Sports Medicine Research: In the Lab & In the Field: Age-Related Differences in Neurocognitive Recovery from Sports-Related Concussion (Sports Med Res)


Friday, January 11, 2013

Age-Related Differences in Neurocognitive Recovery from Sports-Related Concussion

Recovery from sports-related concussion: Days to return to neurocognitive baseline in adolescents versus young adults.

Zuckerman SL, Lee YM, Odom MJ, Solomon GS, Forbes JA, Sills AK. Surg Neurol Int. 2012;3:130

Recently, The American Medical Society for Sports Medicine released its new consensus statement on concussion in sport and commented that concussions in younger athletes have a more prolonged recovery.  Zuckerman, et al. sought to verify this statement by assessing potential age-related differences in neurocognitive recovery after sports-related concussion. In a two year retrospective and observational study, athletes diagnosed with a concussion were placed into 2 groups based on age at the time of concussion (13-16 years old versus 18-22 years old).  Inclusion criteria were participation in organized high school or collegiate sports, valid pre-participation baseline neurocognitive testing (ImPACT) data, two or more valid post-concussion neurocognitive assessments within 30 days of injury, and fluency in English.  Athletes were excluded if they had a self-reported history of learning disability, ADHD, dyslexia, autism, brain surgery, seizure disorder, drug/alcohol abuse, or psychiatric disorders. After review of an extensive database of concussed athletes, the authors selected 100 athletes in each study group. Athletes in both groups were matched based on number of previous concussions; however, gender and type of sport played were not, resulting in the 18-22 year old group having almost thirty percent more female athletes.  The results of the study showed that for all but one of the ImPACT neurocognitive testing endpoints the younger study group required more time for return to baseline performance (verbal memory, visual memory, reaction time and post-concussion scale).

The results of this study are noteworthy because it shows that on a large scale there appears to be age-related differences in the duration of neurocognitive recovery to concussion injuries.  While neurocognitive testing, such as ImPACT, is still only recommended to be used as part of a more comprehensive concussion management strategy it is being adopted by many high schools and colleges.  Research that delineates potential differences in scores among athletes can be very helpful to clinicians trying to decide what kind of role neurocognitive testing has in their concussion management strategy. Understanding age related differences can also allow clinicians to better explain projected recovery times to patients and their families.   Do you have any experience with neurocognitive testing as part of your concussion management strategy? Do you find that your younger athletes take longer to recover than older athletes?

Written by: Stephen Stache, MD
Reviewed by: Jeffrey B. Driban

Related Posts:

Zuckerman SL, Lee YM, Odom MJ, Solomon GS, Forbes JA, & Sills AK (2012). Recovery from sports-related concussion: Days to return to neurocognitive baseline in adolescents versus young adults. Surgical neurology international, 3 PMID: 23227435


MST ATC said...

So, are we seeing predominate effects of age per-se or effects of gender? For instance, progesterone has known effects on increasing both neuron myelination and neuronal differentiation. Both of these known effects on the nervous system could promote quicker return to baseline neurocognitive levels.

With such a gender discrepancy, it would seem to be a major flaw to attribute this entirely to an age effect.

Stephen Stache said...

Your point is well made MST ATC. I feel that the data in this article would be slightly more powerful if the researchers had accounted for age. However, other research has shown age-dependent differences in recovery and symptom patterns that are independent of gender, and gender independent of age, i.e. high school athletes had longer recovery time than college athletes and female athletes had worse symptom scores and poorer performance on certain neurocognitive testing.

The bigger point I think you highlighted it that concussion research is still very fragmented and as the field of study continues to develop, hopefully better studies build upon current research and clarify important clinical questions.

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