Abstract
Purpose of Review
Sport-related concussion (SRC) is a significant public health problem. Understanding the behavioral and personal factors that influence risk and incidence of SRC is critically important for appropriate care and management. Sensation-seeking and impulsivity have been posited to be two such factors that may be significantly associated with SRC. We performed a focused review of recent evidence of the relationships between sensation-seeking and impulsivity in athletes with SRC.
Recent Findings
While the research is relatively limited, extant findings demonstrate a significant relationship between sensation-seeking and contact sport participation and risk of prior and future SRC. Impulsivity appears to be common among athletes competing in high contact sports and may contribute to neural and functional brain changes following SRC; however, causal relationships between impulsivity, contact sport participation, and SRC have not been demonstrated.
Summary
Both sensation-seeking and impulsivity are significantly associated with SRC in collegiate athletes. Interventions designed to ameliorate high levels of these constructs may prove to be beneficial avenues to reducing SRC risk and improving patient care and outcomes.
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Data Availability
Not applicable.
References
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McCrory P, Meeuwisse WH, Aubry M, Cantu B, Dvorak J, Echemandia RJ, et al. Consensus statement on concussion in sport: the 4th International Conferences on Concussion in Sport held in Zurich, November 2012. Br J Sports Med. 2013;47(5):250–8. https://doi.org/10.1136/bjsports-2013-092313.
Koh JO, Cassidy JD, Watkinson EJ. Incidence of concussion in contact sports: a systematic review of the evidence. Brain Inj. 2003;17(10):901–17. https://doi.org/10.1080/0269905031000088869.
Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil. 2006;21(5):375–8. https://doi.org/10.1097/00001199-200609000-00001.
Broglio SP, Puetz TW. The effect of sport concussion on neurocognitive function, self-report symptoms, and postural control: a meta-analysis. Sports Med. 2008;38:53–67. https://doi.org/10.2165/00007256-200838010-00005.
McAllister T, McCrea M. Long-term cognitive and neuropsychiatric consequences of repetitive concussion and head-impact exposure. J Athl Train. 2017;52(3):309–17. https://doi.org/10.4085/1062-6050-52.1.14.
Rabinowitz AR, Levin HS. Cognitive sequelae of traumatic brain injury. Psychiatr Clin North Am. 2014;37(1):1–11. https://doi.org/10.1016/j.psc.2013.11.004.
Wood TA, Hsieh KL, An R, Ballard RA, Sosnoff JJ. Balance and gait alterations observed more than 2 weeks after concussion: a systematic review and meta-analysis. Am J Phys Med Rehabil. 2019;98(7):566–76. https://doi.org/10.1097/PHM.0000000000001152.
Meier TB, Giraldo-Chica M, España LY, Mayer AR, Harezlak J, Nencka AS, et al. Resting-state fMRI metrics in acute sport-related concussion and their association with clinical recovery: a study from the NCAA-DoD care consortium. J Neurotrauma. 2020;37(1):152–62. https://doi.org/10.1089/neu.2019.6471.
Mustafi SM, Harezlak J, Koch KM, Nencka AS, Meier TB, West JD, et al. Acute white-matter abonormalities in sports-related concussion: a diffusion tensor imaging study from the NCAA-DoD CARE Consortium. J Neurotrauma. 2018;35(22):2653–64. https://doi.org/10.1089/neu.2017.5158.
Stern RA, Adler CH, Chen K, Navitsky M, Luo J, Dodick DW, et al. Tau positron-emission tomography in former National Football League players. N Engl J Med. 2019;380:1716–25. https://doi.org/10.1056/NEJMoa1900757.
Wang Y, Nelson LD, LaRoche AA, Pfaller AY, Nencka AS, Kock KM, et al. Cerebral blood flow alterations in acute sport-related concussion. J Neurotrauma. 2016;33(13):1227–36. https://doi.org/10.1089/neu.2015.4072.
