Long-Term Cognitive Impairments of Sports Concussions in College-Aged Athletes: A Meta-Analysis

Abstract

Introduction/PurposeThis meta-analysis aimed to investigate the long-term (3+ months) consequences of concussion across cognitive domains (processing speed, memory, attention, and executive functions) and subdomains in young adult athletes (university, professional, or recreational).MethodsSix databases (EMBASE, PubMed, PsycINFO, SPORTDiscus, Web of Science, and Cochrane List of Registered Trials) were searched for studies that compared cognitive performance between athletes with a history of concussion (HOC) and control athletes who never sustained a brain injury. Thus, the analyses were restricted to the studies investigating sports concussions.ResultsNineteen studies, including 20 independent experiments with 1514 participants (521 HOC athletes, 1184 controls), were identified. Athletes from the HOC group sustained an average of 2.40 ± 0.99 concussions, with an average of 29.88 ± 19.26 months after injury. Importantly, all HOC athletes were tested at least 3 months after their most recent concussion. The results indicated significant medium-to-large group differences (Hedges’ g = 0.55–1.03; P values < 0.0001) for executive functions subdomains on both standardized clinical tests and screening tools. Specifically, HOC athletes had lower cognitive performance relative to controls in strategy generation/regulation, verbal set-shifting and interference management on standardized clinical tests (Regensburger verbal fluency S words and G/R words), and response inhibition (ImPACT Impulse Control composite) and prospective working memory (Cogstate two-back task) on screening tools. Encoding phase of visual memory (Brief Visuospatial Memory Test) on standardized clinical tests approached significance (Hedges’ g = 0.40; P values = 0.08).ConclusionsThe current findings provide a preliminary guideline to clinicians for the assessment of cognition in HOC athletes and inform future guidelines on common data elements of sport-related concussions.

Investigating the diagnostic accuracy of a paper-and-pencil and a computerized cognitive test battery for pediatric mild traumatic brain injury.

“…At the EC visit, the paper-and-pencil HVLT-R immediate recall was the sole significant predictor of group classification across batteries. While meta-analyses in adults (Belanger & Vanderploeg, 2005; Belanger et al, 2005; Redlinger et al, 2022) have shown group differences between mTBI and control groups in verbal learning, pmTBI studies to date have not supported the clinical utility of the HVLT-R. Specifically, pmTBI patients showed similar recall performance on the HVLT-R to that of controls at 7–10 days and 30-day postinjury at the group level (Newsome et al, 2016), as well as 6-month postinjury (Baillargeon et al, 2012).…”

“…Current literature has also been inconclusive in determining whether the cognitive effects of pmTBI are limited to the acute and SA phases of injury or extend substantially in time postinjury. While some studies have reported null findings on the lingering cognitive effects of mTBI in both pediatric and adult populations (Moore et al, 2018; Redlinger et al, 2022), other studies have indicated a subset of cognitively impaired individuals beyond what is expected in a normative sample in pediatric (5%; Babikian et al, 2013; Beauchamp et al, 2018; Iverson et al, 2006; McGrath et al, 2013; Rieger et al, 2013) and adult mTBI populations (Makdissi et al, 2010; Sicard, Caron, et al, 2021; Sicard et al, 2020). Numerous potential methodological differences can account for the discrepancies in these findings, including the heterogeneity of samples, cognitive tests employed, and assessment endpoints.…”

“…The present study hypothesized that the paper-and-pencil neuropsychological battery would have higher sensitivity and specificity than the computerized test battery across both SA and EC injury phases based on previous studies suggesting time-limited sensitivity for computerized testing (acute phase only; Cole et al, 2018; Czerniak et al, 2020; Nelson et al, 2016, 2017). Measures of attention and memory/working memory were expected to be the most sensitive relative to other cognitive tasks (Belanger & Vanderploeg, 2005; Belanger et al, 2005, 2010; Moore et al, 2018; Redlinger et al, 2022). Further, we predicted that the rate of impairment on both batteries would be significantly elevated in the pmTBI group (i.e., more than one measure) relative to the HC group at the SA visit only (Beauchamp et al, 2015; Beauchamp et al, 2018).…”

The association between symptom burden and processing speed and executive functioning at 4 and 12 weeks following pediatric concussion

“…Processing speed refers to the ability to process information and complete cognitive tasks quickly and efficiently. While some studies have indicated alterations in processing speed in the days following concussion (Kontos et al, 2014) that tend to resolve by a few months post-injury (Hou et al, 2023;Robertson-Benta et al, 2023;Rohling et al, 2011), other studies have reported null findings across injury phases (Alsalaheen et al, 2021;Redlinger et al, 2022;Sicard et al, 2022;Sicard, Hergert, et al, 2021). Processing speed is closely linked to executive functioning (EF), which encompasses top-down cognitive processes responsible for planning, organizing, initiating, monitoring, and controlling goaldirected behavior.…”

“…Accumulating evidence in pediatric and adult samples has suggested that EF is particularly susceptible to concussion, with lower performance on EF tasks in individuals within weeks to months of a concussion relative to individuals without concussion (Baillargeon et al, 2012;Chadwick et al, 2021;Halterman et al, 2006;Howell et al, 2013;Lax et al, 2015;Loher et al, 2014;Mayr et al, 2014;Moore et al, 2014Moore et al, , 2015Moore et al, , 2016Moore et al, , 2017Moore et al, , 2019Ozen et al, 2013;Ozturk et al, 2021;Robertson-Benta et al, 2023;Sicard, Caron, et al, 2021;Sicard et al, 2018Sicard et al, , 2019Sicard et al, , 2020Sicard, Harrison, et al, 2021). A recent meta-analysis indicated that athletes with a history of concussion (at least 3 months from their last concussion) perform more poorly on EF tasks when compared to controls with no history of concussion, although no such differences were observed for other cognitive domains (Redlinger et al, 2022).…”