A-27 APOE & BDNF Polymorphisms Interact to Affect Memory Performance at Baseline in Adolescent Athletes

Objective

Although several single-nucleotide polymorphisms have been associated with cognitive functioning in a variety of healthy and clinical samples, the influence of gene x gene interactions on cognition is poorly understood. The purpose of this study was to examine interactive relationships between apolipoprotein E (APOE) and brain-derived neurotrophic factor (BDNF) polymorphisms on cognitive functioning in a sample of healthy adolescent athletes.

Method

Participants of this cross-sectional study included 82 athletes (53.7% male, age, M = 12.85, SD = 1.13) who completed the Immediate Post-Concussion and Cognitive Testing (ImPACT) computerized battery at baseline as part of a school-based sports-concussion management program. Athletes also provided a buccal sample for determination of their APOE and BDNF genotypes. Two-way analyses of variance (ANOVAs) were used to evaluate the effect of APOE (ε4+ vs. ε4-) and BDNF (Met+ vs. Met-) genotypes on the ImPACT cognitive composites.

Results

ANOVAs showed non-significant main effects for both APOE and BDNF genotypes across the four cognitive composites. However, there was a significant APOE x BDNF genotype interaction for the verbal (p = .01; ηp2 = .08) and visual (p = .013; ηp2 = .08) memory composites, such that ε4+/Met+ carriers demonstrated poorer performance relative to the other allele combinations (ε4+/Met-, ε4−/Met+, ε4−/Met-). No significant interactions were observed for the visual motor speed (p = .20; ηp2 = .02) or reaction time (p = .87; ηp2 < .001) composites.

Conclusions

Our findings suggest a meaningful relationship between APOE and BDNF genotypes on verbal and visual memory performance in healthy adolescent athletes. These findings will need to be replicated using much larger samples, and future studies will need to explore these associations following sports-related concussion.

Testing the Hybrid Battery Approach to Evaluating Sports-Related Concussion in the National Hockey League: A Factor Analytic Study

Purpose

Traditional “paper and pencil” neuropsychological tests and computerized test batteries have been employed in the assessment of sports-related concussion (SRC). Each type of test has inherent strengths and weaknesses. The NHL has constructed a “hybrid” battery of tests that uses both traditional and computerized measures in the evaluation of its players suspected of SRC. The purpose of this paper is to use factor analytic techniques to examine the relationships among the measures that comprise this battery.

Methods

Post-injury neuropsychological test data using the hybrid battery were obtained from 343 NHL players following their first concussion while playing in the league. ImPACT was used as the computer test battery. The traditional battery included: Hopkins Verbal Learning Test, Brief Visuospatial Memory Test, Color Trails, PSU Cancellation, Symbol Digits Modalities Test (including incidental memory), and Verbal Fluency.

Results

Five factors were extracted explaining 64.55% of the variance. The factor labels and the measures principally loading on each factor were as follows: Factor 1, Verbal Learning and Memory (HVLT Total and Delayed Recall); Factor 2, Processing Speed (Color Trails A/B, PSU Cancellation, and SDMT-Total); Factor 3, Visual Memory (BVMT- Total and Delayed); Factor 4, Cued Memory (ImPACT-Visual and Verbal Memory Composites); and Factor 5, Reaction Time (ImPACT Reaction Time and Visual Motor Speed composites).

Conclusion

These data underscore the unique contributions of traditional and ImPACT neuropsychological measures to the evaluation SRC in a sample of professional hockey players. It appears that both approaches measure different aspects of cognitive functioning. The next logical step is to use these data in evaluating the diagnostic utility of these measures as part of a combined battery.

The Utility of the King-Devick Test in Evaluating Professional Ice Hockey Players with Suspected Concussion

Purpose

The King-Devick (KD) is a measure of rapid number naming used in the evaluation of sports-related concussion (SRC). Recent data from the Canadian Football League and Rugby Union suggest that the KD should not be used as a stand-alone measure of SRC. The purpose of this study was to examine the diagnostic utility of the KD in professional ice hockey players.

Methods

NHL players who were suspected of having a concussion were evaluated with the KD and either the SCAT3 or the SCAT5. Players who were evaluated and not diagnosed with concussion served as Active controls. A small group of non-Active control players was also tested twice and was included in the present study for comparison.

Results

1605 players were evaluated with the KD at baseline. Of these, 53 were diagnosed with concussion, 76 were Active controls, and 11 were non-Active controls. Concussed players revealed a decline in performance from baseline to acute evaluation, t(52)=3.05, p<.01, d=.42 while Active controls significantly improved, t(75)=2.05, p<.05, d=.24. No significant change between baseline and acute testing was observed for non-Active controls. Using a cut score of any decline in performance from baseline to suspected injury evaluation yielded Sensitivity=64%, Specificity=61%, Positive Predictive Value=53% and Negative Predictive Value=71%.

