Baseline assessment of cognitive performance is common practice under many concussion management protocols and is required for collegiate athletes by the NCAA. The purpose of baseline cognitive assessment is to understand an athlete’s individual uninjured cognitive performance, as opposed to using population normative data. This baseline can then serve as a reference point for recovery after concussion and can inform return-to-play decisions. However, multiple factors, including lack of effort, can contribute to misrepresentation of baseline results which raises concern for reliability during return-to-play decision-making. Measuring effort across a continuum, rather than as a dichotomous variable (good versus poor effort) may provide informative insight related to cognitive performance at baseline.

Collegiate athletes (n = 231) completed the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) as part of their baseline pre-participation concussion evaluation. ImPACT creates composite scores of Verbal Memory, Visual Memory, Visual-Motor Speed, and Reaction Time. Baseline self-reported symptoms and total hours of sleep the night prior to testing are also collected through ImPACT. ImPACT has one embedded indicator within the program to assess effort, and research has identified an additional three embedded indicators. Athletes were also administered one stand-alone performance validity test, either the Medical Symptom Validity Test (n = 130) or the Rey Dot Counting Test (n = 101), to independently measure effort. Effort was estimated across a continuum (zero, one, two, or three or more failed effort indicators) with both stand-alone and embedded effort indicators. We evaluated the relationship between effort, symptoms, self-reported sleep, Reaction Time composite score and Visual-Motor Speed composite score using a linear regression model.

We found that 121 athletes passed all effort indicators, while 39 athletes failed only one effort indicator, 40 athletes failed two effort indicators, and 31 athletes failed three or four (three+) effort indicators. Self-reported symptoms and total hours of sleep were not related to effort, but Reaction Time and VisualMotor Speed composites were. Specifically, performance on the Visual-Motor Speed composite was significantly worse for athletes who failed two or three+ effort indicators compared to athletes who did not fail any, and performance on the Reaction Time composite was significantly worse only for athletes who failed three+ effort indicators. Additionally, athletes who failed one or more effort indicators and reported less sleep performed worse on both the Visual-Motor Speed and Reaction Time composites, compared to those who reported less sleep and did not fail any effort indicators.

Athletes who failed one effort indicator did not perform significantly worse on Reaction Time and Visual-Motor Speed composites compared to those who passed all effort indicators. However, 31% of athletes failed two or more effort indicators and these athletes performed worse on cognitive tests, likely due to factors impacting their ability to put forth good effort. These results suggest that effort is more complex than a previously used dichotomous variable and highlights the importance of using several indicators of effort throughout baseline assessments. In addition, the importance of sleep should be emphasized during baseline assessments, especially when effort is questionable.

Prior research has found that a greater history of concussion is associated with subtle increases in symptom endorsement. Recent work indicates that a family history of psychiatric disorder is a potential risk factor for prolonged recovery following a single injury. While greater symptom endorsement is observed among those with a personal psychiatric history, the potential role of family psychiatric history in elevated symptom endorsement in the context of repeated concussion has not been investigated. Therefore, the objective of this work was to determine whether family psychiatric history moderates the association of concussion history and elevated symptom endorsement in active collegiate athletes.

A total of 176 (mean age = 21.19 ± 1.63; 116 male) collegiate athletes completed this study at the Medical College of Wisconsin. Participant’s family psychiatric history was collected through a modified Family History Screen (FHS) regarding the participant’s biological parents, siblings, and children, focusing on questions relating to major depressive disorder (MDD; 3 total questions) and general psychiatric history (5 total questions). Concussion history was assessed through a semi-structured interview using American College of Rehabilitation Medicine criteria for mild traumatic brain injury. Concussion symptoms were measured via the Sport Concussion Assessment Tool (SCAT-5) and psychological distress was assessed using the Brief Symptom Inventory-18 (BSI-18). General linear models tested the association of the number of prior concussions with log-transformed SCAT-5 and BSI-18 scores. Additional general linear models were fit to assess the effects of number of prior concussions, family psychiatric history (MDD family history and general family history, each coded as Yes/No), and the interaction of prior concussion and family psychiatric history on log-transformed SCAT-5 and BSI-18 scores. Sex was included as a covariate in all models.

