Magdalena Wojtowicz

High School Athletes With ADHD and Learning Difficulties Have a Greater Lifetime Concussion History.

Objective: Examine lifetime history of concussions in adolescents who have developmental problems in comparison with those with no developmental problems. Method: Thirty-two thousand four hundred eighty-seven adolescent athletes completed baseline/pre-season evaluations. Based on self-reported histories, athletes were divided into four groups: ADHD only, ADHD and learning difficulties (LD), LD only, and controls. Results: Athletes with ADHD, LD, or ADHD plus LD reported a greater prevalence of prior concussions than athletes without these developmental conditions (ps < .05). When adjusting for sex differences in concussion prevalence rates (boys are greater than girls), there was an increase in prevalence of prior injuries in those with ADHD, and ADHD plus learning difficulties compared with those with LD only. This pattern was found for both girls and boys. There was no additive effect of having both conditions. Conclusion: Developmental conditions in adolescent athletes, such as ADHD and learning difficulties, are associated with a greater prevalence rate of prior concussion.

MR Spectroscopy Findings in Retired Professional Rugby League Players

The aim of this study was to examine brain neurometabolite concentrations in retired rugby league players who had a history of numerous self-reported concussions. Participants were 16 retired professional rugby league players (ages 30-45 years) with an extensive history of concussion and participation in contact sports, and 16 age- and education-matched controls who had no history of neurotrauma or participation in contact sports. All completed a clinical interview, psychological and cognitive testing, and magnetic resonance spectroscopy (MRS) investigation. MRS voxels were placed in posterior cingulate grey matter and parietal white matter. Neurometabolite concentrations were quantified using LCModel. It was hypothesized that retired athletes would differ on N-acetyl aspartate, myo-inositol, choline, glutamate, and glutathione. Retired players had significantly lower concentrations of grey matter glutathione (p=0.02, d=0.91). They did not significantly differ in concentrations of other neurometabolites. There were no significant differences between groups on measures of depression, anxiety, or cognitive functioning. The retired athletes reported significantly greater alcohol use (p<0.01; Cohens d=1.49), and they had worse manual dexterity using their non-dominant hand (p=0.03; d=1.08). These preliminary findings suggest that MRS might be modestly sensitive to biochemical differences in athletes after their athletic careers have ended in the absence of clinical differences in cognitive performance and self-reported psychological functioning.

Consistency of Self-reported Concussion History in Adolescent Athletes.

Relying on self-reported concussion injury history is common in both clinical care and research. However, young athletes may not provide consistent medical information. To date, little is known about the reliability of self-reported concussion history in high school students. This study examined whether student athletes reported their lifetime history of concussions consistently over time. Self-reported concussion history was examined in 4792 student athletes (ages 13-18) from Maine who completed a preseason health survey on two occasions (median re-test interval = 23.7 months; standard deviation = 7.3; interquartile range = 12.4-24.5). Consistency of self-reported concussion history was determined by differences in the number of concussions reported during the second survey. Inconsistent concussion history was defined primarily by a decrease in the number of lifetime concussions reported at the second testing, compared with at the first testing. The majority of the sample (80.3%) reported no change in the number of concussions between the two baseline assessments. A minority (15.9%; n = 763) reported more concussions during the second assessment. Only 3.8% (n = 181) of student athletes provided inconsistent concussion histories, defined as fewer concussions at the second assessment. Boys provided inconsistent concussion histories a little more frequently, compared with girls (5.3% and 2.0%, respectively; p < 0.001). Similarly, athletes with self-reported attention-deficit hyperactivity disorder (ADHD) provided inconsistent concussion histories somewhat more frequently, compared with those without ADHD (7.8% and 3.5%, respectively; p < 0.001). Of the athletes with inconsistent concussion histories, greater degree of inconsistency was associated with a greater number of concussions initially reported at baseline (rs = 0.54; p < 0.001). Only a small proportion of student athletes provided inconsistent concussion histories. Male gender, ADHD, and greater number of baseline concussions were significantly associated with inconsistency in reporting. Overall, these findings suggest that student athletes are quite consistent when reporting their concussion history when surveyed twice during high school.

