A dose-response relation of headers and concussions with cognitive impairment in professional soccer players.

The purpose of this study was to determine the effects of headers and concussions on cognitive impairment in professional soccer players. A group of 84 active professional soccer players from several premier league soccer clubs underwent neuropsychological evaluations. The dose-response relation between the number of headers in one professional season and the number of soccer-related concussions on cognitive functioning was investigated. It was found that the number of headers in one season was related to poorer results on tests measuring focused attention and visual/verbal memory. Soccer-related concussions were related to poorer results on tests measuring sustained attention and visuoperceptual processing. The findings suggest that headers as well as concussions separately contribute to cognitive impairment.

Neuropsychological effects of interferon beta-1a in relapsing multiple sclerosis. Multiple Sclerosis Collaborative Research Group.

Cognitive dysfunction is common in multiple sclerosis (MS), yet few studies have examined effects of treatment on neuropsychological (NP) performance. To evaluate the effects of interferon beta-1a (IFNbeta-1a, 30 microg administered intramuscularly once weekly [Avonex]) on cognitive function, a Comprehensive NP Battery was administered at baseline and week 104 to relapsing MS patients in the phase III study, 166 of whom completed both assessments. A Brief NP Battery was also administered at 6-month intervals. The primary NP outcome measure was 2-year change on the Comprehensive NP Battery, grouped into domains of information processing and learning/memory (set A), visuospatial abilities and problem solving (set B), and verbal abilities and attention span (set C). NP effects were most pronounced in cognitive domains vulnerable to MS: IFNbeta-1a had a significant beneficial effect on the set A composite, with a favorable trend evident on set B. Secondary outcome analyses revealed significant between-group differences in slopes for Brief NP Battery performance and time to sustained deterioration in a Paced Auditory Serial Addition Test processing rate, favoring the IFNbeta-1a group. These results support and extend previous observations of significant beneficial effects of IFNbeta-1a for relapsing MS.

Refining a measure of brain injury sequelae to predict postacute rehabilitation outcome: rating scale analysis of the Mayo-Portland Adaptability Inventory.

OBJECTIVE: Evaluate the psychometric properties of the Mayo-Portland Adaptability Inventory (MPAI). DESIGN: Rating scale (Rasch) analysis of MPAI and principal component analysis of residuals; the predictive validity of the MPAI measures and raw scores was assessed in a sample from a day rehabilitation program. SETTING: Outpatient brain injury rehabilitation. PARTICIPANTS: 305 persons with brain injury. RESULTS: A 22-item scale reflecting severity of sequelae of brain injury that contained a mix of indicators of impairment, activity, and participation was identified. Scores and measures for MPAI scales were strongly correlated and their predictive validities were comparable. CONCLUSIONS: Impairment, activity, and participation define a single dimension of brain injury sequelae. The MPAI shows promise as a measure of this construct.

Acute traumatic brain injury in amateur boxing.

UNLABELLED: Via neuropsychological testing, this research team found post-match cognitive impairment in amateur boxers despite the fighters' use of headgear. BACKGROUND: Acute traumatic brain injury (ATBI) represents the neurologic consequence of concussive and subconcussive blows to the head. Evidence suggests that ATBI may be associated with boxing and collision sports such as American football and soccer, thus potentially exposing millions of athletes annually. OBJECTIVE: The objectives of this study were to determine whether significant ATBI occurs in boxers who compete and, if present, the nature of the cognitive impairment. A secondary objective was to determine if headgear could reduce the risk for ATBI in amateur boxing. DESIGN: In this inception cohort study, 38 amateur boxers underwent neuropsychological examination before and shortly after a boxing match and were compared with a control group of 28 amateur boxers who were tested before and after a comparable physical test. The main outcome measures were neuropsychological tests (memory, mental and fine-motor speed, planning, and attention) proven to be sensitive to cognitive changes incurred in contact and collision sports. RESULTS: The boxers who competed exhibited an ATBI pattern of impaired performance in planning, attention, and memory capacity when compared with controls. They had significantly different findings in the Categorization Task Test (P = 0.047); Digit Symbol Test (P = 0.02); Logical Memory: Short Term Memory and Long Term Memory subtests (both tests, P < 0.001); and Visual Reproduction: Short Term Memory subtest (P < 0.001) and Long Term Memory subtest (P < 0.03). CONCLUSION: Participation in amateur boxing matches may diminish neurocognitive functioning despite the use of headgear. The neurocognitive impairment resembles cognitive symptoms due to concussions. Guidelines are needed to reduce the risk for repeated ATBI.

