Sex and age differences in depression and baseline sport-related concussion neurocognitive performance and symptoms
Covassin T., Elbin RJ., Larson E., Kontos AP. Clin J Sport Med; ahead of print
One of the keys to concussion management is a neurocognitive assessment (e.g., ImPACT). Neurocognitive assessments can be influenced by mood (e.g., depression), which can be influenced by gender. For example, women report higher incidence of depression levels compared to males. However, these neurocognitive assessments do not include depression or mood-based questions to estimate a more appropriate baseline measure. Therefore, the objective of this study was to examine depression and baseline neurocognitive function and concussion symptoms in male and female high school and college athletes. A secondary purpose was to examine differences in depression, neurocognitive function, and concussion signs and symptoms between gender as well as age groups. This was a cross-sectional study that included 1,616 college (n = 837) and high school (n = 779) athletes from 3 states participating in a variety of competitive sports. Each athlete took a baseline ImpACT test (measures neurocognitive function as well as concussion signs and symptoms) and Beck Depression Inventory II test (measures level of depression). Based on the Beck Depression Inventory II test athletes were grouped into minimal, mild, moderate, or severe depression and then the depression-based groups were used to compare differences among ImPACT scores. The severe depression groups scored significantly lower on visual memory and significantly higher with total sign and symptom score, migraine symptoms, and cognitive symptoms compared to lower-level depression athletes. The comparison for total depression symptoms as well as total concussion signs and symptoms revealed no significant difference for age group or sex; however, there were differences for specific signs and symptoms. High school athletes reported more migraine symptoms compared to collegiate athletes. Collegiate athletes reported higher emotional and sleep symptoms compared to high school athletes. Women performed better than males on verbal and motor processing speeds. Collegiate athletes performed better on motor processing speed than high school athletes. Symptom cluster analysis revealed that women reported higher signs and symptoms score (using a likert scale 1 to 7) within cognitive, emotional, and sleep categories. There was also an interaction between age, sex, and sleep symptoms, where college women reported more symptoms than high school girls; while men reported equally between age groups.
Assessing an athlete’s baseline neurocognitive performance is critical to postconcussion testing. The slightest variable (e.g., depression) could affect the assessment tool, and needs to be accounted for. Athletes with severe depression scored lower on visual memory and reported more migraine and cognitive concussion symptoms than athletes with lower-level depression scores, which could be attributed to hippocampal depression (functions for memory performance). The lower visual memory may be correlated to the increased severity of reported migraine symptoms. Also, those with depression usually have many somatic complaints, which explains the high total concussive signs and symptoms score. Clinicians should be aware that high school athletes reported more migraine symptoms. Collegiate athletes reported more problems with emotional, cognitive and sleep symptoms. The researchers reported that based on these findings there should be depression symptoms included in baseline assessment scores. Do you think this would have an effect if an athlete was on depression medication? Would you be able to determine if you athlete is in a depressed state and should not be baseline tested?
Written by: Jane McDevitt MS, ATC, CSCS
Reviewed by: Jeff Driban
Covassin T, Elbin RJ 3rd, Larson E, & Kontos AP (2012). Sex and Age Differences in Depression and Baseline Sport-Related Concussion Neurocognitive Performance and Symptoms. Clinical Journal of Sport Medicine PMID: 22246342