School of Psychology, Beijing Sport University, Beijing, China.
Sport Science School, Beijing Sport University, Beijing, China.
Am J Sports Med. 2023 Nov;51(13):3604-3618. doi: 10.1177/03635465221142855. Epub 2023 Feb 17.
Rates of sports-related concussion (SRC) are high in adolescents. Ambiguity exists regarding the effect of SRC on cognitive function in adolescents.
To rigorously examine adolescents' cognitive function after SRC.
Systematic review and meta-analysis; Level of evidence, 4.
Web of Science, Scopus, and PubMed were searched from database inception until September 2021. Studies were included if participants were adolescents aged 13 to 18 years, if the definition of SRC was fully consistent with the Berlin Consensus Statement on Concussion in Sport, if the study included a control group or in-group baseline test, and if the study reported cognitive outcomes (eg, visual memory, processing speed) that could be separately extracted.
A total of 47 studies were included in the systematic review, of which 31 were included in the meta-analysis, representing 8877 adolescents with SRC. Compared with individuals in the non-SRC group, individuals with SRC had worse performance in cognitive function and reported more symptoms not only in the acute phase but also in the prolonged phase (1-6 months after injury) (visual memory: = -0.21, 95% CI, -0.37 to -0.05, = .012; executive function: = -0.56, 95% CI, -1.07 to -0.06, = .028; and symptoms: = 1.17, 95% CI, 0.13 to 2.22, = .028). Lower scores in most of the outcomes of cognitive function were observed at <3 days and at 3 to 7 days, but higher scores for verbal memory ( = 0.10; 95% CI, 0.03 to 0.17; = .008) and processing speed ( = 0.17; 95% CI, 0.10 to 0.24; < .001) were observed at 7 to 14 days after SRC relative to baseline. The effects of SRC on cognitive function decreased over time (100% of the variance in reaction time, < .001; 99.94% of the variance in verbal memory, < .001; 99.88% of the variance in visual memory, < .001; 39.84% of the variance in symptoms, = .042) in control group studies. Study design, participant sex, measurement tools, and concussion history were found to be modulators of the relationship between cognitive function and SRC.
This study revealed that adolescent cognitive function is impaired by SRC even 1 to 6 months after injury. Results of this study point to the need for tools to measure cognitive function with multiple parallel versions that have demographically diversiform norms in adolescents. Effective prevention of SRC, appropriate treatment, and adequate evaluation of cognitive function before return to play are needed in adolescent SRC management. Moreover, caution is warranted when using the baseline-to-postconcussion paradigm in return-to-play decisions.
青少年中运动相关性脑震荡（SRC）的发生率很高。SRC 对青少年认知功能的影响尚存在争议。
严格评估青少年 SRC 后的认知功能。
系统评价和荟萃分析；证据水平，4 级。
从数据库建立开始到 2021 年 9 月，在 Web of Science、Scopus 和 PubMed 上进行了检索。如果参与者为 13 至 18 岁的青少年，且 SRC 的定义与柏林运动性脑震荡共识声明完全一致，且研究包括对照组或同组基线测试，并报告了可单独提取的认知结果（例如，视觉记忆、处理速度），则纳入研究。
系统评价共纳入 47 项研究，其中 31 项研究纳入荟萃分析，共纳入 8877 例 SRC 青少年。与非 SRC 组相比，SRC 组的认知功能更差，不仅在急性期，而且在延长期（损伤后 1-6 个月）报告更多的症状（视觉记忆： = -0.21，95%CI -0.37 至 -0.05， =.012；执行功能： = -0.56，95%CI -1.07 至 -0.06， =.028；以及症状： = 1.17，95%CI 0.13 至 2.22， =.028）。在损伤后<3 天和 3-7 天观察到大多数认知功能结果的得分较低，但在损伤后 7-14 天观察到言语记忆（ = 0.10；95%CI 0.03 至 0.17； =.008）和处理速度（ = 0.17；95%CI 0.10 至 0.24； <.001）的得分较高。SRC 对认知功能的影响随着时间的推移而减弱（反应时间的 100%方差， <.001；言语记忆的 99.94%方差， <.001；视觉记忆的 99.88%方差， <.001；症状的 39.84%方差， =.042），在对照组研究中。研究设计、参与者性别、测量工具和既往脑震荡史被发现是认知功能与 SRC 之间关系的调节剂。
本研究表明，青少年的认知功能在损伤后 1 至 6 个月仍受到 SRC 的损害。本研究结果表明，需要有工具来测量认知功能，且这些工具应具有多样化的、适用于青少年的人口统计学常模的多个平行版本。在青少年 SRC 管理中，需要有效的预防 SRC、适当的治疗和充分评估认知功能，以恢复运动。此外，在制定恢复运动的决策时，应谨慎使用从基线到脑震荡后的范式。