Neuropsychological impairment in amateur soccer players.

CONTEXT: Soccer players incur concussions during matches and training sessions, as well as numerous subconcussive blows to the head from impacts with the soccer ball (headers). The combination of soccer-related concussions and the number of headers may be a risk for chronic traumatic brain injury (CTBI). OBJECTIVE: To determine whether amateur soccer players have evidence of CTBI. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of 33 amateur soccer players and 27 amateur athletes involved in swimming and track (controls) in the Netherlands who underwent interviews and neuropsychological testing. MAIN OUTCOME MEASURES: Performance of soccer players vs controls on 16 neuropsychological tests having 27 outcomes. RESULTS: Compared with control athletes, amateur soccer players exhibited impaired performance on tests of planning (39% vs 13%; P=.001) and memory (27% vs 7%; P=.004). Among soccer players, 9 (27%) had incurred 1 soccer-related concussion and 7 (23%) had had 2 to 5 concussions during their career. The number of concussions incurred in soccer was inversely related to the neuropsychological performance on 6 of the neuropsychological tests. CONCLUSIONS: Our results indicate that participation in amateur soccer in general and concussion specifically is associated with impaired performance in memory and planning functions. Due to the worldwide popularity of soccer, these observations may have important public health implications.

Chronic traumatic brain injury in professional soccer players.

OBJECTIVE: To determine the presence of chronic traumatic brain injury in professional soccer players. METHODS: Fifty-three active professional soccer players from several professional Dutch soccer clubs were compared with a control group of 27 elite noncontact sport athletes. All participants underwent neuropsychological examination. The main outcome measures were neuropsychological tests proven to be sensitive to cognitive changes incurred during contact and collision sports. RESULTS: The professional soccer players exhibited impaired performances in memory, planning, and visuoperceptual processing when compared with control subjects. Among professional soccer players, performance on memory, planning, and visuoperceptual tasks were inversely related to the number of concussions incurred in soccer and the frequency of "heading" the ball. Performance on neuropsychological testing also varied according to field position, with forward and defensive players exhibiting more impairment. CONCLUSION: Participation in professional soccer may affect adversely some aspects of cognitive functioning (i.e., memory, planning, and visuoperceptual processing).

Criteria for progressive modification of neurobehavioral batteries.

Six specific issues affecting the progressive modification of neurobehavioral test batteries used in field studies of populations exposed to neurotoxicants are discussed and test review recommendations are provided addressing each issue. The issues include: (a) general test review standards, (b) comprehensive assessment, (c) tailored batteries, (d) incorporation of new tests and techniques, (e) personnel and mechanisms for review, and (f) development of a battery assessing peripheral nervous system function.

The mental efficiency of the elderly person with type II diabetes mellitus.

Cognitive function is often impaired in type I diabetes mellitus, especially when onset is in early childhood. Limited evidence suggests similar impairment in the much larger population of older persons with type II diabetes. We report here the results of 13 measures of mental efficiency in persons between 65 and 77 years of age without gross mental impairment. Nineteen persons with type II diabetes were compared with 19 controls with normal glycosylated hemoglobin values and to seven persons not previously known to have diabetes but who had elevated glycosylated hemoglobin. Significant differences (P less than .05) between the nondiabetic control and diabetic groups were noted on eight of the 13 tests. The group of subjects with elevated glycosylated hemoglobins showed levels of cognitive performance intermediate between the normal and known diabetic groups on the majority of tests. These findings confirm that mental efficiency is frequently impaired in older persons with diabetes. Given the high prevalence of diabetes in the aging population we suggest that diabetes may be another important factor contributing to premature loss of cognitive abilities in older people.

IQ: R.I.P.

In the early decades of this century, "IQ," as score and concept, not only satisfied psychology's need for metrical respectability, but it caught the public's fancy and rapidly became a household word. Reified in many popular tests, it has withstood onslaughts from factor analysis, from concerned social scientists, from judicial fiat, and from scientific knowledge about mental abilities, brain functions, and neuropathology. In neuropsychological practice its use--and that of any scores representing sums or averages of disparate data obtained from tests of brain functions and mental abilities--can obscure specific facets of a subject's neuropsychological status or misrepresent it generally. This 70-year-old concept has outlived its usefulness. Neuropsychology needs to seek more appropriate alternatives to the IQ for describing and conceptualizing mental functioning.

