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Age of First Concussion and Cognitive, Psychological, and Physical Outcomes in NCAA Collegiate Student Athletes

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Abstract

Objective

Concussions are common among youth athletes and could disrupt critical neurodevelopment. This study examined the association between age of first concussion (AFC) and neurocognitive performance, psychological distress, postural stability, and symptoms commonly associated with concussion in healthy collegiate men and women student athletes.

Methods

Participants included 4267 collegiate athletes from various contact, limited-contact, and non-contact sports (1818 women and 2449 men) who completed baseline assessments as part of the Concussion Assessment, Research and Education (CARE) Consortium. Psychological distress was assessed with the Brief Symptom Inventory 18; neurocognitive performance was assessed with the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT); symptoms commonly associated with concussion were assessed with the ImPACT Post-Concussion Symptom Scale; postural stability was assessed with the Balance Error Scoring System. Generalized linear models were used to examine the effects of AFC on clinical outcomes separately in men and women.

Results

Later AFC was associated with lower global (Exp(B) = 0.96, P = 0.001) and somatic (Exp(B) = 0.96, P = 0.002) psychological distress on the Brief Symptom Inventory 18 and faster ImPACT reaction time (B =  − 0.003, P = 0.001) in women. AFC was not associated with any clinical outcomes in men.

Conclusion

Younger AFC was associated with some differences in psychological distress and reaction time among women but not men; however, these results are likely not clinically meaningful. Sociodemographic disparities, pre-existing conditions, and sport type may impact clinical and cognitive outcomes in collegiate athletes more than concussion history. Future work should examine the relationship between AFC and lifespan-related outcomes.

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Acknowledgements

Contributing CARE Consortium Investigators Include: April Marie (Reed) Hoy, MS, ATC (Azusa Pacific University); Darren Campbell, MD (Brigham Young University); Louise A. Kelly, PhD (California Lutheran University); John DiFiori, MD (Hospital for Special Surgery, National Basketball Association); Justus D. Ortega, PhD (Humboldt State University); Nicholas Port, PhD (Indiana University); Margot Putukian MD (Major League Soccer); T. Dianne Langford, PhD and Jane McDevitt, PhD, ATC, CSCS (Temple University); Christopher C. Giza, MD (University of California, Los Angeles); Holly J. Benjamin MD (University of Chicago); Thomas W. Kaminski, PhD, ATC (University of Delaware); James R. Clugston, MD, MS (University of Florida); Joseph B. Hazzard, Jr., ATC (University of Houston-Clear Lake); Patrick G. O’Donnell, MHA (University of Massachusetts Memorial Medical Center); Luis A Feigenbaum, PT, DPT, ATC (University of Miami); James T. Eckner, MD, MS (University of Michigan); Jason P. Mihalik, PhD, CAT(C), ATC (University of North Carolina at Chapel Hill); Christina L. Master, MD (University of Pennsylvania); Anthony P. Kontos, PhD and Michael Collins, PhD (University of Pittsburgh Medical Center); Sara P.O. Chrisman, MD, MPH (University of Washington); Alison Brooks, MD, MPH (University of Wisconsin-Madison); Jonathan Jackson, MD and Gerald McGinty, PT, DPT (United States Air Force Academy); Carlos Estevez, DPT, OCS, ECS (United States Coast Guard Academy); Kenneth L. Cameron, PhD, MPH, ATC (United States Military Academy); Adam Susmarski, DO (United States Naval Academy); Christopher M. Miles, MD (Wake Forest University); Laura Lintner DO (Winston-Salem University).

Author information

Authors and Affiliations

  1. Department of Psychology, The Ohio State University, Columbus, OH, USA

    Jena N. Moody & Jasmeet P. Hayes

  2. Chronic Brain Injury Initiative, The Ohio State University, Columbus, OH, USA

    Jasmeet P. Hayes & Jaclyn B. Caccese

  3. Interdisciplinary Biomechanics and Movement Science Program, Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA

    Thomas A. Buckley

  4. Department of Kinesiology, University of Georgia, Athens, GA, USA

    Julianne D. Schmidt

  5. Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA

    Steven P. Broglio

  6. Indiana University School of Medicine, Indianapolis, IN, USA

    Thomas W. McAllister

  7. Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Michael McCrea

  8. Uniformed Services University of the Health Science and Walter Reed National Military Medical Center, Bethesda, MD, USA

    Paul F. Pasquina

  9. School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, 453 W 10th Ave, Columbus, OH, USA

    Jaclyn B. Caccese

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  1. Jena N. Moody
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Consortia

CARE Consortium Investigators

Contributions

JNM carried out analyses and interpretation of data, drafted the initial manuscript, reviewed and revised the manuscript for important intellectual content, approved the final version of the manuscript, and agrees to be accountable for all aspects of the work. JPH conceptualized and designed the study, interpreted the data, reviewed and revised the manuscript for important intellectual content, approved the final version of the manuscript, and agrees to be accountable for all aspects of the work. TAB and JDS conceptualized and designed the study, reviewed and revised the manuscript for important intellectual content, approved the final version of the manuscript, and agree to be accountable for all aspects of the work. SPB, TWM, MM, and PFP conceptualized and designed the CARE Consortium, received funding for the CARE Consortium, reviewed and revised the manuscript for important intellectual content, approved the final version of the manuscript, and agree to be accountable for all aspects of the work. JBC conceptualized and designed the study, interpreted the data, reviewed and revised the manuscript for important intellectual content, approved the final version of the manuscript, and agrees to be accountable for all aspects of the work. Named authors and CARE Consortium Investigators contributed to data acquisition, reviewed and revised the manuscript for important intellectual content, approved the final manuscript, and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Jaclyn B. Caccese.

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Conflict of interest

All of the authors declare that they have no conflicts of interest to disclose.

Funding

Data collection and sharing for this project was conducted with support from the National Collegiate Athletic Association (NCAA) and the Department of Defense (DOD). The US Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick MD 21702–5014 is the awarding and administering acquisition office. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs, through the Combat Casualty Care Research Program, endorsed by the Department of Defense, through the Joint Program Committee 6/ Combat Casualty Care Research Program – Psychological Health and Traumatic Brain Injury Program under Award No. W81XWH1420151. Opinions, interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the Department of Defense. This work was supported by the National Institute on Aging (NIA) of the National Institutes of Health (NIH) R01AG058822 (to JPH), and The Ohio State University Discovery Themes Chronic Brain Injury Initiative (JPH and JBC). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Availability of data

The CARE Consortium dataset used in the present study is available in the FITBIR repository (https://fitbir.nih.gov/).

Ethics approval

The local IRB at each performance site, as well as the US Army Medical Research and Materiel Command Human Research Protection Office, reviewed and approved all study procedures. This study was performed in accordance with the Declaration of Helsinki.

Consent to participate

All participants provided written informed consent prior to participation in this study.

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Moody, J.N., Hayes, J.P., Buckley, T.A. et al. Age of First Concussion and Cognitive, Psychological, and Physical Outcomes in NCAA Collegiate Student Athletes. Sports Med 52, 2759–2773 (2022). https://doi.org/10.1007/s40279-022-01719-7

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