More prior concussions were significantly associated with greater symptom severity scores on the SCAT-5 (x2=26.87, p<0.001, unstandardized beta[B](standard error[SE])=0.25(0.05)) and BSI-18 (x2=20.94, p<0.00, B(SE)=0.19(0.04)). For the models investigating the effects of family psychiatric history, neither the main effect of MDD family history nor the MDD family history by prior concussion interaction were significant for either the SCAT-5 (ps>0.05) or BSI-18 (ps>0.05). Similarly, for the general history model, neither the main effect of general family psychiatric history nor the interaction of general family psychiatric history and number of prior concussions were significant for either the SCAT-5 (ps>0.05) or BSI-18 (ps>0.05). For both the MDD family history and general psychiatric family history models, the number of prior concussions remained positively associated with subjective symptoms on both the SCAT-5 (X2=20.10, p<0.001, and x2=23.50, p<0.001) and BSI-18 (x2=16.46, p<0.001, and x2=20.68, p<0.001).

The results of the current study provide further evidence for a relationship between elevated sub-clinical symptom endorsement and the number of prior concussions in active, collegiate athletes. The results do not, however, support the hypothesis that the association between prior concussion and an athletes’ level of symptom endorsement are moderated by the family psychiatric history. Additional research is needed to determine what factors predispose some individuals to the adverse chronic effects of repeated concussion.

Former professional American football players have a high relative risk for neurodegenerative diseases like chronic traumatic encephalopathy (CTE). Interpreting low cognitive test scores in this population occasionally is complicated by performance on validity testing. Neuroimaging biomarkers may help inform whether a neurodegenerative disease is present in these situations. We report three cases of retired professional American football players who completed comprehensive neuropsychological testing, but “failed” performance validity tests, and underwent multimodal neuroimaging (structural MRI, Aß-PET, and tau-PET).

Three cases were identified from the Focused Neuroimaging for the Neurodegenerative Disease Chronic Traumatic Encephalopathy (FIND-CTE) study, an ongoing multimodal imaging study of retired National Football League players with complaints of progressive cognitive decline conducted at Boston University and the UCSF Memory and Aging Center. Participants were relatively young (age range 55-65), had 16 or more years of education, and two identified as Black/African American. Raw neuropsychological test scores were converted to demographically-adjusted z-scores. Testing included standalone (Test of Memory Malingering; TOMM) and embedded (reliable digit span, RDS) performance validity measures. Validity cutoffs were TOMM Trial 2 < 45 and RDS < 7. Structural MRIs were interpreted by trained neurologists. Aß-PET with Florbetapir was used to quantify cortical Aß deposition as global Centiloids (0 = mean cortical signal for a young, cognitively normal, Aß negative individual in their 20s, 100 = mean cortical signal for a patient with mild-to-moderate Alzheimer’s disease dementia). Tau-PET was performed with MK-6240 and first quantified as standardized uptake value ratio (SUVR) map. The SUVR map was then converted to a w-score map representing signal intensity relative to a sample of demographically-matched healthy controls.

All performed in the average range on a word reading-based estimate of premorbid intellect. Contribution of Alzheimer’s disease pathology was ruled out in each case based on Centiloids quantifications < 0. All cases scored below cutoff on TOMM Trial 2 (Case #1=43, Case #2=42, Case #3=19) and Case #3 also scored well below RDS cutoff (2). Each case had multiple cognitive scores below expectations (z < -2.0) most consistently in memory, executive function, processing speed domains. For Case #1, MRI revealed mild atrophy in dorsal fronto-parietal and medial temporal lobe (MTL) regions and mild periventricular white matter disease. Tau-PET showed MTL tau burden modestly elevated relative to controls (regional w-score=0.59, 72nd%ile). For Case #2, MRI revealed cortical atrophy, mild hippocampal atrophy, and a microhemorrhage, with no evidence of meaningful tau-PET signal. For Case #3, MRI showed cortical atrophy and severe white matter disease, and tau-PET revealed significantly elevated MTL tau burden relative to controls (w-score=1.90, 97th%ile) as well as focal high signal in the dorsal frontal lobe (overall frontal region w-score=0.64, 74th%ile).

Low scores on performance validity tests complicate the interpretation of the severity of cognitive deficits, but do not negate the presence of true cognitive impairment or an underlying neurodegenerative disease. In the rapidly developing era of biomarkers, neuroimaging tools can supplement neuropsychological testing to help inform whether cognitive or behavioral changes are related to a neurodegenerative disease.

It has been posited that alcohol use may confound the association between greater concussion history and poorer neurobehavioral functioning. However, while greater alcohol use is positively correlated with neurobehavioral difficulties, the association between alcohol use and concussion history is not well understood. Therefore, this study investigated the cross-sectional and longitudinal associations between cumulative concussion history, years of contact sport participation, and health-related/psychological factors with alcohol use in former professional football players across multiple decades.