Brain damage is a family affair.

Behavioral alterations due to brain damage that compromise the quality of patients' lives also affect the well-being of patients' families. Family distress following head injury has been well-documented. With other cerebral disorders, similar emotional burdens and family disruptions are experienced by the immediate family. Most families suffer many of the core problems arising from the patient's dependency and cognitive inefficiency, and from social reactions to the patient's disability. Moreover, emotional disturbances and executive disorders associated with the site or nature of the lesion(s) affect patients' interaction with their families differentially creating distinctive patterns of family burden. Specific family problems may be relieved through education, counselling, and emotional support.

Cerebral dysfunction in the Munchausen syndrome.

Brain dysfunction has been noted Munchausen syndrome patients but rarely explored. We describe five Munchausen syndrome patients who all appeared intellectually intact because of their excellent verbal skills. However, formal neuropsychological assessment testing revealed deficits in conceptual organization, management of complex information, and judgement. We suggest that subtle but important neuropsychological impairment may contribute significantly to the aberrant behavior of Munchausen syndrome patients. Typical Munchausen behaviors such as irascibility, the desperate search for care, and pseudologia fantastica, may be understood as solutions to problems created by brain damage.

Sampling problems and nonparametric solutions in clinical neuropsychological research.

Research data in clinical neuropsychology frequently do not conform to the requirements for parametric statistical analysis. In some of these cases, data analysis by parametric techniques does not identify existing differences. The usefulness of nonparametric statistical tools in evaluating irregular data sets is demonstrated in three cases examples. Methodological considerations arising from these examples are discussed.

Recovery of memory and learning functions following traumatic brain injury.

Twenty-four traumatically brain-injured males, of whom eight had sustained right-sided, eight left-sided, and eight bilateral or diffuse closed head injuries, took a battery of neuropsychological tests within the first six months, the second six months, the second year and the third year post injury. Performances on WAIS Digits Forward and Backward and Rey's Auditory-Verbal Learning Test were classified as within or below normal range. Comparisons were made (1) between time periods and tests and (2) between subgroups formed by severity, site of lesion, and age. The findings give an overall picture of wide performance variability with consistent improvement in immediate memory span and learning. Recovery varied with the specific nature of the tested function, task complexity, and severity of injury. Neither age, site of injury, not recency were associated with improvement.

Living with the characterologically altered brain injured patient.

Characterological defects secondary to brain injury tend to disrupt normal family interaction patterns and create adjustment problems for the patient's close family members. Social and psychological ties, expectations, and vulnerabilities make caretaking spouses and dependent children particularly susceptible to emotional stresses. Unrealistic expectations often compound these problems. Almost all family members experience some depression. Counseling family members can improve the quality of their adjustment and their care of the patient. Counseling goals include helping the family readjust expectations, providing practical management advice, and alerting family members to their own needs. Specific recommendations for dealing with common family problems are offered.

Subtle sequelae of brain damage. Perplexity, distractibility, and fatigue.

Subtle problems of perplexity, distractibility, and fatigue accompany all kinds of brain injury for they appear to result from disruption of accustomed neural pathways and loss or change of mental function. Emotional disturbances may mask these subtle problems, but they can also result from them. Clinical experience indicates that these problems are more apt to become stressful when the patient misinterprets or copes ineffectively with them. That these common problems of brain injured adults may be overlooked in the usual clinical examination was shown in a comparison of clinical records of 50 patients referred for neuropsychological consultation with records of 46 patient-participants in a longitudinal neuropsychological study. Significantly more reports of these problems appeared in the latter group of records. However, consultation records did reflect emotional distress. Irritability, depression, or anxiety affected all but six consultation patients and appeared with equal frequency among working patients as among those unable to work or needing full-time care. This suggests that some of their emotional distress resulted from less obvious problems than those impairing mobility, strength, or competency. Counseling can reduce the patient's vulnerability to the psychologically crippling effects of perplexity, distractibility, and fatigue. Specific recommendations for patient and family counseling are offered.