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Collins MW, Grindel SH, Lovell MR, et al. Relationship Between Concussion and Neuropsychological Performance in College Football Players. JAMA. 1999;282(10):964–970. doi:10.1001/jama.282.10.964
Author Affiliations: Department of Behavioral Health, Henry Ford Health System, Detroit, Mich (Drs Collins and Lovell); Departments of Family Practice (Dr Grindel) and Family Medicine/Sports Medicine (Dr McKeag), University of Pittsburgh, Pittsburgh, Pa; Departments of Clinical and Health Psychology (Drs Dede, Moser, and Sears and Mr Phalin), Community and Family Health (Dr Nicolette), and Sports Health (Mr Wasik), and Department of Orthopedics and Rehabilitation, College of Medicine (Dr Indelicato), University of Florida, Gainesville; Departments of Athletic Training (Ms Nogle) and Psychology (Mr Cordry and Ms Daugherty), Michigan State University, East Lansing; and Department of Sports Medicine, St Vincent's Medical Center, Erie, Pa (Dr Grindel).
Context Despite the high prevalence and potentially serious outcomes associated
with concussion in athletes, there is little systematic research examining
risk factors and short- and long-term outcomes.
Objectives To assess the relationship between concussion history and learning disability
(LD) and the association of these variables with neuropsychological performance
and to evaluate postconcussion recovery in a sample of college football players.
Design, Setting, and Participants A total of 393 athletes from 4 university football programs across the
United States received preseason baseline evaluations between May 1997 and
February 1999. Subjects who had subsequent football-related acute concussions
(n=16) underwent neuropsychological comparison with matched control athletes
from within the sample (n=10).
Main Outcome Measures Clinical interview, 8 neuropsychological measures, and concussion symptom
scale ratings at baseline and after concussion.
Results Of the 393 players, 129 (34%) had experienced 1 previous concussion
and 79 (20%) had experienced 2 or more concussions. Multivariate analysis
of variance yielded significant main effects for both LD (P<.001) and concussion history (P=.009),
resulting in lowered baseline neuropsychological performance. A significant
interaction was found between LD and history of multiple concussions and LD
on 2 neuropsychological measures (Trail-Making Test, Form B [P=.007] and Symbol Digit Modalities Test [P=.009]),
indicating poorer performance for the group with LD and multiple concussions
compared with other groups. A discriminant function analysis using neuropsychological
testing of athletes 24 hours after acute in-season concussion compared with
controls resulted in an overall 89.5% correct classification rate.
Conclusions Our study suggests that neuropsychological assessment is a useful indicator
of cognitive functioning in athletes and that both history of multiple concussions
and LD are associated with reduced cognitive performance. These variables
may be detrimentally synergistic and should receive further study.
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