Former professional American football players completed general health questionnaires in 2001 and 2019, including demographic information, football history, concussion/medical history, and health-related/psychological functioning. Alcohol use frequency and amount was reported for three timepoints: during professional career (collected retrospectively in 2001), 2001, and 2019. During professional career and 2001 alcohol use frequency included none, 1-2, 3-4, 5-7 days/week, while amount included none, 12, 3-5, 6-7, 8+ drinks/occasion. For 2019, frequency included never, monthly or less, 2-4 times/month, 2-3 times/week, >4 times/week, while amount included none, 1-2, 3-4, 5-6, 7-9, 10+ drinks/occasion. Scores on a screening measure for Alcohol Use Disorder (CAGE) were also available at during professional career and 2001 timepoints. Concussion history was recorded in 2001 and binned into five groups: 0, 1-2, 3-5, 6-9, 10+. Depression and pain interference were assessed via PROMIS measures at all timepoints. Sleep disturbance was assessed in 2001 via separate instrument and with PROMIS Sleep Disturbance in 2019. Spearman’s rho correlations tested associations between concussion history and years of sport participation with alcohol use across timepoints, and whether poor health functioning (depression, pain interference, sleep disturbance) in 2001 and 2019 were associated with alcohol use both within and between timepoints.

Among the 351 participants (Mage=47.86[SD=10.18] in 2001), there were no significant associations between concussion history or years of contact sport participation with CAGE scores or alcohol use frequency/amount during professional career, 2001, or 2019 (rhos=-.072-.067, ps>.05). In 2001, greater depressive symptomology and sleep disturbance were related to higher CAGE scores (rho=.209, p<.001; rho=.176, p<.001, respectively), while greater depressive symptomology, pain interference, and sleep disturbance were related to higher alcohol use frequency (rho=.176, p=.002; rho=.109, p=.045; rho=.132, p=.013, respectively) and amount/occasion (rho=.215, p<.001; rho=.127, p=.020; rho=.153, p=.004, respectively). In 2019, depressive symptomology, pain interference, and sleep disturbance were not related to alcohol use (rhos=-.047-.087, ps>.05). Between timepoints, more sleep disturbance in 2001 was associated with higher alcohol amount/occasion in 2019 (rho=.115, p=.036).

Increased alcohol intake has been theorized to be a consequence of greater concussion history, and as such, thought to confound associations between concussion history and neurobehavioral function later in life. Our findings indicate concussion history and years of contact sport participation were not significantly associated with alcohol use cross-sectionally or longitudinally, regardless of alcohol use characterization. While higher levels of depression, pain interference, and sleep disturbance in 2001 were related to greater alcohol use in 2001, they were not associated cross-sectionally in 2019. Results support the need to concurrently address health-related and psychological factors in the implementation of alcohol use interventions for former NFL players, particularly earlier in the sport discontinuation timeline.

Recent studies have begun to explore the role of psychological resilience in pediatric mTBI recovery, with findings associating higher levels of resilience with shorter recovery and lower levels of resilience mediated by pre-injury anxiety and depression associated with persistent symptoms. The purpose of this study is to extend the current literature by further exploring the relationship between resilience, post-injury emotional changes, and length of recovery from pediatric mTBI. Based upon previous literature, we predicted that resilience would explain a unique portion of the variance in length of recovery above and beyond acute post-injury emotional symptoms in adolescents recovering from mTBI compared with orthopedic injured (OI) controls.

The current study pulled data from a larger project utilizing a prospective cohort design in two cohorts of high school student-athletes aged 14-18 (N = 32). Participants with mTBI (n = 17) or OI (n = 15) sustained during sport were recruited within 10 days of injury from a quaternary care setting. Participants completed a neuropsychological screening evaluation within one week of enrollment, including self-report rating scales of resilience (Connor-Davidson Resilience Scale-10; CD-RISC) and self- and parent-reported post-concussion symptoms (Post-Concussion Symptom Inventory, Second Edition; PCSI-2). Hierarchical regression analysis was performed with days from injury to recovery as the dependent variable. Predictors were entered in three steps: (1) group (mTBI/OI) and sex, (2) PCSI self- and parent-reported post-injury change in emotional symptoms, and (3) CD-RISC raw score. Bonferroni correction was utilized to control for multiple comparisons.

Group and sex did not provide significant prediction when entered into the first block of the model (p= .61). Introducing PCSI emotional ratings in the second block showed statistically significant improvement, F (2,26) = 5.12, p< .01), accounting for 31% of the variance in recovery length. Addition of the CD-RISC in the third block was not statistically significant (p=.59). Post hoc testing indicated parent ratings on the PCSI were significantly associated with recovery length t(32) = 3.16, p < .01, while self-reported ratings were not (p=.54).

