Skip to main content

Advertisement

Log in

Factors Contributing to Disparities in Baseline Neurocognitive Performance and Concussion Symptom Scores Between Black and White Collegiate Athletes

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Background

National Collegiate Athletic Association (NCAA) concussion guidelines state that all NCAA athletes must have a concussion baseline test prior to commencing their competitive season. To date, little research has examined potential racial differences on baseline neurocognitive performance among NCAA athletes. The purpose of this study was to investigate differences between Black and White collegiate athletes on baseline neurocognitive performance and self-reported symptoms.

Methods

A total of 597 collegiate athletes (400 White, 197 Black) participated in this study. Athletes self-reported their race on the demographic section of their pre-participation physical examination and were administered the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) neurocognitive battery in a supervised, quiet room. Controlling for sex, data were analyzed using separate one-way analyses of covariance (ANCOVAs) on symptom score, verbal and visual memory, visual motor processing speed, and reaction time composite scores.

Results

Results revealed significant differences between White and Black athletes on baseline symptom score (F (1,542) = 5.82, p = .01), visual motor processing speed (F (1,542) = 14.89, p < .001), and reaction time (F (1,542) = 11.50, p < .01). White athletes performed better than Black athletes on baseline visual motor processing speed and reaction time. Black athletes reported higher baseline symptom scores compared to Whites. There was no statistical difference between race on verbal memory (p = .08) and that on visual memory (p = .06).

Conclusions

Black athletes demonstrated disparities on some neurocognitive measures at baseline. These results suggest capturing an individual baseline on each athlete, as normative data comparisons may be inappropriate for athletes of a racial minority.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. United States Census Bureau. Web site. http://quickfacts.census.gov/qfd/states/39/3988000.html. Updated October 14, 2015. Accessed November 1, 2016.

  2. National Collegiate Athletic Association. Sport sponsorship, participation, and demographics search 2016. Available from: http://web1.ncaa.org/rgdSearch/exec/saSearch

    Google Scholar 

  3. Coakley J. Sport in society: issues and controversies. 9th ed. New York: McGraw-Hill; 2007.

    Google Scholar 

  4. Broglio SP, Cantu R, Gioia GA, et al. National athletic trainers’ association position statement: management of sport concussion. J Ath Train. 2014;49(2):245–65.

    Article  Google Scholar 

  5. McCrory P, Meeuwisse WH, Aubry M, Cantu RC, Dvorak J, Echemendia RJ, et al. Consensus statement on concussion in sport: the 4th international conference on concussion in sport held in Zurich, November 2012. Br J Sports Med. 2013;47:250–8.

    Article  PubMed  Google Scholar 

  6. NCAA Sport Medicine Handbook Online. https://www.ncaapublications.com/searchadv.aspx?IsSubmit=true&SearchTerm=MEDICINE Accessed May 5, 2017.

  7. Manly J, Jacobs D. Future directions in neuropsychological assessment with African Americans. In: Ferraro FR, editor. Minority and cross-cultural aspects of neuropsychological assessment. Lisse: Swets and Zeitlinger; 2001. p. 79–96.

    Google Scholar 

  8. Chen T, Kaufman A, Kaufman J. Examining the interaction of age x race pertaining to Black-White differences at ages 15-93 on six horn abilities assessed by K-FAST, K-SNAP, and KAIT subtests. Percept Mot Skills. 1994;79:1683–90.

    Article  PubMed  CAS  Google Scholar 

  9. Kush J, Watkins M. Construct validity of the WISC-III verbal and performance factors for Black special education students. Assessment. 1997;4:297–304.

    Article  PubMed  CAS  Google Scholar 

  10. Ross T, Lichtenburg P, Christensen B. Normative data on the Boston Naming Test for elderly adults in a demographically diverse medical sample. Clin Neuropsychol. 1995;9:321–5.

    Article  Google Scholar 

  11. Manly J, Jacobs D, Sano M, Bell K, Merchant C, Small S. Cognitive test performance among nondemented elderly African Americans and Whites. Neurology. 1998b;50:1238–45.

    Article  PubMed  CAS  Google Scholar 

  12. Boone K, Victor T, Wen J, Razani J, Ponton M. The association between neuropsychological scores and ethnicity, language, and acculturation variables in a large patient population. Arch Clin Neuropsych. 2007;22:355–65.

