Confirmatory factor analysis of imPACT cognitive tests in high school athletes.

Abstract

ImPACT is the most commonly utilized computerized neurocognitive assessment for the clinical management of sport concussion. The cognitive composite scores that ImPACT currently reports include Verbal Memory, Visual Memory, Visual Motor Speed, Reaction Time, and Impulse Control. However, exploratory factor analytic studies report that two or more factors may better represent ImPACT's latent structure, suggesting that the current cognitive composites may not adequately represent the cognitive constructs ImPACT assesses. The latent structure of ImPACT cognitive baseline scores was examined using exploratory (EFA) and confirmatory factor analysis (CFA) of valid baseline ImPACT scores for 36,091 high school athletes. These athletes were randomly divided into two samples. The first sample was a calibration sample used for EFA and the second sample was a cross-validation sample used for CFA to estimate the best model identified in the calibration phase, along with other models that were reported in the literature or based on theoretical considerations, including hierarchical and bifactor models. EFA identified a first-order four-factor solution consisting of Visual Memory, Visual Reaction Time, Verbal Memory, and Working Memory constructs. CFA indicated that this four-factor model provided superior fit for the data, while the current five-composite structure of ImPACT provided a poor fit for the data. The latent constructs identified in this study using CFA do not map well onto the composite scores that are currently used to interpret ImPACT performance. Future research should investigate whether interpretation of ImPACT based on the constructs identified here will be more useful for clinical decision making than current approaches. Public Significance StatementImPACT assesses cognitive abilities and is used for return-to-play decisions after sport concussion. Our research demonstrates that these cognitive abilities are not well represented by current ImPACT composites used for interpretation. Additional research is needed to determine if the four cognitive domains identified here (Visual Memory, Visual Reaction Time, Verbal Memory, and Working Memory) are more useful for clinical management of concussion than the five ImPACT composites currently in use.

A systematic review and meta-analysis of factors influencing ImPACT concussion testing in high school and collegiate athletes with self-reported ADHD and/or LD.

“…Recent factor analysis evidence has called into question the current composites used by ImPACT as well as its concordance with other standard neuropsychological assessments, which suggests that possible known cognitive effects of ADHD and/or LD might not present as one would expect on ImPACT testing (Alsalaheen et al, 2016; Maietta, Ahmed, et al, 2021). Future research is needed to address the relationship and concordance between the cognitive effects found on ImPACT and how they relate to cognitive effects of ADHD and/or LD that are known to be present on standard neuropsychological measures.…”

“…ImPACT is a 20-min computerized neurocognitive assessment that is composed of a demographic questionnaire (where athletes can report history of neurodevelopmental disorders), six cognitive subtests, and symptom ratings (Lovell et al, 2006). Cognitive subtests include Word Memory, Design Memory, X’s and O’s, Symbol Match, Color Match, and Three Letters, which are currently combined to form five composite scores—Verbal Memory, Visual Memory, Visual Motor Speed, Reaction Time, and Impulse Control—although the factorial validity of these composites has been called into question (Allen & Gfeller, 2011; Gerrard et al, 2017; Maietta, Ahmed, et al, 2021; Schatz & Maerlender, 2013). Assessed symptoms include cognition, sleep/arousal, physical, and affective symptoms (Karr & Iverson, 2022), although alternative constructs and symptom indices have also been suggested (Kontos et al, 2012; Merritt et al, 2015).…”

Cognitive profiles following sport-related concussion in high school athletes.

“…Cluster analysis was conducted on each PC group and analyses were cross-sectional. Neurocognitive factor scores were calculated using the four-factor structure found in previous research (Maietta, Ahmed, et al, 2021). Subtest scores were standardized and averaged with other scores on the factor to which they belonged.…”

“…Scores from these subtests are combined by ImPACT software to form five composite scores—Verbal Memory, Visual Memory, Visual Motor Speed, Reaction Time, and Impulse Control. Recent literature has called into question the validity of the five-composite structure that ImPACT currently utilizes (Allen & Gfeller, 2011; Gerrard et al, 2017; Maietta, Ahmed, et al, 2021; Schatz & Maerlender, 2013). Exploratory and confirmatory factor analysis (conducted in independent samples of more than 18,000 athletes each) found no support for the five-composite structure currently utilized but identified an alternate four-factor solution that demonstrated superior fit (Maietta, Ahmed, et al, 2021).…”

“…Recent literature has called into question the validity of the five-composite structure that ImPACT currently utilizes (Allen & Gfeller, 2011; Gerrard et al, 2017; Maietta, Ahmed, et al, 2021; Schatz & Maerlender, 2013). Exploratory and confirmatory factor analysis (conducted in independent samples of more than 18,000 athletes each) found no support for the five-composite structure currently utilized but identified an alternate four-factor solution that demonstrated superior fit (Maietta, Ahmed, et al, 2021). As such, the four-factor solution identified in this previous research was used for the present cluster analysis.…”