Findings indicated that psychological resilience did not explain a unique portion of the variance in length of recovery above and beyond acute parent report of postinjury emotional symptoms in adolescents recovering from mTBI compared with orthopedic injured (OI) controls. Interestingly, sex, group (mTBI vs. OI), and self-reported acute postinjury emotional symptoms were not significant predictors of recovery length in this sample. Results highlight the significant role of acute changes in emotional symptoms in adolescents recovering from mTBI and OI in predicting length of recovery, as well as the importance of obtaining separate caregiver report. A more robust understanding of factors contributing to recovery from injury can help inform and improve preventive measures and treatment plants for those at risk or impacted; however, psychological resilience may not uniquely contribute to predicting length of recovery in acutely injured adolescents, limiting value added to the clinical exam. Future studies should explore the relationship between type of injury and recovery time in larger samples.

Neuropsychological assessment is the cornerstone of concussion management, and the nature of its delivery can vary widely. While literature concerning post-concussion care typically revolves around in-person evaluation, the proliferation of computerized neuropsychological tests (CNTs) has allowed for some distance between concussion patients and the neuropsychologist. In the wake of a global pandemic, several papers describing the use of telehealth for concussion care have emerged; however, the small samples found in these studies may suggest that access to care remains an issue. Additionally, telehealth may not be a sustainable fee-for-service approach as CMS aims to curtail telehealth reimbursement for behavioral health clinicians. The objective of the present study is to describe a remote neuropsychological consultation model of concussion management and evaluate its productivity and impact in a rural setting.

In this model, a neuropsychologist based at an academic medical center in the northeastern United States consulted to middle school, high school, and collegiate concussion management programs. Students typically were administered baseline ImPACT tests prior to participation in sports, and all students in the current sample completed post-injury ImPACT tests as part of return to play protocols. The neuropsychologist read test results through the test’s online portal, then communicated interpretation and recommendations via email or phone to the school’s representative (e.g., athletic trainer, athletic director, or school nurse). 837 unique concussions were recorded between 2019 and 2022. After removing abnormal cases (e.g., COVID-19 school closures, extended college breaks, non-concussions, and non-return to play decisions), 790 unique concussions (51.4% male) were included for analysis, with a mean age of 16.84 years (SD=2.17). Descriptive statistics were used to characterize the sample.

Across 790 unique concussions, 7 were middle school, 571 were high school, and 212 were college students. 1,750 total postinjury ImPACT tests were administered over the three-year period. Per concussion, an average of 2.22 (SD=0.90) tests were used. Average time to the last ImPACT given was 18.47 days (SD=16.59), with a median of 15 days. Ten concussions (1.27% of total concussions) occurred within 3 months of a previous injury. The distance between schools and the medical center ranged from 2.4 to 102 miles (M=60.29; SD=34.34).

The current study suggests that there is value in a remote model of neuropsychological consultation for concussion management. While telehealth offers a promising method of evaluation for concussion, it may be inaccessible and present reimbursement challenges. The remote consultation model described here increases access to care by eliminating in-person visits, which decreases demand for physical space at medical centers and increases access to rural populations with seemingly no negative effect on care. This consultation model also allows neuropsychologists working in concussion management more flexibility, potentially increasing the volume of cases they can assess. This program evaluation suggests remote models have merit, but replication studies in different regions of the country are needed.

Factors such as physical activity and sports participation may have a positive effect on executive functioning. However, people involved in sports are at a higher risk of experiencing a concussion, which may have a detrimental effect. Previous research has yet to investigate those combined negative and positive effects while also utilizing a comprehensive assessment of executive function. This study aims precisely to examine the effects of physical activity, athletic status and concussion history on subjective (e.g., questionnaire) and objective measures (e.g., latent variables) of three well-established components of executive function (i.e., inhibiting, shifting, and updating) in young adults.

247 Canadian university students (ages 18 - 25; 83% female) completed a remote assessment of executive function involving nine computerized tasks and a behavioural self-report, in addition to demographic questionnaires and items assessing weekly physical activity, athletic status, and concussion history. A linear regression analysis was used to assess the effects of the predictor variables (age, sex, concussion history, physical activity and athletic status) on subjective reporting of executive functioning using the Executive Function Index. Furthermore, structural equation modelling (SEM) was used to predict objective executive function using a three-factor model (shifting, updating, inhibition).