Conclusion

Our data are consistent with previous studies suggesting that while the KD is useful in differentiating concussed and not concussed athletes acutely, the relatively low predictive values indicate that a decline in KD performance should not be used as a standalone measure to diagnose concussion.

Mild traumatic brain injury in sports: neuropsychology's contribution to a developing field

Mild traumatic brain injuries are common at all levels of athletic competition. Although once considered a "routine part of the game," a significant amount of attention has recently been placed on these injuries at the professional, college, and high school levels. This paper reviews the epidemiology of sports-related brain injuries, the pathophysiology of the injuries, and the role of neuropsychology in this newly emerging area. Issues related to the adequacy of neuropsychological test instruments and approaches are discussed in light of future directions for research.

Neuropsychological test performance prior to and following sports-related mild traumatic brain injury

OBJECTIVE

To examine the utility of neuropsychological tests in assessing college athletes prior to and following a sports-related mild Traumatic Brain Injury (mTBI).

DESIGN

A prospective study of college athletes who sustained mTBI while engaged in sport. Preinjury baseline neuropsychological test data were obtained for athletes at risk for mTBI. Following an mTBI, the athlete and his or her matched noninjured control were evaluated at 2 hours, 48 hours, 1 week, and I month postinjury.

SETTING

Male and female athletes from a Division I college.

PARTICIPANTS

Male and female athletes from the football, men's ice hockey, men's and women's soccer, and men's and women's basketball teams at Penn State University. A total of 29 injured and 20 noninjured athletes participated in the study.

INTERVENTIONS

Neuropsychological test batteries were administered at baseline and serially following mTBI.

MAIN OUTCOME MEASURES

Post-Concussion Symptom Checklist, Hopkins Verbal Learning Test, Symbol Digit Modalities Test, Stroop Color-Word Test, Trail Making Test, VIGIL/W, List Learning, Digit Span, Penn State Cancellation Test, and Controlled Oral Word Association.

RESULTS

Neuropsychological test data yielded significant differences between injured athletes and controls at 2 hours and 48 hours following cerebral concussion; injured athletes performing significantly worse than controls. Injured athletes reported a significantly greater number of postconcussion symptoms 2 hours following injury but not at the 48-hour assessment. No multivariate group differences were found at 1 week, but univariate analyses suggested significant differences on a few measures. At 1 month postinjury, a statistically significant difference was found on one measure with injured athletes marginally outperforming controls.

CONCLUSIONS

Neuropsychological tests are useful in the detection of cognitive impairment following mTBI. The test data appear to be more effective than subjective report of symptoms in differentiating between injured and noninjured athletes at 48 hours postinjury. Although significant individual variability existed, most injured athletes recovered within 1 week of injury. A battery of tests, rather than any single test, is necessary to capture the variability that exists among injured athletes.

The acute neuropsychological effects of heading in soccer: a pilot study

OBJECTIVE

The main objective of this study was to prospectively examine the acute effects of heading in soccer on cognitive function.

DESIGN

This was a prospective cross-over study using a brief neuropsychological battery to assess cognitive function. The tests were performed before and after two separate practice sessions, with athletes serving as their own controls.

SETTING

Male and female Division I college athletes.

PARTICIPANTS

Members of the men's and women's varsity collegiate Penn State University soccer teams. Forty-four males and 56 females entered and finished the study. All athletes had a normal physical examination.

INTERVENTIONS

Before and after both practice sessions, all athletes had a brief battery of neuropsychological tests and a symptom checklist.

MAIN OUTCOME MEASURES

Neuropsychological tests symptom checklist compared at baseline with those after the practice sessions.

RESULTS

There were no significant differences in pretest scores between groups and no difference on posttest scores between heading and nonheading groups. A significant difference was detected using MANOVA (p = < 0.001) between pre- and posttest scores for measures of attention and concentration, indicating a practice effect. A gender-specific effect in one test measuring attention and concentration was found. There was no difference in symptoms before and after heading as compared with exertional controls.

CONCLUSIONS

In this study, soccer players heading the ball does not appear to lead to acute changes in cognitive function as assessed by a brief neuropsychological battery. There are practice effects that occur with repetitive neuropsychological testing and gender differences with certain tests.

Managing successive minor head injuries: which tests guide return to play?

This case report describes a female college basketball player who experienced brief loss of consciousness with hemiparesis after being struck in the jaw during a game. When she returned to play a month later, she sustained a second mild head injury, which resulted in persistent headache, cognitive difficulties, and reversal in hand dominance. She has since recovered fully. This case addresses return-to-play issues for the head-injured athlete, especially the risk of recurrent injury. It also illustrates the utility of neuropsychological testing when standard medical tests fail to detect any abnormalities.