An Examination of Adolescent Athletes and Nonathletes on Baseline Neuropsychological Test Scores

Context: An estimated 15.3 million adolescent students are enrolled in US high schools, with approximately 7.8 million participating in athletics. Researchers have examined various demographics in high school athletes; however, athletic participation may play a larger role in test performance than previously thought. Currently, investigations of concussion assessment may rely on uninjured athletes as controls. However, due to the intense nature of athletics, this may not be an appropriate practice. Objective: To examine differences between athletes and nonathletes using a common computerized neuropsychological test. Design: Retrospective cross-sectional study. Setting: High schools from a school district in Columbus, Ohio. Patients or Other Participants: A total of 662 adolescent high school students (athletes: n = 383, female n = 18; nonathletes: n = 279, female n = 193). Main Outcome Measure(s): Participants were administered a computerized neuropsychological test battery (Immediate Post-Concussion Assessment and Cognitive Test [ImPACT]) during baseline concussion assessment. Differences between groups were established for output composite scores. Results: Differences were found between athletes and nonathletes in composite reaction time (F1,522 = 14.855, P < .001) and total symptom score (F1,427 = 33.770, P < .001). Nonathletes reported more symptoms, whereas athletes had faster reaction times. No differences were present in composite verbal memory, composite visual memory, composite visual motor speed, or composite impulse control (P > .05). Conclusions: Symptom reporting and reaction time differed between high school athletes and nonathletes. Participation in extracurricular activities may lead to cognitive differences in adolescents that can influence performance on the Immediate Post-Concussion Assessment and Cognitive Test battery. Researchers should account for these differences in baseline performance when making concussion diagnostic and management decisions.

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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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The Effect of Test Setting Upon Test-Retest Reliability of ImPACT Baseline Tests in High School Athletes

Neurology ◽

10.1212/01.wnl.0000801956.01474.ba ◽

2021 ◽

Vol 98 (1 Supplement 1) ◽

pp. S23.2-S23

Author(s):

Mark Thomas William Roberts ◽

Jonathan Danield Lichtenstein

Keyword(s):

High School ◽

Reaction Time ◽

Verbal Memory ◽

Visual Memory ◽

Motor Speed ◽

High School Athletes ◽

Retest Reliability ◽

Concussion Management ◽

Visual Motor ◽

Test Retest Reliability

ObjectiveTo determine the test-retest reliability of ImPACT baseline tests across different schools within the same larger concussion management program.BackgroundImPACT is the most widely used concussion management cognitive testing tool. Baseline testing is often required for high school sports participation. Typically, testing occurs every 2 years based on test-retest reliability statistics in previous studies. Demographic and environmental factors, such as age, sex, number of participants, and supervision, all impact baseline performance. Studies to date have not examined test-retest differences across testing sites, such as between school differences.Design/MethodsCross-sectional retrospective design. Valid baseline tests from high school athletes over a 2-year interval were included. Participants who experienced concussions prior to or between tests were excluded. A total of 979 student athletes from 5 schools were included. The Intra-class correlations were determined over a 2-year period for each ImPACT composite score and school.ResultsICC estimates averaged between schools reflected good reliability for visual-motor speed (0.833), visual memory (0.673) and reaction time (0.615) over the two-year period. Verbal memory (0.586) and impulse control (0.556) were less reliable. Between schools a greater range of composite reliability was observed for reaction time (0.484–0.730) and impulse control (0.461–0.655) compared to verbal memory (0.534–0.637), visual memory (0.61–0.719), and visual-motor speed (0.769–914).ConclusionsAs previously established, reliability of ImPACT baselines vary by composite. This study revealed that reliability also varies by setting, as different schools yielded different ICCs. Consistent with the literature, the most reliable measure was visual-motor speed. The greatest difference in reliability between schools was for reaction time. These results suggest that test setting and environment affect reliability of ImPACT baseline scores, with varying effects per composite. Attention must be paid to environmental setting to improve reliability of baseline cognitive test performance to maximize athlete safety.

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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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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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Sport Specialization Characteristics Between Rural and Suburban High School Athletes

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117751386 ◽

2018 ◽

Vol 6 (1) ◽

pp. 232596711775138 ◽

Cited By ~ 7

Author(s):

David R. Bell ◽

Eric G. Post ◽

Stephanie M. Trigsted ◽

Daniel A. Schaefer ◽

Timothy A. McGuine ◽

...