The three-factor measurement model of executive function fit the data adequately: x2 = 26.10, df = 17, p = 0.07, CFI = 0.97, TLI = 0.95, RMSEA = 0.05 [90% CI: 0.00-0.09], SRMR = 0.04. Then, the three-factor SEM of executive function also fit the data adequately: X2 = 66.38, df = 51, p = 0.07, CFI = 0.95, TLI = 0.93, RMSEA = 0.04 [90% CI: 0.00-0.06], SRMR = 0.05. Using SEM, no direct relationship was found between the factors of executive function and the predictor variables (i.e., age, physical activity, concussion history, and athletic status). Sex was significantly related to inhibition (b = 0.52, p = 0.02), such that males had greater inhibition. For the regression, physical activity (b = 0.09, p < .01), concussion history (b = 3.29, p < .05) and athletic status (b = -4.01, p < .05) were found to be significant predictors for the Executive Function Index.

Concussion history, physical activity, and athletic status were all predictive of subjective but not objective measures of executive function. Interestingly, these findings align with previous research that demonstrated performance-based executive function measures often do not align with self-report measures, which may suggest they are complementary but measure slightly different aspects of the underlying executive function construct. Mixed findings in the extant literature regarding sex differences and executive function require continued research to understand better the relationship and mechanisms behind the sex differences in inhibition. In summary, these findings offer support for the differentiation between subjective and objective measures of executive function when investigating their relationship with physical activity, sport participation, concussion history, age and sex.

To explore the use of Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and Heart Rate Variability (HRV) tests in the follow-up of concussions among college athletes. To provide a foundation for interpreting changes following a concussion by exploring the effects of self reported biological sex at birth on ImPACT and HRV values at baseline and after a concussion.

Data was prospectively collected within a pre-existing concussion management program. Baseline assessment (T1) included psychological questionnaires, the ImPACT test, and six minutes of HRV recording (standing, sitting, following a pacer). When a concussion occurred, the athlete was re-tested within 72 hours (T2) and tested again before returning to play (T3). 169 (55 females) athletes aged 16 to 22 years old completed the baseline testing and 30 (8 females) concussion cases were followed.

At baseline, females had higher Total Symptom scores, Sleep-Arousal Symptoms scores and Affective Symptoms scores (p ≤ 0.001). They also displayed significantly higher relative power of the very low-frequency bands (%VLF) (p < 0.05) in sitting position compared to males. There were no significant sex-related differences for any of the five ImPACT Index scores (Verbal Memory, Visual Memory, Impulse Control, Visual Motor, Reaction Time).

Mixed model repeated measure ANOVAs were performed within the concussed group. Significant differences were found between T1 and T2 as well as between T2 and T3 for Vestibular-Somatic Symptoms scores (p < 0.05); as expected, athletes displayed higher scores at T2 and scores were similar at T1 and T3. Total Symptoms scores and Cognitive-Sensory Symptoms scores were only found significantly higher at T2 compared to T3. Affective Symptoms scores were significantly higher at T1 and T2 compared to T3. < 0.05). There was no significant influence of sex on symptom scores. Of the ImPACT scores, the Visual Memory Index score showed a significant increase after concussion (T2 vs T1) (p < 0.05), with no significant difference between T2 and T3. For HRV, concussion showed a significant effect on %High Frequency (HF) HRV value sitting (p < 0.05) where T2 was significantly lower than T3.There was also a significant effect of sex on %HF when time and position were considered, with males having higher %HF values at T1 and lower %HF at T2 and T3 than females.

At baseline, females displayed higher symptoms scores than males but after a concussion there were no significant differences in symptoms scores. No sex-related differences were found for any of the ImPACT scores at baseline nor after a concussion. Before concussion, female athletes had higher HRV %VLF while sitting, suggesting more activation of their sympathetic nervous system and stress. For concussed athletes, Vestibular-Somatic Symptoms seemed to be the most stable and reliable when assessing symptoms at baseline and before returning to play. For ImPACT, Visual Memory Index was decreased significantly after a concussion. HRV %HF values showed significant variations according to sex after a concussion. HF values are thought to reflect parasympathetic nervous system activation. Our results support the idea that the activity of the autonomic nervous system can be disturbed in the days/weeks following a concussion.