Bernick C, Shan G, Zetterberg H, Banks S, Mishra VR, Bekris L, et al. Longitudinal change in regional brain volumes with exposure to repetitive head impacts. Neurology. 2020;94(3):e232–40. https://doi.org/10.1212/WNL.0000000000008817.
Daneshvar DH, Goldstein LE, Kiernan PT, Stein TD, McKee AC. Post-traumatic neurodegeneration and chronic traumatic encephalopathy. Mol Cell Neurosci. 2015;66(Part B):81–90. https://doi.org/10.1016/j.mcn.2015.03.007.
Deshpande SK, Hasegawa RB, Rabinowitz AR, Whyte J, Roan CL, Tabatabaei A, et al. Association of playing high school football with cognition and mental health later in life. JAMA Neurol. 2017;74(8):909–18. https://doi.org/10.1001/jamaneurol.2017.1317.
Gavett BE, Stern RA, McKee AC. Chronic traumatic encephalopathy: a potential late effect of sport-related concussive and subconcussive head trauma. Clin Sports Med. 2011;30(1):179–88. https://doi.org/10.1016/j.csm.2010.09.007.
Kerr ZY, Evenson KR, Rosamond WD, Mihalik JP, Guskiewicz KM, Marshall SW. Association between concussion and mental health in former collegiate athletes. Inj Epidemiol. 2014;1(28):28. https://doi.org/10.1186/s40621-014-0028-x.
McKee AC, Cantu RC, Nowinski CJ, Hedley-Whyte ET, Gavett BE, Budson AE, et al. Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury. J Neuropathol Exp Neurol. 2009;68(7):709–35. https://doi.org/10.1097/NEN.0b013e3181a9d503.
McKee AC, Cairns NJ, Dickson DW, Folkerth RD, Keene CD, Litvan I, et al. The first NINDS/NIBIB consensus meeting to define neuropathological criteria for the diagnosis of chronic traumatic encephalopathy. Acta Neuropathol. 2016;131(1):75–86. https://doi.org/10.1007/s00401-015-1515-z.
Randolph C, Karantzoulis S, Guskiewicz K. Prevalence and characterization of mild cognitive impairment in retire national football league players. J Int Neuropsychol Soc. 2013;19(8):873–80. https://doi.org/10.1017/S1355617713000805.
Abrahams S, Mc Fie S, Patricios J, Posthumus M, September AV. Risk factors for sports concussion: An evidence-based systematic review. Br J Sports Med. 2013;48(2):91–7. https://doi.org/10.1136/bjsports-2013-092734.
Makdissi M, Davis G, Jordan B, Patricios J, Purcell L, Putukian M. Revisiting the modifiers: how should the evaluation and management of acute concussions differ in specific groups? Br J Sports Med. 2013;47(5):314–20. https://doi.org/10.1136/bjsports-2013-092256.
Rosenthal JA, Foraker RE, Collins CL, Comstock RD. National high school athlete concussion rates from 2005-2006 to 2011-2012. Am J Sports Med. 2014;42(7):1710–5. https://doi.org/10.1177/0363546514530091.
McEwan D, Boudreau P, Curran T, Rhodes RE. Personality traits of high-risk sport participants: a meta-analysis. J Res Pers. 2019;79:83–93. https://doi.org/10.1016/j.jrp.2019.02.006.
Sharma L, Markon KE, Clark LA. Toward a theory of distinct types of “impulsive” behaviors: a meta-analysis of self-report and behavioral measures. Psychol Bull. 2014;140(2):374–408. https://doi.org/10.1037/a0034418.
Smith GT, Fischer S, Cyders MA, Annus AM, Spillane NS, McCarthy DM. On the validity and utility of discriminating among impulsivity-like traits. Assessment. 2007;14(2):155–70. https://doi.org/10.1177/1073191106295527.
Steinberg L, Albert D, Cauffman E, Banich M, Graham S. Age differences in sensation seeking and impulsivity as indexed by behavior and self-report: evidence for a dual systems model. Dev Psychol. 2008;44(6):1764–78. https://doi.org/10.1037/a0012955.
