Ali Muhammad, Asghar Nek, Li Adam, Hannah Theodore, Spiera Zachary, Marayati Naoum Fares, Dreher Nickolas, Durbin John, Gometz Alex, Lovell Mark, Choudhri Tanvir
1Neurosurgery Department, Icahn School of Medicine at Mount Sinai, New York.
2Concussion Management of New York, New York; and.
J Neurosurg Pediatr. 2021 May 7;28(1):69-75. doi: 10.3171/2020.11.PEDS20821. Print 2021 Jul 1.
Concussions in youth sports comprise an estimated 1.6-3.8 million annual injuries in the US. Sex, age, and attention-deficit hyperactivity disorder (ADHD) have been identified as salient risk factors for concussion. This study seeks to evaluate the role of premorbid depression or anxiety (DA), with or without antidepressant use, on the incidence of concussion and the recovery of symptoms and neurocognitive dysfunction after concussion.
Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) was administered to 7453 youth athletes at baseline. Throughout the season, concussions were examined by physicians and athletic trainers, followed by readministration of ImPACT postinjury (PI) and again at follow-up, a median of 7 days PI. Individuals were divided into three categories: 1) unmedicated athletes with DA (DA-only, n = 315), athletes taking antidepressants (DA-meds, n = 81), and those without DA or antidepressant use (non-DA, n = 7039). Concussion incidence was calculated as the total number of concussions per total number of patient-years. The recovery of neurocognitive measures PI was calculated as standardized deviations from baseline to PI and then follow-up in the 5 composite ImPACT scores: symptom score, verbal memory, visual memory, visual motor skills, and reaction time. Univariate results were confirmed with multivariate analysis.
There was no difference in concussion incidence between the DA-only cohort and the non-DA group. However, the DA-meds group had a significantly greater incidence of concussion than both the DA-only group (OR 2.67, 95% CI 1.88-7.18, p = 0.0001) and the non-DA group (OR 2.19, 95% CI 1.16-4.12, p = 0.02). Deviation from baseline in PI symptom scores was greater among the DA-meds group as compared to the non-DA group (OR 1.14, 95% CI 1.01-1.28, p = 0.03). At follow-up, the deviation from baseline in symptom scores remained elevated among the DA-meds group as compared to the non-DA group (OR 1.62, 95% CI 1.20-2.20, p = 0.002) and the DA-only group (OR 1.87, 95% CI 1.12-3.10, p = 0.02). Deviation from baseline in follow-up verbal memory was also greater among the DA-meds group as compared to both the non-DA group (OR 1.57, 95% CI 1.08-2.27, p = 0.02) and the DA-only group (OR 1.66, 95% CI 1.03-2.69, p = 0.04).
Premorbid DA itself does not seem to affect the incidence of concussion or the recovery of symptoms and neurocognitive dysfunction PI. However, antidepressant use for DA is associated with 1) increased concussion incidence and 2) elevated symptom scores and verbal memory scores up to 7 days after concussion, suggesting impaired symptomatic and neurocognitive recovery on ImPACT.
在美国，青少年体育运动中的脑震荡估计每年有160万至380万例受伤情况。性别、年龄和注意力缺陷多动障碍（ADHD）已被确定为脑震荡的显著风险因素。本研究旨在评估病前抑郁或焦虑（DA）（无论是否使用抗抑郁药）对脑震荡发生率以及脑震荡后症状恢复和神经认知功能障碍的影响。
在基线时对7453名青少年运动员进行即时脑震荡后评估和认知测试（ImPACT）。在整个赛季中，由医生和运动训练师检查脑震荡情况，受伤后（PI）再次进行ImPACT测试，并在随访时再次测试，随访时间中位数为受伤后7天。个体被分为三类：1）患有DA但未用药的运动员（仅DA组，n = 315），服用抗抑郁药的运动员（DA用药组，n = 81），以及未患有DA或未使用抗抑郁药的运动员（非DA组，n = 7039）。脑震荡发生率计算为每患者年脑震荡总数。PI时神经认知测量的恢复情况计算为从基线到PI然后到随访时5个综合ImPACT分数（症状评分、言语记忆、视觉记忆、视觉运动技能和反应时间）的标准化偏差。单变量结果通过多变量分析得到证实。
仅DA组和非DA组之间的脑震荡发生率没有差异。然而，DA用药组的脑震荡发生率显著高于仅DA组（OR 2.67，95% CI 1.88 - 7.18，p = 0.0001）和非DA组（OR 2.19，95% CI 1.16 - 4.12，p = 0.02）。与非DA组相比，DA用药组PI时症状评分偏离基线的程度更大（OR 1.14，95% CI 1.01 - 1.28，p = 0.03）。在随访时，与非DA组（OR 1.62，95% CI 1.20 - 2.20，p = 0.002）和仅DA组（OR 1.87，95% CI 1.12 - 3.10，p = 0.02）相比，DA用药组症状评分偏离基线的情况仍然较高。与非DA组（OR 1.57，95% CI 1.08 - 2.27，p = 0.02）和仅DA组（OR 1.66，95% CI 1.03 - 2.69，p = 0.04）相比，DA用药组随访时言语记忆偏离基线的程度也更大。
病前DA本身似乎不影响脑震荡发生率或症状及神经认知功能障碍PI的恢复。然而，使用抗抑郁药治疗DA与以下情况相关：1）脑震荡发生率增加；2）脑震荡后长达7天症状评分和言语记忆评分升高，表明ImPACT测试中症状和神经认知恢复受损。