    Article  Google Scholar 

  13. Manly JJ. Advantages and disadvantages of separate norms for African Americans. Clin Neuropsychol. 2005;19:270–5.

    Article  PubMed  Google Scholar 

  14. Fyffe DC, Mukherjee S, Barnes LL, Manly JJ. Explaining differences in episodic memory performance among older African Americans and whites: the roles of factors related to cognitive reserve test bias. Intl J Neuropsych Soc. 2011;17(4):625–38.

    Article  Google Scholar 

  15. Stern Y, Albert S, Tsai WY. Rate of memory decline in AD is related to education and occupation: cognitive reserve? Neurology. 1999;53:1942–7.

    Article  PubMed  CAS  Google Scholar 

  16. Manly JJ, Jacobs DM, Touradji P, Small SA, Stern Y. Reading level attenuates differences in neuropsychological test performance between African American and White elders. J Intl Neuropsych Soc. 2002;8:341–8.

    Article  Google Scholar 

  17. Whitefield K. Studying cognition in older African Americans: some conceptual considerations. J Aging Eth. 1996;1:41–52.

    Google Scholar 

  18. Mehta K, Simonsick E, Rooks R, Newman A, Pope S, Rubin S, et al. Black and white differences in cognitive function test scores: what explains the difference? J Am Geriatric Soc. 2004;52:2120–7.

    Article  Google Scholar 

  19. Shuttleworth-Edwards A, Kemp R, Rust A, et al. Cross-cultural effects on IQ test performance: a review and preliminary normative indications on WAIS-III test performance. J Clin Exp Neuropsych. 2004;26:903–20.

    Article  Google Scholar 

  20. McCrory P, Meeuwisse W, Dvorak J, Aubry M, Bailes J, Broglio S, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;

  21. Covassin T, Elbin RJ, Larson E, et al. Sex and age differences in depression and baseline sport-related concussion neurocognitive performance and symptoms. Clin J Sports Med. 2012;22(2):98–104.

    Article  Google Scholar 

  22. Covassin T, Swanik CB, Sachs M, et al. Sex differences in baseline neuropsychological function and concussion symptoms of collegiate athletes. Br J Sport Med. 2006;40:923–7.

    Article  CAS  Google Scholar 

  23. Covassin T, Elbin RJ, Harris W, et al. The role of age and sex in symptoms, neurocognitive performance, and postural stability in athletes after concussion. Am J Sport Med. 2012;40(6):1303–12.

    Article  Google Scholar 

  24. Zuckerman SL, Apple RP, Odom MJ, et al. Effect of sex on symptoms and return to baseline in sport-related concussion. J Neurosurg: Pediatrics. 2014;13(1):72–81.

    Google Scholar 

  25. Lichtenstein JD, Moser RS, Schatz P. Age and test setting affect the prevalence of invalid baseline scores on neurocognitive tests. Am J Sports Med. 2014;42(2):479–84.

    Article  PubMed  Google Scholar 

  26. Shuttleworth-Edwards AB, White eld-Alexander VJ, Radloff SE, et al. Computerized neuropsychological profiles of South African versus US athletes: a basic for commentary on cross-cultural norming issues in the sports concussion arena. Phys Sportsmed. 2009;37:45–52.

    Article  PubMed  Google Scholar 

  27. Tsushima WT, Oshiro R. Neuropsychological test performance of Hawaii high school athletes: Hawaii ImPACT normative data. Hawaii Med J. 2008;67(4):93–5.

    PubMed  Google Scholar 

  28. Kontos AP, Elbin RJ, Covassin T, et al. Exploring differences in computerized neurocognitive concussion testing between African American and White athletes. Arch Clin Neuropsych. 2010;25:734–44.

    Article  Google Scholar 

  29. Schatz P, Sandel N. Sensitivity and specificity of the online version of ImPACT in high school and collegiate athletes. Am J Sport Med. 2013;41(2):321–6.

    Article  Google Scholar 

  30. Elbin RJ, Schatz P, Covassin T. One-year test-retest reliability of the online version of ImPACT in high school athletes. Am J Sport Med. 2011;39(11):2319–24.

    Article  CAS  Google Scholar 

  31. Lovell M, Collins M, Podell K, et al. Immediate post-concussion assessment cognitive testing. NeuroHealth Systems: Pittsburgh; 2001.