Pre- and post-morbid mental health conditions can prolong recovery from concussion and are generally detrimental to athletic performance and quality of life. If psychiatric conditions can be identified in athletes at the time of baseline testing, psychological/psychiatric intervention can be implemented to prevent these complications. Given the time constraints on neuropsychological baseline testing, it is important to have time-efficient screening measures. As such, the purpose of this study was to develop and calibrate a psychiatric screening measure within the Post-Concussion Symptom Scale (PCSS) from the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), which is commonly administered to athletes at baseline, thereby “killing two birds with one stone”: (1) screening for psychiatric conditions and (2) obtaining a baseline measurement of concussion-like symptoms.

Participants were 278 undergraduate students from a Canadian university with a mean age of 21.87 years (SD=4.87, range=18 to 52) and a sex composition of 64% females (n=179, Age: M=21.29 years-old, SD=4.34, range: 18 to 52) and 36% males (n=179, Age: M=22.93 years-old, SD=5.57, range: 18 to 50). Participants were a convenience sample collected via online survey platform in exchange for bonus points toward courses through a participant pool system between January and July 2021. The psychiatric screener consisted of the affective subscale from the PCSS (irritability, sadness, feeling more emotional, nervousness) and the criterion measure was the Depression, Anxiety, and Stress Scales (DASS-42). Statistical analyses were conducted in R v.4.3 and included confirmatory factor analysis and receiver operating characteristic (ROC) curve analyses. Although a balance was sought between sensitivity and specificity, the former was prioritized given that this is intended as a screening measure. Males and females were analyzed separately as females tend to report more symptoms than males. Mild, moderate, and severe elevations were predicted for depression, anxiety, and stress, based on standard DASS cutoffs.

The CFA analyses revealed good fit for both the PCSS (CFI=.992; TLI=.991; RMSEA=.053; SRMR=.066) and DASS (CFI=.995; TLI=.995; RMSEA=.053; SRMR=.065) models. Cutoffs of >3, >4, and >8 (SENS= .77-.80, SPEC= .52-.83) optimally classified males as having mild, moderate, and severe depression, respectively; and cutoffs of >8, >8, and >9 (SENS= .79-.83, SPEC= .63-.67) optimally classified females as having mild, moderate, and severe depression, respectively. A cutoff of >2 (SENS= .78-.81, SPEC= .35-.39) optimally classified males as having both mild and moderate anxiety (insufficient n in severe group); and >7, >8, and >9 (SENS= .80-.85, SPEC= .63-.68) optimally classified females as having mild, moderate, and severe anxiety. Cutoffs of >5and >8(SENS= .80-.86, SPEC= .70-.85) were optimal for detecting mild and moderate stress in males (insufficient n in severe group); and >8, >8, and >9 (SENS= .80.89, SPEC= .60-.75) were optimal in females.

The affective subscale within the PCSS operates well as a psychiatric screening measure. In general, females had higher cutoffs and the cutoffs for mild and moderate levels of the conditions tended to be similar. Males were less onsistent, with cutoffs varying widely depending on the construct and severity.

Studies have reported that athletic conditioning or training may have neuropsychological benefits for adult athletes, including enhanced processing speed, executive function, and working memory and attention. However, others have reported that these benefits may be attenuated by an athlete’s level of exposure to repetitive, subconcussive head impacts, such as heading the ball in soccer. Neurocognitive dispersion, or intraindividual variability (IIV), has become an increasingly popular tool to assess neuropsychological performance in various clinical populations. Less dispersion is typically associated with more consistent and better overall performance (i.e., fewer lapses of reaction time and accuracy). However, few studies have utilized these measures in healthy young adults. The objective of this study was to determine if athletes and non-athletes exhibited different levels of neurocognitive dispersion on a battery of neuropsychological tasks. It was hypothesized that athletes would exhibit less neurocognitive dispersion compared to non-athletes, despite their exposure to repetitive subconcussive head impacts.

Division 1 varsity and club team university athletes (n = 74, Mage = 19.93, female = 55%), and non-athlete undergraduate students (N = 154, Mage = 20.12, female = 69%) completed a neuropsychological battery consisting of 13 cognitive tests. Outcomes for each test were converted to standard scores and combined for overall neuropsychological performance. Two measures of IIV, intraindividual standard deviation (ISD) and maximum discrepancy (MD), were calculated across all 13 cognitive tests for each participant. Intraindividual standard deviation was calculated by taking the standard deviation of the mean performance across each task for each participant. Maximum discrepancy was calculated by subtracted the lowest standard score from the highest standard score per participant across all 13 cognitive tests.

