Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada.
J Int Neuropsychol Soc. 2024 Jul;30(6):533-545. doi: 10.1017/S1355617724000043. Epub 2024 Jan 26.
Symptoms and cognition are both utilized as indicators of recovery following pediatric concussion, yet their interrelationship is not well understood. This study aimed to investigate: 1) the association of post-concussion symptom burden and cognitive outcomes (processing speed and executive functioning [EF]) at 4 and 12 weeks after pediatric concussion, and 2) the moderating effect of sex on this association.
This prospective, multicenter cohort study included participants aged 5.00-17.99 years with acute concussion presenting to four Emergency Departments of the Pediatric Emergency Research Canada network. Five processing speed and EF tasks and the Post-Concussion Symptom Inventory (PCSI; symptom burden, defined as the difference between post-injury and retrospective [pre-injury] scores) were administered at 4 and 12 weeks post-concussion. Generalized least squares models were conducted with task performances as dependent variables and PCSI and PCSI*sex interaction as the main predictors, with important pre-injury demographic and injury characteristics as covariates.
311 children (65.0% males; median age = 11.92 [IQR = 9.14-14.21 years]) were included in the analysis. After adjusting for covariates, higher symptom burden was associated with lower Backward Digit Span (χ = 9.85, = .043) and Verbal Fluency scores (χ = 10.48, = .033) across time points; these associations were not moderated by sex, ≥ .20. Symptom burden was not associated with performance on the Coding, Continuous Performance Test, and Color-Word Interference scores, ≥ .17.
Higher symptom burden is associated with lower working memory and cognitive flexibility following pediatric concussion, yet these associations were not moderated by sex. Findings may inform concussion management by emphasizing the importance of multifaceted assessments of EF.
症状和认知均被用作儿童脑震荡后恢复的指标，但两者之间的关系尚不清楚。本研究旨在调查：1）脑震荡后 4 周和 12 周时，脑震荡后症状负担与认知结局（加工速度和执行功能[EF]）之间的关联；2）性别对这种关联的调节作用。
这是一项前瞻性、多中心队列研究，纳入了急性脑震荡后到儿科急救研究加拿大网络的四个急诊部就诊的 5.00-17.99 岁的参与者。在脑震荡后 4 周和 12 周时，对 5 项加工速度和 EF 任务以及脑震荡后症状问卷（PCSI；症状负担，定义为损伤后与回顾性[损伤前]评分之间的差异）进行了评估。使用任务表现作为因变量，PCSI 和 PCSI*性别交互作用作为主要预测因子，以重要的损伤前人口统计学和损伤特征作为协变量，进行广义最小二乘模型分析。
311 名儿童（65.0%为男性；中位数年龄=11.92[IQR=9.14-14.21 岁]）纳入分析。调整协变量后，较高的症状负担与回溯数字跨度（χ=9.85， =.043）和言语流畅性评分（χ=10.48， =.033）在各个时间点上呈负相关；性别对此无调节作用，≥.20。症状负担与编码、连续动作测试和颜色-词语干扰评分上的表现无关，≥.17。
较高的症状负担与儿童脑震荡后工作记忆和认知灵活性下降有关，但这些关联不受性别调节。研究结果为脑震荡管理提供了信息，强调了 EF 进行全面评估的重要性。
