Lingering effects of concussion in athletes with multiple injuries

Archives of Clinical Neuropsychology -


Iverson, G. L., R. J. Echemendia and B. L. Brooks.



Objective: There is considerable interest in the possibility of cumulative effects in athletes who suffer multiple concussions. The purpose of this study was to examine whether athletes with a history of three or more concussions perform more poorly on neuropsychological testing, or report more subjective symptoms, during a baseline, preseason evaluation. Methods: An archival database including 786 male athletes who underwent preseason testing with a computerized battery (ImPACT) was used to select the participants. Twenty-six athletes, between the ages of 17 and 22 (mean = 19.7, S.D. = 1.4) with a history of three or more concussions, wereidentified. Athletes with no history of concussion were precisely matched, in a case–control fashion, on age, education, school, sport, and, when possible, position. Results: The two groups were compared on the four neuropsychological composite scores from ImPACT using multivariate 898 Abstracts / Archives of ClinicalNeuropsychology 22 (2007) 793–907 analysis of variance (MANOVA) followed by univariate ANOVAs. MANOVA revealed no overall significant effect [F(4, 47) = 1.6, p = .19, observed power = .46). Exploratory ANOVAs were conducted using Verbal Memory, Visual Memory, Reaction Time, Processing Speed, and Post-Concussion Scale composite scores as dependent variables. There was a significant effect for only the Verbal Memory composite (p = .028, Cohen’s d = .63). Nonparametric analysis of the Verbal Memory composite also revealed a significant difference (p = .005). Conclusions: Participants in this study were more carefully matched than any previously published study. The results of this study were not definitive. However, there is modest evidence that athletes with multiple concussions could have a lingering adverse effect.

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