Kirtida Patel

Concussion Baseline Testing: Preexisting Factors, Symptoms, and Neurocognitive Performance

CONTEXT Neurocognitive test scores are often considered an important aspect of concussion management. To best use these data, clinicians must understand potential factors that may influence baseline performance on these tests. OBJECTIVE To determine preexisting factors that may influence performance on the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). DESIGN Cross-sectional study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 486 National Collegiate Athletic Association Division I collegiate student-athletes. MAIN OUTCOME MEASURE(S) To determine neurocognitive functioning and total symptom score at baseline, ImPACT was administered. Outcomes were verbal memory, visual memory, visual motor speed, reaction time, and total symptom score. A self-report demographic section at the beginning of ImPACT was used to gather information concerning previous treatment for headaches, migraines, and psychiatric conditions; diagnosis of attention-deficit/hyperactivity disorder; and exposure to previous strenuous exercise. We conducted multivariate analyses of variance to determine if the ImPACT composite and total symptom scores differed according to preexisting factors (P < .0083). RESULTS Sex showed an effect on verbal memory (P = .001), visual motor speed (P < .001), and reaction time (P = .006), with women performing better than men. A previous diagnosis of attention-deficit/hyperactivity disorder affected visual motor speed (P = .008). Previous treatment for headaches (P < .001), migraines (P = .001), a psychiatric condition (P < .001), or a diagnosis of attention-deficit/hyperactivity disorder (P < .001) all showed effects on the total symptom score. Strenuous exercise did not affect neurocogntive performance or total symptom score. CONCLUSIONS Based on our findings and the previous literature, we suggest that many preexisting factors influence baseline neurocognitive data. Baseline testing is an important aspect of concussion management. Sports medicine professionals should be cognizant of these factors when developing concussion-management protocols.

Concussion management in collegiate student-athletes: return-to-academics recommendations

Concussions in collegiate athletics can affect student-athletes both on the field and in the classroom. As policies are made to outline return-to-play decisions and timelines, this article will make the case that return-to-academics should also be included and follow a step-wise protocol. Complete cognitive rest is a cornerstone of concussion recovery and slow reintroduction to academics should precede return-to-play. The college structure allows for student-athletes to begin small doses of cognitive activity after the recommended complete cognitive rest. It is recommended that return-to-academics involves a team approach to help the student-athlete navigate the responsibilities of course work while healing from a brain injury.

Genetics Influence Neurocognitive Performance at Baseline but Not Concussion History in Collegiate Student-athletes

Objective: This study investigates 4 single-nucleotide polymorphisms [Apolipoprotein E (APOE), APOE promoter, catechol-O-methyl transferase (COMT), and dopamine D2 receptor] that have been implicated in concussion susceptibility and/or cognitive ability in collegiate student-athletes. Design: Cross-sectional study. Setting: Neuroscience laboratory at Elon University. Participants: Two hundred fifty division I collegiate student-athletes (66 women, 184 men) from various sports. Intervention: All participants completed Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) testing at baseline concussion testing and had a buccal swab taken for DNA for genotyping. Main Outcome Measures: Self-reported history of concussions and neurocognitive performance were taken from ImPACT. Results: Individuals carrying an &egr;4 allele in their APOE gene had a significantly slower reaction time (P = 0.001). Individuals homozygous for the Val allele of the COMT gene showed significantly worse impulse control scores (P = 0.014). None of the genotypes were able to predict self-reported concussion history in collegiate student-athletes. Conclusions: These results indicate that certain genotypes may influence performance on cognitive testing at baseline and that the APOE genotypes may not influence concussion susceptibility as suggested by past studies.

Potential factors influencing recovery from concussion in collegiate student-athletes:

Background Factors including sex, previous diagnosis of migraines, previous diagnosis of Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder, and a history of concussion may influence the length of recovery from concussion in collegiate student-athletes. Purpose To better understand factors that may influence recovery from concussion in collegiate-student athletes. Methods A total of 91 student-athletes from a Division I NCAA University who sustained concussions from the fall of 2011 to the spring of 2015 were evaluated. They were considered recovered from their concussion when neurocognitive and symptom scores returned to baseline and they were cleared by their physician. Analyses of variance were conducted to determine if potential factors influenced concussion recovery (p < .0125). Results No significant differences were found for sex (males = 7.4 ± 5.9; females = 8.3 ± 4.8 days; p = 0.417), previous diagnosis of migraines (diagnosis = 8.0 ± 5.7; no diagnosis = 7.8 ± 5.4 days; p = 0.926), or history of concussion (history = 8.3 ± 5.7; no history = 5.6 ± 3.4 days; p = 0.088). However, a significant difference in the length of recovery was found between those with a previous diagnosis of Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder and those without (diagnosis = 13.3 ± 7.3; no diagnosis = 7.3 ± 4.9 days; p = 0.002). Conclusion Student-athletes with Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder show significantly longer recovery from concussions than those without. Further investigation of this and other factors that influence recovery from concussion may help in concussion recovery and return-to-play guidelines that improve student-athlete well-being.