Mosti C, Coccaro EF. Mild traumatic brain injury and aggression, impulsivity and history of other- and self-directed aggression. J Neuropsychiatr Clin Neurosci. 2018;30(3):220–7. https://doi.org/10.1176/appi.neuropsych.17070141.
Schroth ML. A comparison of sensation seeking among different groups of athletes and nonathletes. Personal Individ Differ. 1995;18(2):219–22. https://doi.org/10.1016/0191-8869(94)00144-H.
Veliz P, Esteban McCabe S, Eckner JT, Schulenberg JE. Concussion, sensation-seeking and substance use among US adolescents. Subst Abus. 2019:1–9. https://doi.org/10.1080/08897077.2019.1671938.
Beidler E, Covassin T, Donnellan MB, Nogle S, Pontifex MB, Kontos AP. Higher-risk taking behaviors and sensation seeking needs in collegiate student-athletes with a history of multiple sport-related concussions. Br J Sports Med. 2017;51(11):A66–A6A66. https://doi.org/10.1136/bjsports-2016-097270.172.
Hollis SJ, Stevenson MR, McIntosh AS, Shores EA, Collins MW, Taylor CB. Incidence, risk, and protective factors of mild traumatic brain injury in a cohort of Australian nonprofessional male rugby players. Am J Sports Med. 2009;37(12):2328–33. https://doi.org/10.1177/0363546509341032.
•• Liebel SW, Van Pelt KL, Garcia G-GP, Czerniak LL, McCrea MA, McAllister T, et al. The relationship between sport-related concussion and sensation-seeking. Int J Mol Sci. 2020;21:9097. https://doi.org/10.3390/ijms21239097This article is the first to employ a prospective design to elucidate the relationships between sensation-seeking and SRC risk and incidence.
Broglio SP, McCrea M, McAllister T, Harezlak J, Katz B, Hack D, et al. A national study on the effects of concussion in collegiate athletes and US military service academy members: the NCAA-DoD Concussion Assessment, Research, and Education (CARE) Consortium structure and methods. Sports Med. 2017;47:1437–51. https://doi.org/10.1007/s40279-017-0707-1.
O’Connor KL, Allred CD, Cameron KL, Campbell DE, Houston MN, Johnson BR, et al. The prevalence of concussion within the military academies: findings from the Concussion Assessment, Research, and Education (CARE) Consortium. Br J Sports Med. 2017;51(11):A33–A3A33. https://doi.org/10.1136/bjsports-2016-097270.84.
Dretsch MN, Silverberg N, Gardner AJ, Panenka WJ, Emmerich T, Crynen G, et al. Genetics and other risk factors for past concussions in active-duty soldiers. J Neurotrauma. 2017;34:869–75. https://doi.org/10.1089/neu.2016.4480.
Kahler CW, Spillane NS, Metrik J, Leventhal AM, Monti PM. Sensation seeking as a predictor of treatment compliance and smoking cessation treatment outcomes in heavy social drinkers. Pharmacol Biochem Behav. 2009;93(3):285–90. https://doi.org/10.1016/j.pbb.2009.01.033.
Tomko RL, Bountress KE, Gray KM. Personalizing substance use treatment based on pre-treatment impulsivity and sensation seeking: a review. Drug Alcohol Depend. 2016;167(1):1–7. https://doi.org/10.1016/j.drugalcdep.2016.07.022.
•• Goswami R, Dufort P, Tartaglia MC, Green RE, Crawley A, Tator CH, et al. Frontotemporal correlates of impulsivity and machine learning in retired professional athletes with a history multiple concussions. Brain Struct Funct. 2016;221(4):1911–25. https://doi.org/10.1007/s00429-015-1012-0This article provides compelling evidence of the negative neurophysiological and neurofunctional consequences of SRC.
Vella SA, Benson A, Sutcliffe J, McLaren C, Swann C, Schweickle MJ, et al. Self-determined motivation, social identification and the mental health of adolescent male team sport participants. J Appl Sport Psychol. 2020:1–15. https://doi.org/10.1080/10413200.2019.1705432.
