Gardner Ryan M, Yengo-Kahn Aaron, Bonfield Christopher M, Solomon Gary S
a Vanderbilt Sports Concussion Center , Vanderbilt University School of Medicine , Nashville , TN , USA.
b Department of Neurological Surgery , Vanderbilt University School of Medicine , Nashville , TN , USA.
Phys Sportsmed. 2017 Feb;45(1):1-10. doi: 10.1080/00913847.2017.1248221. Epub 2016 Oct 28.
Baseline and post-concussion neurocognitive testing is useful in managing concussed athletes. Attention deficit hyperactivity disorder (ADHD) and stimulant medications are recognized as potential modifiers of performance on neurocognitive testing by the Concussion in Sport Group. Our goal was to assess whether individuals with ADHD perform differently on post-concussion testing and if this difference is related to the use of stimulants.
Retrospective case-control study in which 4373 athletes underwent baseline and post-concussion testing using the ImPACT battery. 277 athletes self-reported a history of ADHD, of which, 206 reported no stimulant treatment and 69 reported stimulant treatment. Each group was matched with participants reporting no history of ADHD or stimulant use on several biopsychosocial characteristics. Non-parametric tests were used to assess ImPACT composite score differences between groups.
Participants with ADHD had worse verbal memory, visual memory, visual motor speed, and reaction time scores than matched controls at baseline and post-concussion, all with p ≤ .001 and |r|≥ 0.100. Athletes without stimulant treatment had lower verbal memory, visual memory, visual motor speed, and reaction time scores than controls at baseline (p ≤ 0.01, |r|≥ 0.100 [except verbal memory, r = -0.088]) and post-concussion (p = 0.000, |r|> 0.100). Athletes with stimulant treatment had lower verbal memory (Baseline: p = 0.047, r = -0.108; Post-concussion: p = 0.023, r = -0.124) and visual memory scores (Baseline: p = 0.013, r = -0.134; Post-concussion: p = 0.003, r = -0.162) but equivalent visual motor speed and reaction time scores versus controls at baseline and post-concussion.
ADHD-specific baseline and post-concussion neuropsychological profiles, as well as stimulant medication status, may need to be considered when interpreting ImPACT test results. Further investigation into the effects of ADHD and stimulant use on recovery from sport-related concussion (SRC) is warranted.
脑震荡前后的神经认知测试有助于管理脑震荡运动员。注意缺陷多动障碍（ADHD）和兴奋剂药物被体育界脑震荡小组认为是神经认知测试成绩的潜在影响因素。我们的目标是评估患有ADHD的个体在脑震荡后测试中的表现是否不同，以及这种差异是否与兴奋剂的使用有关。
进行回顾性病例对照研究，4373名运动员使用ImPACT测试组合进行了基线和脑震荡后测试。277名运动员自我报告有ADHD病史，其中206名报告未接受兴奋剂治疗，69名报告接受了兴奋剂治疗。每组与报告无ADHD或兴奋剂使用史的参与者在几个生物心理社会特征上进行匹配。使用非参数检验评估组间ImPACT综合得分差异。
患有ADHD的参与者在基线和脑震荡后的言语记忆、视觉记忆、视觉运动速度和反应时间得分均低于匹配的对照组，所有p值均≤0.001且|r|≥0.100。未接受兴奋剂治疗的运动员在基线时（p≤0.01，|r|≥0.100[言语记忆除外，r=-0.088]）和脑震荡后（p=0.000，|r|>0.100）的言语记忆、视觉记忆、视觉运动速度和反应时间得分均低于对照组。接受兴奋剂治疗的运动员在基线时言语记忆（p=0.047，r=-0.108；脑震荡后：p=0.023，r=-0.124）和视觉记忆得分较低（基线：p=0.013，r=-0.134；脑震荡后：p=0.003，r=-0.162），但在基线和脑震荡后与对照组的视觉运动速度和反应时间得分相当。
在解释ImPACT测试结果时，可能需要考虑ADHD特异性的基线和脑震荡后神经心理学特征以及兴奋剂药物状态。有必要进一步研究ADHD和兴奋剂使用对运动相关脑震荡（SRC）恢复的影响。
