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Michael W. Collins, PhD; Scott H. Grindel, MD; Mark R. Lovell, PhD; Duane E. Dede, PhD; David J. Moser, PhD; Benjamin R. Phalin, BS; Sally Nogle, MA, ATC; Michael Wasik, MEd, ATC; David Cordry, MA; Michelle Klotz Daugherty, MA; Samuel F. Sears, PhD; Guy Nicolette, MD; Peter Indelicato, MD; Douglas B. McKeag, MD

JAMA. 1999;282:964-970.

Context  Despite the high prevalence and potentially serious outcomes associated with concussion in athletes, there is little systematic research examining risk factors and short- and long-term outcomes.

Objectives  To assess the relationship between concussion history and learning disability (LD) and the association of these variables with neuropsychological performance and to evaluate postconcussion recovery in a sample of college football players.

Design, Setting, and Participants  A total of 393 athletes from 4 university football programs across the United States received preseason baseline evaluations between May 1997 and February 1999. Subjects who had subsequent football-related acute concussions (n=16) underwent neuropsychological comparison with matched control athletes from within the sample (n=10).

Main Outcome Measures  Clinical interview, 8 neuropsychological measures, and concussion symptom scale ratings at baseline and after concussion.

Results  Of the 393 players, 129 (34%) had experienced 1 previous concussion and 79 (20%) had experienced 2 or more concussions. Multivariate analysis of variance yielded significant main effects for both LD (P<.001) and concussion history (P=.009), resulting in lowered baseline neuropsychological performance. A significant interaction was found between LD and history of multiple concussions and LD on 2 neuropsychological measures (Trail-Making Test, Form B [P=.007] and Symbol Digit Modalities Test [P=.009]), indicating poorer performance for the group with LD and multiple concussions compared with other groups. A discriminant function analysis using neuropsychological testing of athletes 24 hours after acute in-season concussion compared with controls resulted in an overall 89.5% correct classification rate.

Conclusions  Our study suggests that neuropsychological assessment is a useful indicator of cognitive functioning in athletes and that both history of multiple concussions and LD are associated with reduced cognitive performance. These variables may be detrimentally synergistic and should receive further study.

Author Affiliations: Department of Behavioral Health, Henry Ford Health System, Detroit, Mich (Drs Collins and Lovell); Departments of Family Practice (Dr Grindel) and Family Medicine/Sports Medicine (Dr McKeag), University of Pittsburgh, Pittsburgh, Pa; Departments of Clinical and Health Psychology (Drs Dede, Moser, and Sears and Mr Phalin), Community and Family Health (Dr Nicolette), and Sports Health (Mr Wasik), and Department of Orthopedics and Rehabilitation, College of Medicine (Dr Indelicato), University of Florida, Gainesville; Departments of Athletic Training (Ms Nogle) and Psychology (Mr Cordry and Ms Daugherty), Michigan State University, East Lansing; and Department of Sports Medicine, St Vincent's Medical Center, Erie, Pa (Dr Grindel).

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