A Retrospective Cross-Sectional and Longitudinal Study of the Effects of Age on CNS Vital Signs Scores in High-School Athletes
Current recommendations for concussion management acknowledge the importance of objective assessments of neuropsychological (NP) ability, and computerized NP assessments have been widely integrated into the concussion management protocols of high schools. The optimal intervals for baseline test administration in high-school athletes are currently uncertain. The ability to accurately detect subtle NP deficits is particularly important for high-school athletes, in which concussions are increasingly recognized for adverse effects to the developing brain.
The aim of this study was to assess the pattern of change in neurocognitive test performance, as well as changes in different domains of NP functioning over time.
Baseline computerized NP assessments were conducted at six high schools over 4 academic years using CNS Vital Signs, a battery consisting of seven well-established NP tests. Data were retrospectively examined for age differences in both cross-sectional (n = 3015) and longitudinal (n = 1221) analyses.
Moderate changes were observed across several NP domains over time (Cohen’s d = 0.39–0.61), with the largest improvements observed in executive functioning (mean improvement 5.78, 95% confidence interval [CI] 5.41–6.14, p < 0.001), psychomotor speed (mean improvement 4.59, 95% CI 3.97–5.22, p < 0.001), cognitive flexibility (mean improvement 5.11, 95% CI 4.76–5.45, p < 0.001), and reaction time (mean improvement −12.44 ms, 95% CI −10.10 to −14.78, p < 0.001). Improvements in NP performance were most pronounced between the freshman and senior years.
There is an appreciable change that occurs each year of high school in one or more domains of an NP battery, with executive functioning indicating the greatest magnitude of change. Females performed better relative to males across all time points though males exhibited more substantial improvement over time.
KeywordsExecutive Functioning Cognitive Flexibility Psychomotor Speed Continuous Performance Test Test Administration
Compliance with Ethical Standards
The project described in this paper and the preparation of this material were completed without funding.
Conflicts of interest
Sharon Rogers is contracted by the six schools that participated in this study to provide advisement relating to sports medicine policies and procedures. Patrick Smith, Alexandra Stephenson, and Erik Everhart declare they have no conflicts of interest relevant to this work.
SR was responsible for study conception and design, data acquisition, drafting and revising the article, approval of the drafts and final version, and serves as the corresponding author. PS was responsible for contributions to the intellectual content, design of the work, data analysis and interpretation, drafting and revising the article, and approval of the drafts and final version. AS was responsible for contributions to the intellectual content and final approval. EE was responsible for interpretation of data, significant contributions to the intellectual content, drafting and revising the article, and approval of the drafts and final version.
- 2.Institute of Medicine and National Research Council. Sports-related concussions in youth: improving the science, changing the culture. Washington, DC: The National Academies Press; 2013.Google Scholar
- 10.ImPact Applications, Inc. Schools, club teams, and organizations: FAQ. https://www.impacttest.com/audience/?teams-1. Accessed 5 Nov 2015.
- 21.Luna B. Developmental changes in cognitive control through adolescence. In: Bauer P, editor. Advances in child development and behavior. Waltham: Academic Press; 2009. p. 233–78.Google Scholar