Genotypes are related to neurocognitive performance but not concussion history in collegiate student-athletes

Background Single-nucleotide polymorphisms (SNPs) of neurologically relevant genes play a role in concussions from increasing susceptibility or hampering cognitive performance. Objective The purpose of this study was to investigate the effects of polymorphisms of APOE, APOE promoter, COMT and DRD2 on baseline neurocognitive function and concussion history in collegiate student-athletes. Design Cross-sectional. Setting Collegiate campus in North Carolina. Participants 262 (194 males, 68 females) collegiate student-athletes. Assessment of risk factors Buccal mucosa swabs were collected from participants. SNP genotyping was run on all samples to determine APOE, APOE promoter, COMT, and DRD2 genotypes. Participants were split into three groups based on their genotypes for each gene. Outcome measures Participants completed the Immediate Post-Concussion Assessment and Cognitive Testing neurocognitive assessment which generated composite scores on Verbal Memory, Visual Memory, Visuomotor Speed, and Reaction Time as well as Impulse Control Results None of the genotype variables influenced number of concussions (p>0.05). MANOVA analysis determined no differences for APOE promoter and DRD2 genotypes (p>0.05). There were statistical differences for APOE for Visuomotor composite (APOE-e3 (m=41.2, %95 CI [40.8, 42.1]) vs e4 (m=39.1, %95 CI [37.8, 40.5], p=0.017) and Reaction Time (APOE-e4 (m=0.62, %95 CI [0.60, 0.64]) was different than both e2 (m=0.57, %95 CI [0.54, 0.60] and e3(m=0.58, %95 CI [0.56, 0.59], p<0.005). There were also differences for COMT for Impulse Control (Val/Val (m=6.2 %95 CI [5.4, 7.1]) was different Val/Met (m=4.7, %95 CI [4.1, 5.2] and Met/Met (m=4.7, %95 CI [3.8, 5.6], p<0.02). Conclusions APOE and COMT single nucleotide polymorphisms lead to significant differences in neurocognitive performance at baseline but not concussion history. Competing interests None.

Implications of attention deficit and hyperactivity disorders on neurocognitive performance and recovery in collegiate student–athletes

Background Approximately 3–13% of college-aged students have a diagnosis of Attention Deficit/Hyperactivity Disorder (ADD/ADHD) which is characterised by impulsivity, inattention, and cognitive speed deficits which affects academic, athletic, and occupational performance even when treated. Objective The purpose of this study was to examine baseline neurocognitive differences in collegiate student-athletes with diagnosis of ADD/ADHD as well as recovery time from concussion. Design Cross-sectional. Setting Collegiate campus in North Carolina Participants Participants of this study included 1161 student-athletes (varsity, n=272 and club, n=889). 89 participants were followed post-concussion with 8 having diagnosis of ADD/ADHD. Assessment of risk factors Diagnosis of ADD/ADHD and days of recovery following concussion. Outcome measures Participants completed the Immediate Post-Concussion Assessment and Cognitive Testing which generated composite scores on Verbal Memory, Visual Memory, Visuomotor Speed, and Reaction Time as well as Total Symptom Scores. Main results There were no significant differences between groups for Visual Memory, Reaction Time and Total Symptom Scores (p>0.05). Those with diagnosis of ADD/ADHD (n=146) had lower verbal memory(mno=85.3, %95 CI: [84.6, 86] vs. madd=82.5, %95 CI:[80.7, 84.3], F(1, 1145)=8.6, p=0.003) and slower visuomotor speed (mno=41.7, %95 CI: [41.3, 42.7] vs. madd=40.5, %95: CI:[39.5,41.5],F(1,1145)=8.6,p=0.027) compared to those without a diagnosis. Those with ADD/ADHD took almost two times longer to recover than those without (mno=7.3 days, %95 CI: [6.2, 8.4] vs. madd=13.3 days, %95 CI:[9.4, 17.2], F(1, 89)=9.8, p=0.002). Conclusions Student-athletes with diagnosis of ADD/ADHD may benefit from targeted interventions as part of return to play/learn protocols. Previous research has shown that practice may help rehabilitate those with cognitive and visuomotor processing speed deficits following a concussion. Competing interests None.