Keyword(s):

High School ◽

High School Students ◽

High Schools ◽

Sport Participation ◽

Suburban Schools ◽

High School Athletes ◽

School Students ◽

Rural High Schools ◽

Study Enrollment ◽

Younger Age

Background: Sport specialization has been associated with overuse injuries and is more common in larger high schools, which are often located in more urban/suburban settings. However, sport participation characteristics have not been compared between suburban and rural high schools. Purpose/Hypothesis: The purpose of this study was to examine the differences in sport participation characteristics between athletes at suburban and rural high schools. It was hypothesized that suburban high school students would be more likely to be highly specialized, participate in more athletic competitions per year, and play in a league outside of school. We also hypothesized that suburban high school students would start playing their primary sport at a younger age, would have participated in their primary sport for longer, and would play more months per year and hours per week. Study Design: Cross-sectional study. Methods: High school athletes from 4 high schools (2 suburban and 2 rural) participated in this study (N = 354 [222 females]; mean age, 15.7 ± 1.2 years). Athletes were on a school-sponsored athletic team in 1 of 4 sports (volleyball, tennis, basketball, soccer). The suburban schools (study enrollment, n = 226) had total school enrollments of 2271 and 622 students, while the rural schools (study enrollment, n = 128) had total school enrollments of 443 and 297. Participants completed a questionnaire prior to the start of their high school sport season. The questionnaire consisted of demographic information, a sport specialization scale, and sport participation information. Primary sport competition volume in the previous 12 months was classified as high (>60 primary sport competitions), moderate (30-60), or low (<30). Sport specialization status was classified via a 3-point scale as low, moderate, or high. Results: As compared with athletes at rural schools, athletes at suburban schools started playing their primary sport at a younger age (suburban, 7.8 ± 2.9 years; rural, 9.7 ± 3.2 years; P < .001) and participated for more years (suburban, 7.9 ± 3.1 years; rural, 6.1 ± 3.3 years; P < .001), more months per year (suburban, 7.6 ± 3.6 months; rural, 5.6 ± 2.8 months; P < .001), and more hours per week (suburban, 15.2 ± 5.1 hours; rural, 12.9 ± 3.3 hours; P < .001). Athletes at suburban schools were more likely than rural athletes to be classified as highly specialized (χ2 = 52.5, P < .001), participate in more competitions (χ2 = 16.5, P < .001), play in a league outside of school (χ2 = 18.4, P < .001), and train in their primary sport for >8 months per year (χ2 = 27.8, P < .001) and >16 hours per week (χ2 = 15.0, P < .001). Conclusion: High school athletes at suburban schools are more likely to exhibit sport participation patterns that are associated with increased risk of overuse injury. These include being classified as highly specialized, playing their primary sport >8 months per year and >16 hours per week, engaging in a high competition volume, and participating in a sport league (eg, club) outside of school. Efforts aimed at safe sport participation should target these groups, as they seem more likely to violate safe sport recommendations.

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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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Relationship between cognitive processes and academic performance in high school students

Psychologia ◽

10.21500/19002386.1816 ◽

2015 ◽

Vol 9 (2) ◽

pp. 85-100

Author(s):

Laura Puerta

Keyword(s):

High School ◽

Academic Performance ◽

High School Students ◽

Cognitive Processes ◽

Sustained Attention ◽

Verbal Memory ◽

Visual Memory ◽

Verbal Learning ◽

School Students ◽

Cross Sectional

The purpose of this investigation was to determine the relationship between the cognitive processes and the academic performance by a non-experimental correlational study with a cross-sectional design. Participants were 60 students between 14 and 17 years old, who were randomly selected from high school tenth grade without a history of personality disorder or intellectual disability. Academic performance was evaluated from the school average reported by educational documents. Cognitive processes measured were: focused and sustained attention, cognitive flexibility and inhibitory control, delayed visual memory, auditory verbal learning and delayed auditory verbal memory, visualconstructive praxis, naming function of language and verbal fluency. A neuropsychological battery was used for that purpose. According to the Rho Spearman, the results indicated that there is a statistically significant relationship between the two following cognitive processes and academic performance: sustained attention (p=0.01) and the naming function of language (p=0.05).

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Disparities on Baseline Performance Using Neurocognitive and Oculomotor Clinical Measures of Concussion

The American Journal of Sports Medicine ◽

10.1177/0363546520946753 ◽

2020 ◽

Vol 48 (11) ◽

pp. 2774-2782 ◽

Cited By ~ 1

Author(s):

Jessica Wallace ◽

Ryan Moran ◽

Erica Beidler ◽

Jamie McAllister Deitrick ◽

James Shina ◽

...

Keyword(s):

High School ◽

African American ◽

Reaction Time ◽

Title I ◽

Verbal Memory ◽

Visual Memory ◽

Title I Schools ◽

Black African ◽

Motor Processing ◽

Baseline Performance

Background: Given the high participation of Black/African American individuals in high school sports, especially high-risk sports for concussion, it is important to note if racial and socioeconomic status (SES) differences exist in baseline performance on clinical measures of concussion. Purpose: To explore the association between race and SES on baseline concussion assessments of neurocognitive performance and oculomotor function in adolescent athletes. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: A total of 564 high school athletes (mean ± SD age, 15.33 ± 1.1 years) completed the baseline Immediate Post-Concussion Assessment and Cognitive Test and King-Devick (KD) battery before the start of their competitive season. Race was defined as either White/non-Hispanic or Black/African American. SES status was determined by whether the individual’s participating high school was a Title I or non–Title I school. A series of multivariable linear regression analyses were conducted to evaluate the association of computerized neurocognitive test scores (verbal memory, visual memory, motor processing speed, and reaction time), symptom severity scores, and KD scores by race and SES. Results: White/non-Hispanic individuals performed significantly better than Black/African American individuals on verbal memory ( P < .01), visual memory ( P < .01), visual motor processing speed ( P < .01), and reaction time ( P < .01) and had a lower symptom score ( P < .01). Regarding SES, individuals from non–Title I schools performed better on visual memory ( P = .05) and reaction time ( P = .02) than individuals from Title I schools. Examination of cumulative KD test reading time revealed that there was no association between race on baseline reading times ( P = .12). There was a significant association between cumulative reading time and SES ( P = .02). Individuals from non–Title I schools performed significantly faster than individuals from Title I schools on KD test time. Conclusion: Overall, race and SES influence neurocognitive and oculomotor concussion baseline performance in high school athletes. These findings add to the growing literature on the influence of race and SES on neurocognitive and oculomotor function baseline concussion assessments; they highlight the necessity for individualized concussion baseline measurements or race-specific normative reference values.

