Concussion history and cognitive function in a large cohort of adolescent athletes.
Taylor KM, Kioumourtzoglou MA, Clover J, Coull BA, Dennerlein JT, Bellinger DC, and Weisskopf MG. Am J Sports Med. 2018. [Epub Ahead of Print].
https://journals.sagepub.com/doi/abs/10.1177/0363546518798801
Take Home Message: An adolescent athlete with a history of concussion, especially at a young age, is likely to have lower cognitive function than their peers.
While the number of concussions among adolescents has recently risen, we know little about how a history of concussion among this populations affects the brain. Therefore, Taylor and colleagues completed a retrospective study to evaluate the relationship between concussion and cognitive function in a large cohort of adolescents. From 2009 to 2014, 5,616 student-athletes (1,370 females, 13-19 years old) from Southern California had mandatory preparticipation physicals, some of which required a cognitive test. The researchers collected demographic information for all participants including, concussion history, age at first concussion, years since last concussion, sex, race/ethnicity, current school district, handedness, age at assessment, height, weight, BMI, and cognitive test results from the computer-based ImPACT test. The cognitive test yielded a composite verbal memory, visual memory, visual motor speed, reaction time, and impulse control scores. Researchers then calculated a score for all composite scores that was normalized to the test results of those without a concussion. This allowed them to compare the results across scales.. Overall, a student-athlete with a history of a concussion was more likely to have a lower cognitive score than their peers without a concussion history. A student athlete’s cognitive scores worsened with each additional concussion. Finally, researchers found that when the concussion occurred at a younger age, an athlete’s cognitive scores were worse than student athletes with a concussion at an older age.
Overall, the data presented in this study indicates that concussions sustained during adolescence could impact overall cognitive function. This is alarming to clinicians who typically care for youth populations, especially those involved in contact sports. While this data is alarming, more detail would be helpful. Data such as the severity of the concussion sustained, the applied treatment, and how return to participation was determined would all be helpful to better understand the results. Even so, clinicians should be aware of the impact that concussions can have on cognitive function of the developing brain and be aware of the best practices for identifying, treating, and returning adolescent student-athletes to play.
Questions for Discussion: How do you answer questions from patients or their parents about the consequences of concussions?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban
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When a patient or parent asks me about the consequences of concussion, I always try to answer in a way where I am considering that they may or may not be educated about concussion. Typically, I begin explaining the signs and symptoms of concussion in addition to treatment. In the past, it was believed that individuals with concussion should be woken up from sleep to monitor them through the night. However, now it is best for the patient to sleep.They should also limit or completely avoid screen time. Concussion is injury to the brain, and after the brain gets damaged it needs to heal. With that being said, there are potentially long-term consequences associated with concussion especially with multiple concussions. Some of these consequences may be difficulty with memory, motor skills, learning ability, reaction time, etc. As this article explained, concussions can be more detrimental to younger adolescents than those who are older. That obviously makes sense because older children have more developed brains. In any type of contact sport, it is important for athletes to wear protective equipment, such as helmets, to limit risk for head injury, especially in youth sports. This can help to keep children safe from concussion and limit decrease in cognitive function.
Savannah,
Thank you for the comment. I like your approach when discussing concussions with others who may or may not be educated about concussion. Do you also discuss the more long-term consequences with the parents as well? Do you do think parents are receptive to this information generally?