East Carolina University, 245 Ward Sports Medicine Bldg, Greenville, NC, 27858, USA.
Duke University Medical Center, DUMC 3119, Durham, NC, 27710, USA.
Sports Med. 2017 Sep;47(9):1893-1899. doi: 10.1007/s40279-017-0686-2.
Current recommendations for concussion management acknowledge the importance of objective assessments of neuropsychological (NP) ability, and computerized NP assessments have been widely integrated into the concussion management protocols of high schools. The optimal intervals for baseline test administration in high-school athletes are currently uncertain. The ability to accurately detect subtle NP deficits is particularly important for high-school athletes, in which concussions are increasingly recognized for adverse effects to the developing brain.
The aim of this study was to assess the pattern of change in neurocognitive test performance, as well as changes in different domains of NP functioning over time.
Baseline computerized NP assessments were conducted at six high schools over 4 academic years using CNS Vital Signs, a battery consisting of seven well-established NP tests. Data were retrospectively examined for age differences in both cross-sectional (n = 3015) and longitudinal (n = 1221) analyses.
Moderate changes were observed across several NP domains over time (Cohen's d = 0.39-0.61), with the largest improvements observed in executive functioning (mean improvement 5.78, 95% confidence interval [CI] 5.41-6.14, p < 0.001), psychomotor speed (mean improvement 4.59, 95% CI 3.97-5.22, p < 0.001), cognitive flexibility (mean improvement 5.11, 95% CI 4.76-5.45, p < 0.001), and reaction time (mean improvement -12.44 ms, 95% CI -10.10 to -14.78, p < 0.001). Improvements in NP performance were most pronounced between the freshman and senior years.
There is an appreciable change that occurs each year of high school in one or more domains of an NP battery, with executive functioning indicating the greatest magnitude of change. Females performed better relative to males across all time points though males exhibited more substantial improvement over time.
目前关于脑震荡管理的建议承认了对神经心理学（NP）能力进行客观评估的重要性，并且计算机化 NP 评估已广泛整合到高中的脑震荡管理方案中。目前，对于高中运动员进行基线测试的最佳时间间隔尚不确定。对于高中运动员来说，准确检测细微的 NP 缺陷的能力尤为重要，因为越来越多的人认识到脑震荡对发育中大脑的不利影响。
本研究旨在评估神经认知测试表现的变化模式，以及随着时间的推移 NP 功能不同领域的变化。
在 4 个学年中，6 所高中使用 CNS Vital Signs 进行了基线计算机化 NP 评估，该测试由 7 项成熟的 NP 测试组成。对横断面（n=3015）和纵向（n=1221）分析中的年龄差异进行了回顾性检查。
随着时间的推移，多个 NP 领域观察到中等程度的变化（Cohen's d=0.39-0.61），其中执行功能的改善最大（平均改善 5.78，95%置信区间[CI]5.41-6.14，p<0.001），精神运动速度（平均改善 4.59，95%CI 3.97-5.22，p<0.001），认知灵活性（平均改善 5.11，95%CI 4.76-5.45，p<0.001）和反应时间（平均改善-12.44ms，95%CI-10.10 至-14.78，p<0.001）。NP 表现的改善在新生和高年级之间最为明显。
在高中的每一年中，NP 测试的一个或多个领域都会发生明显的变化，其中执行功能的变化幅度最大。与所有时间点相比，女性的表现优于男性，尽管男性的表现随着时间的推移有了更大的提高。