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Testing the Hybrid Battery Approach to Evaluating Sports-Related Concussion in the National Hockey League: A Factor Analytic Study

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acz026.52 ◽

2019 ◽

Vol 34 (5) ◽

pp. 782-782

Author(s):

R J Echemendia ◽

J M Bruce ◽

J Thelen ◽

M Hutchison ◽

P Comper ◽

...

Keyword(s):

Reaction Time ◽

Verbal Memory ◽

Visual Memory ◽

Neuropsychological Test ◽

Verbal Learning ◽

Motor Speed ◽

Post Injury ◽

Neuropsychological Measures ◽

Factor Analytic ◽

Computerized Measures

Abstract Purpose Traditional “paper and pencil” neuropsychological tests and computerized test batteries have been employed in the assessment of sports-related concussion (SRC). Each type of test has inherent strengths and weaknesses. The NHL has constructed a “hybrid” battery of tests that uses both traditional and computerized measures in the evaluation of its players suspected of SRC. The purpose of this paper is to use factor analytic techniques to examine the relationships among the measures that comprise this battery. Methods Post-injury neuropsychological test data using the hybrid battery were obtained from 343 NHL players following their first concussion while playing in the league. ImPACT was used as the computer test battery. The traditional battery included: Hopkins Verbal Learning Test, Brief Visuospatial Memory Test, Color Trails, PSU Cancellation, Symbol Digits Modalities Test (including incidental memory), and Verbal Fluency. Results Five factors were extracted explaining 64.55% of the variance. The factor labels and the measures principally loading on each factor were as follows: Factor 1, Verbal Learning and Memory (HVLT Total and Delayed Recall); Factor 2, Processing Speed (Color Trails A/B, PSU Cancellation, and SDMT-Total); Factor 3, Visual Memory (BVMT- Total and Delayed); Factor 4, Cued Memory (ImPACT-Visual and Verbal Memory Composites); and Factor 5, Reaction Time (ImPACT Reaction Time and Visual Motor Speed composites). Conclusion These data underscore the unique contributions of traditional and ImPACT neuropsychological measures to the evaluation SRC in a sample of professional hockey players. It appears that both approaches measure different aspects of cognitive functioning. The next logical step is to use these data in evaluating the diagnostic utility of these measures as part of a combined battery.

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Factorial Structure of Cognitive Activity Using a Neuropsychological Test Battery

Behavioural Neurology ◽

10.1155/1994/131347 ◽

1994 ◽

Vol 7 (2) ◽

pp. 49-58 ◽

Cited By ~ 9

Author(s):

A. Ardila ◽

M. Rosselli ◽

J. R. Bateman

Keyword(s):

Verbal Memory ◽

Visual Memory ◽

Neuropsychological Test ◽

Cognitive Activity ◽

Test Battery ◽

Factor Ix ◽

Factor Vii ◽

Mental Control ◽

Neuropsychological Test Battery ◽

Wechsler Memory Scale

A general neuropsychological test battery was assembled and individually given to a 98-subject sample, aged 11–12 years old. The battery included some basic and common tests routinely used in the evaluation of language, memory, spatial abilities, concept formation, and praxic abilities. Twenty-five different scores were calculated. A factor analysis with varimax rotation disclosed nine different factors, accounting for about 70% of the variance. Factor I was measured by a Sequential Verbal Memory test and Verbal Fluency subtests (“verbal factor”). Factor II was measured by the Wechsler Memory Scale Visual Memory subtests (immediate and delayed reproduction), and the Rey-Osterrieth Complex Figure (copy and immediate reproduction) (“non-verbal memory and constructional factor”). Factor III was measured by the WMS Logical Memory subtests (immediate and delayed; “verbal memory factor”). Factor IV was associated with fine movements (tapping subtests, right and left hand; “fine movements factor”). Factor V was specially measured by the Information subtest of the WMS and the Boston Naming Test (“verbal knowledge”). Factor VI represented a “praxic ability factor” (ideomotor praxis tests). Delayed Associative Learning subtest measured Factor VII; and Digits measured Factor VIII. Factor IX was a “mental control factor” (Mental Control subtest of the Wechsler Memory Scale). The implications of these results to theories relating to the structure of cognitive activity are discussed.

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