Burman E, Lysholm J, Shahim P, Malm C, Tegner Y. Concussed athletes are more prone to injury both before and after their index concussion: a data base analysis of 699 concussed contact sports athletes. BMJ Open Sport Exerc Med. 2016;2(1):e000092. https://doi.org/10.1136/bmjsem-2015-000092.
Prien A, Grafe A, Rössler R, Junge A, Verhagen E. Epidemiology of head injuries focusing on concussions in team contact sports: a systematic review. Sports Med. 2018;48(4):953–69. https://doi.org/10.1007/s40279-017-0854-4.
Zavorsky GS, Smoliga JM. Risk of concussion for athletes in contact sports at higher altitudes vs at sea level. JAMA Neurol. 2016;73(11):1369–70. https://doi.org/10.1001/jamaneurol.2016.0795.
Rochat L, Ammann J, Mayer E, Annoni J-M, Van der Linden M. Executive disorders and perceived socio-emotional changes after traumatic brain injury. J Neuropsychol. 2009;3(2):213–27. https://doi.org/10.1348/174866408X397656.
Sharma A, Hind K, Hume P, Singh J, Neary JP. Neurovascular coupling by functional near infra-red spectroscopy and sport-related concussion in retired rugby players: the UK Rugby Health Project. Front Hum Neurosci. 2020;14:42. https://doi.org/10.3389/fnhum.2020.00042.
Bailey MR, Simpson EH, Balsam PD. Neural substrates underlying effort, time, and risk-based decision making in motivated behavior. Neurobiol Learn Mem. 2016;133:233–56. https://doi.org/10.1016/j.nlm.2016.07.015.
Nakazato T. Dual-mode dopamine increases mediated by 5-HT 1B and 5-HT 2C receptors inhibition, inducing impulsive behavior in trained rats. Exp Brain Res. 2019;237(10):2573–84. https://doi.org/10.1007/s00221-019-05611-1.
Petzold J, Lee Y, Pooseh S, Oehme L, Beuthien-Baumann B, London ED, et al. Presynaptic dopamine function measured with [18 F] fluorodopa and L-DOPA effects on impulsive choice. Sci Rep. 2019;9:17927. https://doi.org/10.1038/s41598-019-54329-1.
Michałowska-Sawczyn M, Niewczas M, Król P, Czarny W, Rzeszutko A, Chmielowiec K, et al. Associations between the dopamine D4 receptor gene polymorphisms and personality traits in elite athletes. Biol Sport. 2019;36(4):365–72. https://doi.org/10.5114/biolsport.2019.85457.
Abrahams S, McFie S, Lacerda M, Patricios J, Suter J, September AV, et al. Unravelling the interaction between the DRD2 and DRD4 genes, personality traits and concussion risk. BMJ Open Sport Exerc Med. 2019;5(1):e000465. https://doi.org/10.1136/bmjsem-2018-000465.
Cochrane GD, Sundman MH, Hall EE, Kostek MC, Patel K, Barnes KP, et al. Genetics influence neurocognitive performance at baseline but not concussion history in collegiate student-athletes. Clin J Sport Med. 2018;28(2):125–9. https://doi.org/10.1097/JSM.00000000000000443.
Petito A, Altamura M, Iuso S, Padalino FA, Sessa F, D'Andrea G, et al. The relationship between personality traits, the 5HTT polymorphisms, and the occurrence of anxiety and depressive symptoms in elite athletes. PLoS One. 2016;11(6):e0156601. https://doi.org/10.1371/journal.pone.0156601.
• Chen Y-H, Huang EY-K, Kuo T-T, Miller J, Chiang Y-H, Hoffer BJ. Impact of traumatic brain injury on dopaminergic transmission. Cell Transplant. 2017;26(7):1156–68. https://doi.org/10.1177/09636891717714105This article thoroughly reviews the extant literature regarding the possible subtle disruption of neural circuits as well as functional changes at the neurotransmitter level, particularly dopamine physiology, after TBI.
