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.
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 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).
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, access via your institution.
Buy single article
Instant access to the full article PDF.
Price includes VAT (USA)
Tax calculation will be finalised during checkout.
United States Census Bureau. Web site. http://quickfacts.census.gov/qfd/states/39/3988000.html. Updated October 14, 2015. Accessed November 1, 2016.
National Collegiate Athletic Association. Sport sponsorship, participation, and demographics search 2016. Available from: http://web1.ncaa.org/rgdSearch/exec/saSearch
Coakley J. Sport in society: issues and controversies. 9th ed. New York: McGraw-Hill; 2007.
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.
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.
NCAA Sport Medicine Handbook Online. https://www.ncaapublications.com/searchadv.aspx?IsSubmit=true&SearchTerm=MEDICINE Accessed May 5, 2017.
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.
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.
Kush J, Watkins M. Construct validity of the WISC-III verbal and performance factors for Black special education students. Assessment. 1997;4:297–304.
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.
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.
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.
Manly JJ. Advantages and disadvantages of separate norms for African Americans. Clin Neuropsychol. 2005;19:270–5.
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.
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.
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.
Whitefield K. Studying cognition in older African Americans: some conceptual considerations. J Aging Eth. 1996;1:41–52.
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.
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.
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;
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.
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.
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.
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.
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.
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.
Tsushima WT, Oshiro R. Neuropsychological test performance of Hawaii high school athletes: Hawaii ImPACT normative data. Hawaii Med J. 2008;67(4):93–5.
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.
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.
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.
Lovell M, Collins M, Podell K, et al. Immediate post-concussion assessment cognitive testing. NeuroHealth Systems: Pittsburgh; 2001.
Iverson G, Lovell M, Collins M. Interpreting change in ImPACT following sport concussion. Clin Neuropsychol. 2003;17(4):460–7.
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;
Iverson GL, Brooks BL, Collins M, et al. Tracking neuropsychological recovery following concussion in sport. Brain Inj. 2006;20(3):245–52.
Iverson G, Lovell R, Collins M, et al. Tracking recovery from concussion using ImPACT: applying reliable change methodology. Arch Clin Neuropsych. 2002;17:770.
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.
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.
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.
Teng E, Manly J. Neuropsychological testing: helpful or harmful? Alz Disease Assoc Dis. 2005;19:267–71.
Steele C, Aronson J. Stereotype threat and the intellectual test performance of African Americans. J Pers Soc Psych. 1995;69:797–811.
Steele CA. Threat in the air: how stereotypes shape intellectual identity and performance. Am Psychol. 1997;52:613–29.
Katz I. Review of evidence relating to effects of desegregation on the intellectual performance of Negroes. Am Psychol. 1964;19:381–99.
Zuckerman M. Some dubious premises in research and theory on racial differences: scientific, social and ethical issues. Am Psychol. 1990;45:1297–303.
Berry J. Human ecology and cognitive style. New York: Sage-Halstead; 1976.
Moyerman D, Foreman B. Acculturation and adjustment—a meta-analytic study. Hisp J Behav Sci. 1991;14:163–200.
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.
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.
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.
Lezak MD. Neuropsychological assessment. 3rd ed. Oxford: Oxford University Press; 2005.
Mitrushina M, Boone K, Razani J, D’Elia L. Handbook of normative data for neuropsychological assessment. 2nd ed. Oxford: Oxford University Press; 2005.
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.
About this article
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
- Neurocognitive performance
- Collegiate athletes
- Racial disparities
- Baseline testing