An Investigation of Sport Concussion in

UNM Athletes

Richard Campbell, Ph.D.Professor, Dept. of Psychiatry

UNM School of Medicine

Physical Emotional

Cognitive Sleep

Only 10-25% have LOC

Chronic Traumatic Encephalopathy (CTE)

Sport Concussion: Potential Pediatric Health Problem Estimated 1.6-3.8 million SR-related TBIs/year 7.5 million student-athletes/recreational athletes in

high school; 30+ million younger children participating in sports

Cognitive Effects of mTBI/Concussion

? Long term effects of repeated concussion

?vulnerability to repeat concussion

? Younger children/Females more vulnerable or worse outcome?

Management of Sport-Related Concussion: When is it safe to return to play?

20 management guidelines of SR concussion published

Consensus that athletes should not RTP until symptom free Athletes should rest until they are

asymptomatic (no vigorous physical activity or heavy mental exertion

When asymptomatic, return to light aerobic exercise (International Concussion in Sport Conferences in Vienna (Aubry et al., 2002) and Prague (McCrory et al., 2005, and Zurich)

Little consensus on how to measure concussion-related symptoms or impairments (ie symptom free)

– Concussion symptom checklists (Rely on athlete self- report)

– Brief sideline cognitive testing– Postural stability measurements– Neuropsychological testing

• Reasons Concussions are not Reported (McCrea et al., 2004)

– Did not think it was serious (66%)

– Did not want to leave game (41%)– Did not know it was a concussion (36%)– Did not want to let down teammates

(22%)Sports Concussion/mTBI and Boxing

Warden et al. Neurology 2001

• West Point boxers

• Felt ready to be back in class

• Impaired reaction time

Aims• Determine sensitivity of cognitive assessment

tools to sequelae of sport concussion (severity, time to recovery)

– Sideline mental status exam– Traditional paper/pencil neuropsychological

measures– Computerized neuropsychological testing (i.e.,

ImPACT)

• Determine content validity of ImPACT with traditional neuropsychological measures

• To identify brain abnormalities associated with sport concussion and its recovery via neuroimaging (sMRI, DTI, MRS, MEG,fMRI) and their relation to neurocognitive measures

An Investigation of Sports Concussion in University of New Mexico Athletes

• Participants: – N= 103 UNM athletes (n= 76

football, n=7 womens’ soccer, n= 20 mens soccer)

– Hx. of prior concussions: 0 = 72, 1 = 28, 2 = 12, 3 = 2, 6 = 1.

– 8 subjects had concussion 2009

• Procedures– Baseline (preseason)

neuropsychological testing• UNM Neuropsychological Test

Battery and ImPACT– Within 72 hours of concussion

• UNM Neuropsychological Test Battery and ImPACT

• MRI, DTI, MRS, fMRI, MEG– Three weeks or > after concussion

and symptom-free• UNM Neuropsychological Test

Battery and ImPACT• MRI, DTI, MRS, fMRI, MEG

Results: ImPACT and Traditional Neuropsych Tests• ImPACT Verbal Memory Composite Score correlates with:

– HVLT Total Recall Score (r = .19, p = .05)– HVLT Delayed Recall Score (r = .36, p < .001)– HVLT Percent Retention Score (r = .33, p < .001)– BVMT Total Recall Score (r = .35, p < .001)– BVMT Delayed Recall Total Score (r = .22, p = .03).

• ImPACT Visual Memory Score correlates only with BVMT Total Recall Score (r = .29, p < .001).

• ImPACT Visual Motor Composite Score correlates with:– WAIS-IV Symbol Search (r = .42, p < .001) – WAIS-IV Coding r = .41, p< .001)– Trails B (r = .43, p<.001).

• ImPACT Reaction Time Composite Score correlates with:– WAIS-IV Coding (r = -.25, p = .01)– Trails A (r = .29, p < .001)– Trails B, r = .31, p < .001)

• ImPACT Impulse Control Score correlates with Animal Naming (r = .19, p = .05).

ImPACT composite scores weak to modest correlations with traditional neuropsych measures

Neurocognitive function as measured by ImPACT does not seem to be sensitive to number of concussions

Results: Relation of Traditional Neuropsych Tests and Concussion Hx

HVLT Percent Retention T-score (F(3,96) – 2.96, p = .03)

The more concussions one has the more difficult it is to retain information based on traditional verbal memory test

Results: Relation between Traditional Neuropsych Tests and Concussion Severity

The more severe the concussion the more difficulty with processing speed and cognitive flexibility

An Investigation of Sports Concussion in University of New Mexico Athletes

Collaborators:

Chris McGrew, MDRobert Thoma, Ph.D.John King, Ph.D.John Phillips, MDDavid Binder, ATCDavid Smith, ATCAndy Mayer, Ph.D.Arvind Caprihan, Ph.D.Charles Gasparovic, Ph.D.Ron Yeo, Ph.D.

Per LysneMaggie MannellSusan MuraidaJonathan Kurtyka, Ph.D.Laura Lundy, MSDina Hill, Ph.D.Krista Wild, Ph.D.Jessica PommyDavid RuhlMollie MonnigDalin Pulsipher, MSJovan HernandezTerri TeshibaFlannery MeridethMaggie MannellChristina Tedeschi