Controlling for the impact of premorbid functioning, depressive symptoms, and gender, an analysis of covariance (ANCOVA) found significantly less ISD in athletes (M = 11.28, SD = 2.76) compared to non-athletes (M = 12.56, SD = 3.61) across all 13 neuropsychological tasks (η2 = 0.04, p = .004). Similarly, significantly lower MD scores were found in athletes (M = 40.25, SD = 11.14) compared to non-athletes (M = 44.69, SD = 14.07) across all 13 neuropsychological tasks (η2 = 0.03, p = .008). Post-hoc analyses revealed no significant differences when athletes were divided into contact and non-contact athletes.

Similar to prior findings that aerobic exercise may enhance cognitive performance, both contact and non-contact college athletes exhibited less neurocognitive dispersion (as measured by ISD and MD) compared to non-athlete college students. However, no significant differences were found between non-contact athletes and contact athletes (soccer players) who were exposed to repetitive subconcussive heading events. These findings suggest that athletic performance in college-aged athletes may lead to more consistent and therefore overall better neuropsychological performance despite exposure to repetitive subconcussive head impacts.

When neuropsychologists serve as consultants to schools, concussion management programs are associated with fewer referrals, faster cognitive recovery, and reduced incidence of protracted recovery compared to programs with physician consultants. However, accessing neuropsychological services can be challenging due to geographical and financial barriers. Particularly in rural areas, travel associated with post-concussion management can represent as a significant financial and time burden. Increasing accessibility to neuropsychologists has the potential to address these concerns, while also providing quality care to more

individuals. The current study aims to assess the cost-effectiveness and clinical outcomes of a remote, neuropsychologist-led consultation model of concussion management. We hypothesized that this remote model would save patients both money and time, while also improving patient outcomes.

604 high school concussion cases occurring between May 2019 and May 2022 were reviewed; 571 were included in the current analysis. The sample was 51% male with a mean age of 15.8 years (SD=1.32). All students took ImPACT tests following suspected concussions, with tests administered at the school by certified athletic trainers or nurses. Test results were electronically reviewed by the consulting neuropsychologist. Interpretations and recommendations were then sent via email to the school official. Cognitive recovery, defined as the days from the injury to the final ImPACT test, and incidence of repeat concussions, or concussions occurring within 3 months of a previous concussion, were used as indicators of patient outcomes. Financial burden was determined by calculating the round-trip distance in miles from the patient’s school to the neuropsychologist’s medical center, then multiplying this number by the 2022 standard mileage reimbursement rate of $0.63/mile to determine the travel cost for a single consultation.

The sample consisted of 571 individual concussion cases and 1,285 total ImPACT tests. An average of 2.25 tests were administered for each concussion case (SD=0.90), with an average of 18.47 days to the final test (SD=16.59). 8 concussions (1.4% of total concussions) occurred within 3 months of a previous injury. The distance from schools to the closest available neuropsychologist ranged from 2.4 to 102 miles. The remote nature of the consultation model allowed for patients to avoid up to 204 miles, or up to 4.5 hours, of driving for each consultation. Thus, patients saved anywhere from $3.00 to $127.50 in travel costs per consultation.

The remote nature of this consultation model yielded a similar cognitive recovery time to previous literature, indicating that it may be as effective as in-person consultation. Repeat concussions represented less than 1.5% of concussion cases, indicating that care was successful enough to prevent second concussions in the majority of the sample. The remote nature of the model also saved patients time (up to 4.5 hours of driving) and money (up to $127.50 in travel costs). Thus, a remote consultation model has the potential to increase access to first-rate concussion care in rural settings, while also being cost- and time-effective for patients.

Significant advances in the research of sport-related concussion (SRC) and repetitive head impacts (RHI) over the previous decade have translated to improved injury identification, diagnosis, and management. However, an objective gold standard for SRC/RHI treatment has remained elusive. SRC often result in heterogenous clinical outcomes, and the accumulation of RHI over time is associated with long-term declines in neurocognitive functioning. Medical management typically entails an amalgamation of outpatient medical treatment and psychiatric and/or behavioral interventions for specific symptoms rather than treatment of the underlying functional and/or structural brain injury. Transcranial photobiomodulation (tPBM), a form of light therapy, has been proposed as a non-invasive treatment for individuals with traumatic brain injuries (TBI), possibly including SRC/RHI. With the present proof-of-concept pilot study, we sought to address important gaps in the neurorehabilitation of former athletes with a history of SRC and RHI by examining the effects of tPBM on neurocognitive functioning.