Vonder Haar C, Ferland J-MN, Kaur S, Riparip L-K, Rosi S, Winstanley CA. Cocaine self-administration is increased after frontal traumatic brain injury and associated with neuroinflammation. Eur J Neurosci. 2019;50(3):2134–45. https://doi.org/10.1111/ejn.14123.
Vonder Haar C, Lam FCW, Adams WK, Riparip L-K, Kaur S, Muthukrishna M, et al. Frontal traumatic brain injury in rats causes long-lasting impairment in impulse control that are differentially sensitive to pharmacotherapeutics and associated with chronic neuroinflammation. ACS Chem Neurosci. 2016;7(11):1531–42. https://doi.org/10.1021/acschemneuro.6b00166.
Mc Fie S, Abrahams S, Patricios J, Suter J, Posthumus M, September AV. The association between catechol o-methyltransferase (comt) rs4680 polymorphism, harm avoidance scores, and concussion history in rugby union players. Br J Sports Med. 2017;51:A32–A3A32. https://doi.org/10.1136/bjsports-2016-097270.82.
Mc Fie S, Abrahams S, Patricios J, Suter J, Posthumus M, September AV. The association between COMT rs4680 and 5-HTTLPR genotypes and concussion history in South African rugby union players. J Sports Sci. 2018;36(8):920–33. https://doi.org/10.1080/02640414.2017.1346274.
Panenka WJ, Gardner AJ, Dretsch MN, Crynen GC, Crawford FC, Iverson GL. Systematic review of genetic risk factors for sustaining a mild traumatic brain injury. J Neurotrauma. 2017;34(13):2093–9. https://doi.org/10.1089/neu.2016.4833.
Di Battista AP, Rhind SG, Richards D, Churchill N, Baker AJ, Hutchison MG. Altered blood biomarker profiles in athletes with a history of repetitive head impacts. PLoS One. 2016;11(7):e0159929. https://doi.org/10.1371/journal.pone.0159929.
Zhang T, Su J, Guo B, Wang K, Li X, Liang G. Apigenin protects blood–brain barrier and ameliorates early brain injury by inhibiting TLR4-mediated inflammatory pathway in subarachnoid hemorrhage rats. Int Immunopharmacol. 2015;28(1):79–87. https://doi.org/10.1016/j.intimp.2015.05.024.
Miles SR, Harik JM, Hundt NE, Mignogna J, Pastorek NJ, Thompson KE, et al. Delivery of mental health treatment to combat veterans with psychiatric diagnoses and TBI histories. PLoS One. 2017;12(9):e0184265. https://doi.org/10.1371/journal.pone.0184265.
Martens KM, Pechacek KM, Modrak CG, Milleson VJ, Zhu B, Vonder Haar C. Cathodal transcranial direct-current stimulation selectively decreases impulsivity after traumatic brain injury in rats. J Neurotrauma. 2019;36(19):2827–30. https://doi.org/10.1089/neu.2019.6470.
Manuel AL, Murray NWG, Piguet O. Transcranial direct current stimulation (tDCS) over vmPFC modulates interactions between reward and emotion in delay discounting. Sci Rep. 2019;9:18735. https://doi.org/10.1038/s41598-019-55157-z.
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The editors would like to thank Dr. Kamalika Roy for taking the time to review this manuscript.
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SWL and SPB conceptualized the study; SWL, KAME, and SPB wrote, edited, and reviewed the manuscript.
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Spencer W. Liebel and Katherine A. M. Edwards have no conflicts of interest or competing interests directly relevant to the content of this study. Steven P. Broglio received research support from the NCAA and the U.S. Department of Defense.
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Liebel, S.W., Edwards, K.A.M. & Broglio, S.P. Sensation-Seeking and Impulsivity in Athletes with Sport-Related Concussion. Curr Psychiatry Rep 23, 15 (2021). https://doi.org/10.1007/s11920-021-01232-0
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DOI: https://doi.org/10.1007/s11920-021-01232-0