baseline assessment. Only participants with valid ImPACT assessments were included in our analyses. Chi-squared (χ2) tests were performed to compare groups in terms of medical history variables. Independent t-tests were used to compare groups in terms of demographic variables, self-reported hours of sleep, and ImPACT (Verbal and Visual Memory, Visual Motor Speed [VMS], Reaction Time [RT], and Total Symptom Severity [TSS]) outcome scores. Analyses were performed with α=0.05. Results No differences were observed between groups for demographic variables, hours of sleep, or medical history variables (p<0.05). For VMS, the HC- group (42.9+5.63) scored significantly worse (t[304]=2.17, p=0.03; d=0.25; 95% CI [0.1, 2.7]) than the HC+ group (44.3+5.67). For RT, the HC- group (0.55+0.06) performed significantly slower (t[304]=-2.02, p=0.05; d=0.23; 95% CI [-0.03, -0.0003]) than the HC+ group (0.54+0.05). Conclusion Our results suggest HCs may influence ImPACT performance in female collegiate athletes. Clinicians must consider the role of HCs when interpreting ImPACT outcome scores.

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