The current study included 49 participants (45 male) with a history of SRC and/or RHI. Study inclusion criteria included: age 18-65 years and a self-reported history of SRC and/or RHI. Exclusion criteria included: a history of neurologic disease a history of psychiatric disorder, and MRI contraindication. We utilized a non-randomized proof-of-concept design of active treatment over the course of 8-10 weeks, and neurocognitive functioning was assessed at pre- and post-treatment. A Vielight Neuro Gamma at-home brain tPBM device was distributed to each participant following baseline assessment.

Participants completed standardized measures of neurocognitive functioning, including the California Verbal Learning Test (CVLT-3), Delis Kaplan Executive Function System (D-KEFS), Continuous Performance Test (CPT-3), and The NIH Toolbox Cognition Battery. Neurocognitive assessments were collected prior to and following tPBM treatment. Paired t-tests and Wilcoxon’s signed-rank tests were used to evaluate change in performance on measures of neurocognitive functioning for normal and nonnormal variables, respectively, and estimates of effect size were obtained.

Study participants’ ability for adapting to novel stimuli and task requirements (i.e., fluid cognition; t=5.96; p<.001; d=.90), verbal learning/encoding (t=3.20; p=.003; d=.48) and delayed recall (z=3.32; p=.002; d=.50), processing speed (t=3.13; p=.003; d=.47), sustained attention (t=-4.39; p<.001; d=-.71), working memory (t=3.61; p=.001; d=.54), and aspects of executive functioning improved significantly following tPBM treatment. No significant improvements in phonemic and semantic verbal fluencies, reading ability, and vocabulary were shown following tPBM treatment.

The results of this pilot study demonstrate that following 8-10 weeks of active tPBM treatment, retired athletes with a history of SRC and/or RHI experienced significant improvements in fluid cognition, learning and memory, processing speed, attention, working memory, and aspects of executive functioning. Importantly, the majority of effect sizes ranged from moderate to large, suggesting that tPBM has clinically meaningful improvements on neurocognitive functioning across various cognitive domains. These results offer support for future research employing more rigorous study designs on the potential neurorehabilitative effects of tPBM in athletes with SRC/RHI.

Engagement in sporting activities has shown improvement in executive function among youth (Contreras-Osorio et al., 2021). Additionally, participation in specific sports such as soccer has been shown to enhance executive function in youth athletes compared to same-aged non-athletes (Yongtawee et al., 2021). The present study aimed to examine the effects of competitive participation in the United States’ four most popular sports on executive function among youth athletes. The most popular sports, as defined by viewership, revenue, and youth participation in the U.S. are American football, basketball, baseball, and soccer (Injai, 2022; Aspen Institute, 2020).

Data from the following three executive functioning subtests were analyzed in a sample of youth athletes (n=76), aged 8-18 years (mean age=11.94): Delis-Kaplan Executive Function System Trail Making Letter-Number Sequencing (cognitive flexibility), Wechsler Intelligence Scale for Children Fourth Edition Working Memory Index, and Golden Stroop Color-Word Inhibition. Participants completed these measures as part of a larger neuropsychological baseline assessment. Multivariate General Linear Model (GLM) regression was used to examine the influence of total cumulative years playing in one or more of the four most popular sports on executive functioning. A multivariate GLM regression also investigated the unique contributions of total years playing soccer (n=40; mean age=12.40) and total years playing American football (n=32; mean age=12.03) on subtest performance. The unique contributions of basketball (n=14) and baseball (n=21) were not analyzed due to small sample size.

Total cumulative years playing > one of the four most popular sports significantly predicted cognitive flexibility (p=.007) and working memory (p=.002), but not inhibition (p=0.639). Total years playing soccer also significantly predicted cognitive flexibility (p=.029) and working memory (p=0.05), but not inhibition (p=.310). Total years playing American football did not significantly predict performance on tasks requiring cognitive flexibility (p=.186), working memory (p=0.150), or inhibition (p=0.277).

In congruence with previous research, sports participation predicted enhanced cognitive flexibility and working memory on certain executive tasks. Among youth athletes, prolonged competitive participation in one or more of the four most popular sports in the U.S. predicted better performance on measures of cognitive flexibility and working memory. Furthermore, protracted participation in soccer predicted enhanced performance on measures of cognitive flexibility and working memory, whereas extended participation in American football did not. Future research should examine this effect in larger samples within all four sports. Examining the cumulative length of competitive participation in these popular sports on executive function could present a favorable developmental outcome of youth participation if competitive participation is sustained. Additionally, the present data on executive function performance between lasting soccer participation and lasting American football participation suggests that executive function development and performance may be influenced by the sport played. The direction of this possible influence is unclear. More research is needed to establish this observed difference, and to better understand its existence and directionality.