Video and clinical screening of national rugby league players suspected of sustaining concussion

ABSTRACT Primary Objective: This study reviewed the available sideline Sport Concussion Assessment Tool-Third Edition (SCAT3) performance of players who were removed from play using the ‘concussion interchange rule’ (CIR), the available video footage of these incidences, and associated return to play and concussion diagnosis decisions. Research Design: Descriptive, observational case series. Methods and Procedures: Data were collected from all NRL players who used the CIR during the 2014 season. Main Outcomes and Results: Complete SCAT3 and video analysis data were available for 38 (23%) of 167 uses of the concussion interchange rule, of which 20 (52.6%) players were medically diagnosed with concussion. Those with video evidence of unresponsiveness performed more poorly on the modified Balance Error Scoring System (M-BESS; p = .04; Cohen’s d = .69) and reported greater symptoms (p = .03; d = .51). Similarly, players with a vacant stare reported greater symptoms (p = .05; d = .78). Those who demonstrated three signs (unresponsiveness, vacant stare and gait ataxia) performed more poorly on the M-BESS (p = .03; d = 1.4) and reported greater symptoms than those with no observable signs (p = .03; d = 1.4). Conclusions: The SCAT3 is sensitive to the acute effects of concussion in professional athletes; however, a minority of injured athletes might go undetected by this test.

Contribution of Perceived Cognitive Functioning to Quality of Life in Service Members and Veterans With Posttraumatic Stress Disorder

Perceived cognitive impairment is a core clinical feature of posttraumatic stress disorder (PTSD) and may be an important determinant of quality of life (QOL) in those who suffer from this disorder. Using a clinical data repository, we evaluated this hypothesis in a cross-sectional sample of U.S. military service members and veterans who served after September 11, 2001, and were seeking mental health treatment at a tertiary outpatient clinic. A consecutive series of 117 patients with a clinical diagnosis of PTSD completed a battery of questionnaires at intake, including the PTSD Checklist (Weathers, Litz, Herman, Huska, & Keane, 1993), a 4-item Cognitive Symptom subscale of the Neurobehavioral Symptom Inventory (Cicerone & Kalmar, 1995), the Depression Anxiety Stress Scale-21 (Lovibond & Lovibond, 1995), and the Quality of Life Enjoyment and Satisfaction Questionnaire (Endicott, Nee, Harrison, & Blumenthal, 1993). Cognitive symptom reporting was very high, even in the subgroup without a history of traumatic brain injury. In a regression analysis, cognitive symptom severity was independently associated with QOL (β = -.204). This relationship was not explained by comorbid traumatic brain injury, but was restricted to patients with comorbid depression (β = -.278 in the subgroup with an elevated Depression Anxiety Stress Scale-21 Depression subscale; n = 91). In conclusion, perceived cognitive impairment was common in this PTSD sample and helped to explain impairments in QOL, especially in patients with comorbid depression.

Cortical thickness and subcortical brain volumes in professional rugby league players

Purpose The purpose of this study was to examine cortical thickness and subcortical volumes in professional rugby players with an extensive history of concussions compared to control subjects. Method Participants included 24 active and former professional rugby league players [Age M(SD) = 33.3(6.3); Range = 21–44] with an extensive history of concussion and 18 age- and education-matched controls with no history of neurotrauma or participation in contact sports. Participants underwent T1-weighted imaging and completed a neuropsychological battery, including two tests of memory. Whole brain cortical thickness analysis and structural volume analysis was performed using FreeSurfer version 6.0. Results Professional rugby league players reported greater alcohol consumption (p < .001) and had significantly worse delayed recall of a visually complex design (p = .04). They did not differ from controls on other clinical outcome measures. There were no differences in cortical thickness between the groups. Professional players had smaller whole brain (p = .003), bilateral hippocampi (ps = .03), and left amygdala volumes (p = .01) compared to healthy controls. Within the players group, there were significant associations between greater alcohol use and smaller bilateral hippocampi and left amygdala volumes. There were no associations between structural volumes and history of concussions or memory performance. Conclusions The literature examining cortical thickness in athletes with a history of multiple concussions is mixed. We did not observe differences in cortical thickness in professional rugby league players compared to controls. However, smaller subcortical volumes were found in players that were, in part, associated with greater alcohol consumption.

Stigma and Health Services Use Among Veterans and Military Personnel

Despite high rates of physical and mental health difficulties, veterans have low rates of health service utilization. Among other barriers to accessing needed treatment, stigma is associated with poorer quality of healthcare and lower intentions to seek treatment for health concerns. Healthcare-related stigma is prevalent among veterans and includes privacy concerns and a variety of personal beliefs regarding mental illness and treatment that deter them from seeking services. Despite efforts targeted toward reducing stigma, progress in this area has been limited, and increasing access to needed physical and mental healthcare among veterans and service members remains a persistent concern. This chapter explores the various stigma faced by today’s veterans, synthesizes the extant research on stigma-reducing strategies, and provides our recommendations for future directions. Avenues for future work include the development of prospective research designs to more completely examine the impact of stigma on service use, the development of novel approaches to interventions that expand upon existing models, and a focus on normalizing health and treatment seeking in military settings.