Preinjury somatization symptoms contribute to clinical recovery after sport-related concussion

OBJECTIVE: To determine the degree to which preinjury and acute postinjury psychosocial and injury-related variables predict symptom duration following sport-related concussion. METHODS: A total of 2,055 high school and collegiate athletes completed preseason evaluations. Concussed athletes (n = 127) repeated assessments serially (<24 hours and days 8, 15, and 45) postinjury. Cox proportional hazard modeling was used to predict concussive symptom duration (in days). Predictors considered included demographic and history variables; baseline psychological, neurocognitive, and balance functioning; acute injury characteristics; and postinjury clinical measures. RESULTS: Preinjury somatic symptom score (Brief Symptom Inventory-18 somatization scale) was the strongest premorbid predictor of symptom duration. Acute (24-hour) postconcussive symptom burden (Sport Concussion Assessment Tool-3 symptom severity) was the best injury-related predictor of recovery. These 2 predictors were moderately correlated (r = 0.51). Path analyses indicated that the relationship between preinjury somatization symptoms and symptom recovery was mediated by postinjury concussive symptoms. CONCLUSIONS: Preinjury somatization symptoms contribute to reported postconcussive symptom recovery via their influence on acute postconcussive symptoms. The findings highlight the relevance of premorbid psychological factors in postconcussive recovery, even in a healthy athlete sample relatively free of psychopathology or medical comorbidities. Future research should elucidate the neurobiopsychosocial mechanisms that explain the role of this individual difference variable in outcome following concussive injury

Age Differences in Recovery After Sport-Related Concussion: A Comparison of High School and Collegiate Athletes

Younger age has been hypothesized to be a risk factor for prolonged recovery after sport-related concussion, yet few studies have directly evaluated age differences in acute recovery

Prospective, Head-to-Head Study of Three Computerized Neurocognitive Assessment Tools (CNTs): Reliability and Validity for the Assessment of Sport-Related Concussion

Abstract Limited data exist comparing the performance of computerized neurocognitive tests (CNTs) for assessing sport-related concussion. We evaluated the reliability and validity of three CNTs—ANAM, Axon Sports/Cogstate Sport, and ImPACT—in a common sample. High school and collegiate athletes completed two CNTs each at baseline. Concussed ( n =165) and matched non-injured control ( n =166) subjects repeated testing within 24 hr and at 8, 15, and 45 days post-injury. Roughly a quarter of each CNT’s indices had stability coefficients ( M =198 day interval) over .70. Group differences in performance were mostly moderate to large at 24 hr and small by day 8. The sensitivity of reliable change indices (RCIs) was best at 24 hr (67.8%, 60.3%, and 47.6% with one or more significant RCIs for ImPACT, Axon, and ANAM, respectively) but diminished to near the false positive rates thereafter. Across time, the CNTs’ sensitivities were highest in those athletes who became asymptomatic within 1 day before neurocognitive testing but was similar to the tests’ false positive rates when including athletes who became asymptomatic several days earlier. Test–retest reliability was similar among these three CNTs and below optimal standards for clinical use on many subtests. Analyses of group effect sizes, discrimination, and sensitivity and specificity suggested that the CNTs may add incrementally (beyond symptom scores) to the identification of clinical impairment within 24 hr of injury or within a short time period after symptom resolution but do not add significant value over symptom assessment later. The rapid clinical recovery course from concussion and modest stability probably jointly contribute to limited signal detection capabilities of neurocognitive tests outside a brief post-injury window. ( JINS , 2016, 22 , 24–37

A Standardized, Short, and Comprehensive Neuropsychological Test Battery Based on the Luria Neuropsychological Evaluation.

Neuropsychology has played an ever increasing role in neurological and psychiatric evaluations. However, the tests and test batteries available today suffer from a number of problems including an inordinate amount of time to administer, a lack of comprehensiveness, and a failure to yield information directly relevant to diagnosis and treatment. The current article presents a test battery which attempts to integrate two major approaches to neuropsychological testing: the qualitative and the quantitative methods. Each method has significant advantages and disadvantages, while an amalgamation of the two potentially offers a powerful alternative approach to neurodiagnostics. The battery presented in this paper is a standardized version of the comprehensive qualitative battery first described by Luria and recently published by Christensen. The resultant battery is comprehensive, yet can be given in 21/2 hours; it is standardized and quantitative, but yields a qualitative assessment as well. The present study attempts to investigate the general diagnostic effectiveness of the battery, comparing 50 brain-injured and 50 hospitalized control patients. The battery was found to be 93 % diagnostically effective, more successful than any other battery or test reported in the literature. The potential uses and advantages of the battery are described

Diagnostic Validity of a Standardized Neuropsychological Battery Derived from Luria\u27s Neuropsychological Tests.

A. R. Luria has devised an extensive set of procedures used for neuropsychological evaluation. His tests permit the full identification of the specific deficits underlying a disorder and can be completed in about 2 hrs. The most significant flaw in the battery is a lack of standard administration and scoring that has precluded an assessment of its validity. The present study attempted to overcome these deficiencies by developing an objective form, combining Luria\u27s procedures with the advantages of a standard test battery. The resultant test, the Luria-South Dakota Neuro-psychological Test Battery, was evaluated using 50 medical patient controls, average age 42.0 yrs, and 50 neurological patients, average age 44.3 yrs. Of the 285 measures in the battery, 253 significantly discriminated at the .05 level, and only 16 failed to discriminate at the .2 level. A discriminant analysis, using the 30 most effective items, yielded a hit rate of 100%. The battery\u27s potential and the future research necessary are discussed. (13 ref

Relationship of Age and Education to Performance on a Standardized Version of Luria\u27s Neuropsychological tests in Different Patient Populations.

A.R. Luria, a Russian neuropsychologist, developed many qualitative bedside tests that have been effective in the diagnosis and localization of neurological disorders. Recently, a standardized and objectively-scored version of Luria\u27s tests has been developed. Knowledge of the effects of patient age and education on neuro-psychological test performance has been found crucial in the neurodiagnostic decision-making process. The present study examined the effects of patient age(younger subjects between 20 and 40 years and older subjects between 50 and 70 years of age), education (grade school, high school, and post-high school), and diagnosis (normal, schizophrenic, brain damaged) on 14 standardized Luria measures. A weighted means analysis of variance found 11 significant age effects, 14 significant educational effects, and 14 significant effects diagnosis. One significant interaction was found between education and diagnosis, the results support the contention that with appropriate age and educational corrections, the standardized Luria battery would satisfy the need for a short, objectively scored, and diagnostically effective neuropsychological battery