An Investigation of Sport Concussion in UNM Athletes Richard Campbell, Ph.D. Professor, Dept. of Psychiatry UNM School of Medicine

Physical Emotional CognitiveSleep Only % have LOC Chronic Traumatic Encephalopathy (CTE)  Sport Concussion: Potential Pediatric Health Problem  Estimated million SR-related TBIs/year  7.5 million student-athletes/recreational athletes in high school; 30+ million younger children participating in sports Cognitive Effects of mTBI/Concussion  ? Long term effects of repeated concussion  ?vulnerability to repeat concussion  ? Younger children/Females more vulnerable or worse outcome?

Management of Sport-Related Concussion: When is it safe to return to play?  20 management guidelines of SR concussion published  Consensus that athletes should not RTP until symptom free  Athletes should rest until they are asymptomatic (no vigorous physical activity or heavy mental exertion  When asymptomatic, return to light aerobic exercise (International Concussion in Sport Conferences in Vienna (Aubry et al., 2002) and Prague (McCrory et al., 2005, and Zurich)  Little consensus on how to measure concussion-related symptoms or impairments (ie symptom free) – Concussion symptom checklists (Rely on athlete self- report) – Brief sideline cognitive testing – Postural stability measurements – Neuropsychological testing Reasons Concussions are not Reported (McCrea et al., 2004) – Did not think it was serious (66%) – Did not want to leave game (41%) – Did not know it was a concussion (36%) – Did not want to let down teammates (22%) Sports Concussion/mTBI and Boxing Warden et al. Neurology 2001 West Point boxers Felt ready to be back in class Impaired reaction time

Aims Determine sensitivity of cognitive assessment tools to sequelae of sport concussion (severity, time to recovery) – Sideline mental status exam – Traditional paper/pencil neuropsychological measures – Computerized neuropsychological testing (i.e., ImPACT) Determine content validity of ImPACT with traditional neuropsychological measures To identify brain abnormalities associated with sport concussion and its recovery via neuroimaging (sMRI, DTI, MRS, MEG,fMRI) and their relation to neurocognitive measures An Investigation of Sports Concussion in University of New Mexico Athletes Participants: – N= 103 UNM athletes (n= 76 football, n=7 womens’ soccer, n= 20 mens soccer) – Hx. of prior concussions: 0 = 72, 1 = 28, 2 = 12, 3 = 2, 6 = 1. – 8 subjects had concussion 2009 Procedures – Baseline (preseason) neuropsychological testing UNM Neuropsychological Test Battery and ImPACT – Within 72 hours of concussion UNM Neuropsychological Test Battery and ImPACT MRI, DTI, MRS, fMRI, MEG – Three weeks or > after concussion and symptom-free UNM Neuropsychological Test Battery and ImPACT MRI, DTI, MRS, fMRI, MEG

Results: ImPACT and Traditional Neuropsych Tests ImPACT Verbal Memory Composite Score correlates with: – HVLT Total Recall Score (r =.19, p =.05) – HVLT Delayed Recall Score (r =.36, p <.001) – HVLT Percent Retention Score (r =.33, p <.001) – BVMT Total Recall Score (r =.35, p <.001) – BVMT Delayed Recall Total Score (r =.22, p =.03). ImPACT Visual Memory Score correlates only with BVMT Total Recall Score (r =.29, p <.001). ImPACT Visual Motor Composite Score correlates with: – WAIS-IV Symbol Search (r =.42, p <.001) – WAIS-IV Coding r =.41, p<.001) – Trails B (r =.43, p<.001). ImPACT Reaction Time Composite Score correlates with: – WAIS-IV Coding (r = -.25, p =.01) – Trails A (r =.29, p <.001) – Trails B, r =.31, p <.001) ImPACT Impulse Control Score correlates with Animal Naming (r =.19, p =.05).  ImPACT composite scores weak to modest correlations with traditional neuropsych measures

 Neurocognitive function as measured by ImPACT does not seem to be sensitive to number of concussions Results: Relation of Traditional Neuropsych Tests and Concussion Hx HVLT Percent Retention T-score (F(3,96) – 2.96, p =.03)  The more concussions one has the more difficult it is to retain information based on traditional verbal memory test Results: Relation between Traditional Neuropsych Tests and Concussion Severity  The more severe the concussion the more difficulty with processing speed and cognitive flexibility

An Investigation of Sports Concussion in University of New Mexico Athletes Collaborators: Chris McGrew, MD Robert Thoma, Ph.D. John King, Ph.D. John Phillips, MD David Binder, ATC David Smith, ATC Andy Mayer, Ph.D. Arvind Caprihan, Ph.D. Charles Gasparovic, Ph.D. Ron Yeo, Ph.D. Per Lysne Maggie Mannell Susan Muraida Jonathan Kurtyka, Ph.D. Laura Lundy, MS Dina Hill, Ph.D. Krista Wild, Ph.D. Jessica Pommy David Ruhl Mollie Monnig Dalin Pulsipher, MS Jovan Hernandez Terri Teshiba Flannery Merideth Maggie Mannell Christina Tedeschi