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

Abstract

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.

Keywords: adolescents; concussion; duration of effects; mTBI; neurocognitive testing.

Figure 1.

Difference in cognitive test score (standardized units) for global cognitive function and each domain-specific test relative to scores of a hypothetical student tested immediately after a concussion where a higher value on the y-axis indicates better performance and a lower value, a worse performance. Thus, the interpretation of the effect estimate at any point on the x-axis is the estimate relative to the score of a student tested immediately after a concussion. The solid black line shows the estimated score difference, and the dashed lines indicate the 95% CI.