Collins M W, Grindel S H, Lovell M R, Dede D E, Moser D J, Phalin B R, Nogle S, Wasik M, Cordry D, Daugherty K M, Sears S F, Nicolette G, Indelicato P, McKeag D B
Department of Behavioral Health, Henry Ford Health System, Detroit, Mich 48202, USA.
JAMA. 1999 Sep 8;282(10):964-70. doi: 10.1001/jama.282.10.964.
Despite the high prevalence and potentially serious outcomes associated with concussion in athletes, there is little systematic research examining risk factors and short- and long-term outcomes.
To assess the relationship between concussion history and learning disability (LD) and the association of these variables with neuropsychological performance and to evaluate postconcussion recovery in a sample of college football players.
DESIGN, SETTING, AND PARTICIPANTS: A total of 393 athletes from 4 university football programs across the United States received preseason baseline evaluations between May 1997 and February 1999. Subjects who had subsequent football-related acute concussions (n = 16) underwent neuropsychological comparison with matched control athletes from within the sample (n = 10).
Clinical interview, 8 neuropsychological measures, and concussion symptom scale ratings at baseline and after concussion.
Of the 393 players, 129 (34%) had experienced 1 previous concussion and 79 (20%) had experienced 2 or more concussions. Multivariate analysis of variance yielded significant main effects for both LD (P<.001) and concussion history (P=.009), resulting in lowered baseline neuropsychological performance. A significant interaction was found between LD and history of multiple concussions and LD on 2 neuropsychological measures (Trail-Making Test, Form B [P=.007] and Symbol Digit Modalities Test [P=.009]), indicating poorer performance for the group with LD and multiple concussions compared with other groups. A discriminant function analysis using neuropsychological testing of athletes 24 hours after acute in-season concussion compared with controls resulted in an overall 89.5% correct classification rate.
Our study suggests that neuropsychological assessment is a useful indicator of cognitive functioning in athletes and that both history of multiple concussions and LD are associated with reduced cognitive performance. These variables may be detrimentally synergistic and should receive further study.
尽管运动员脑震荡的患病率很高且可能产生严重后果，但很少有系统研究来考察其风险因素以及短期和长期后果。
评估脑震荡病史与学习障碍（LD）之间的关系，以及这些变量与神经心理表现的关联，并评估大学橄榄球运动员样本中的脑震荡后恢复情况。
设计、地点和参与者：1997年5月至1999年2月期间，来自美国4所大学橄榄球项目的393名运动员接受了季前基线评估。随后发生与橄榄球相关急性脑震荡的受试者（n = 16）与样本中匹配的对照运动员（n = 10）进行了神经心理比较。
基线时和脑震荡后的临床访谈、8项神经心理测量以及脑震荡症状量表评分。
在393名运动员中，129名（34%）曾有过1次脑震荡，79名（20%）曾有过2次或更多次脑震荡。多变量方差分析显示，学习障碍（P <.001）和脑震荡病史（P =.009）均有显著的主效应，导致基线神经心理表现降低。在两项神经心理测量（B型连线测验[P =.007]和符号数字模式测验[P =.009]）中，发现学习障碍与多次脑震荡病史之间存在显著交互作用，表明与其他组相比，学习障碍且多次脑震荡的组表现较差。与对照组相比，对急性赛季内脑震荡24小时后的运动员进行神经心理测试的判别函数分析得出总体正确分类率为89.5%。
我们的研究表明，神经心理评估是运动员认知功能的有用指标，多次脑震荡病史和学习障碍均与认知表现下降有关。这些变量可能具有有害的协同作用，应进一步研究。
