Sex differences in neuropsychological function and post-concussion symptoms of concussed collegiate athletes

Tracey Covassin, Philip Schatz, C Buz Swanik
Neurosurgery 2007, 61 (2): 345-50; discussion 350-1

OBJECTIVE: Our purpose was to determine whether sex differences exist with respect to post-concussion symptoms and neurocognitive function in concussed collegiate athletes.

METHODS: A prospective dependent-sample cohort design was used to compare baseline and post-concussion neuropsychological test scores and endorsed symptoms as functions of serial post-concussion assessment with respect to time and sex. The Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) battery was administered to a multicenter analysis group of 79 concussed athletes. This computerized neuropsychological test was given to the athletes during the preseason and, on average, 2 and 8 days postinjury.

RESULTS: Multivariate analyses revealed no significant between-group differences on baseline test performance with respect to sex on any of the ImPACT composite scores or on the total symptom score. Multivariate analyses of post-concussion data revealed a significant main effect of time on ImPACT scores, but no main effect of sex was identified, and no time-by-sex interaction existed. Post hoc analysis revealed that concussed female athletes performed significantly worse than concussed male athletes on visual memory tasks (P = 0.001), and analysis of endorsed post-concussion symptoms revealed that concussed men were significantly more likely than concussed women to report post-concussion symptoms of vomiting (P = 0.001) and sadness (P = 0.017). Athletes' scores were examined individually using the reliable-change methodology. At 2 days post-injury, 58% of concussed athletes had one or more reliable incidents of performance decline or increases in symptom reporting. At 8 days post-concussion, 30% of concussed athletes were still showing one or more reliable change from preseason values.

CONCLUSIONS: College athletes exhibit differences on visual memory composite scores and symptoms post-concussion as a function of sex. These data support the importance of evaluating neuropsychological status and post-concussion symptoms in concussed athletes. In addition, these data illustrate the importance of analyzing an individual athlete's recovery pattern, because individual differences in recovery trajectories may be overshadowed by global norm-group comparisons.

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