    Google Scholar 

  32. Iverson G, Lovell M, Collins M. Interpreting change in ImPACT following sport concussion. Clin Neuropsychol. 2003;17(4):460–7.

    Article  PubMed  Google Scholar 

  33. Schatz P, Robershaw S. Comparing post-concussive neurocognitive test data to normative data presents risks for under-classifying “above average” athletes. Arch Clin Neuropsych. 2014;

  34. Iverson GL, Brooks BL, Collins M, et al. Tracking neuropsychological recovery following concussion in sport. Brain Inj. 2006;20(3):245–52.

    Article  PubMed  Google Scholar 

  35. Iverson G, Lovell R, Collins M, et al. Tracking recovery from concussion using ImPACT: applying reliable change methodology. Arch Clin Neuropsych. 2002;17:770.

    Article  Google Scholar 

  36. Schatz P, Pardini J, Lovell M, et al. Sensitivity and specificity of the ImPACT Test Battery for concussion in athletes. Arch Clin Neuropsych. 2006;21:91–9.

    Article  Google Scholar 

  37. Iverson G, Lovell M, Collins M. Validity of ImPACT for measuring attention, processing speed following sports-related concussion. J Clin Exp Neusopsych. 2005;27:683–9.

    Article  Google Scholar 

  38. Schatz P, Moser R, Solomon GS, Ott SD, Karpf R. Prevalence of invalid computerized baseline neurocognitive test results in high school and collegiate athletes. J Ath Train. 2012;47(3):289–96.

    Article  Google Scholar 

  39. Teng E, Manly J. Neuropsychological testing: helpful or harmful? Alz Disease Assoc Dis. 2005;19:267–71.

    Article  Google Scholar 

  40. Steele C, Aronson J. Stereotype threat and the intellectual test performance of African Americans. J Pers Soc Psych. 1995;69:797–811.

    Article  CAS  Google Scholar 

  41. Steele CA. Threat in the air: how stereotypes shape intellectual identity and performance. Am Psychol. 1997;52:613–29.

    Article  PubMed  CAS  Google Scholar 

  42. Katz I. Review of evidence relating to effects of desegregation on the intellectual performance of Negroes. Am Psychol. 1964;19:381–99.

    Article  Google Scholar 

  43. Zuckerman M. Some dubious premises in research and theory on racial differences: scientific, social and ethical issues. Am Psychol. 1990;45:1297–303.

    Article  PubMed  CAS  Google Scholar 

  44. Berry J. Human ecology and cognitive style. New York: Sage-Halstead; 1976.

    Google Scholar 

  45. Moyerman D, Foreman B. Acculturation and adjustment—a meta-analytic study. Hisp J Behav Sci. 1991;14:163–200.

    Article  Google Scholar 

  46. Kennepohl S, Shore D, Nabors N, et al. African American acculturation and neuropsychological test performance following traumatic brain injury. J Intl Neuropsych Soc. 2004;0:566–77.

    Article  Google Scholar 

  47. Ott S, Schatz P, Solomon G, et al. Neurocognitive performance and symptom profiles of Spanish-speaking Hispanic athletes on the ImPACT test. Arch Clin Neuropsych. 2014;29:152–63.

    Article  Google Scholar 

  48. Holmes L, Torwig J, Casini J, et al. Implication of socio-demographics on cognitive-related symptoms in sports concussion among children. Sports Med Open. 2016;2(38):1–8.

    Google Scholar 

  49. Lezak MD. Neuropsychological assessment. 3rd ed. Oxford: Oxford University Press; 2005.

    Google Scholar 

  50. Mitrushina M, Boone K, Razani J, D’Elia L. Handbook of normative data for neuropsychological assessment. 2nd ed. Oxford: Oxford University Press; 2005.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jessica Wallace.

Ethics declarations

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare that they have no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wallace, J., Covassin, T., Moran, R. et al. Factors Contributing to Disparities in Baseline Neurocognitive Performance and Concussion Symptom Scores Between Black and White Collegiate Athletes. J. Racial and Ethnic Health Disparities 5, 894–900 (2018). https://doi.org/10.1007/s40615-017-0437-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40615-017-0437-y

Keywords

Navigation