Head Trauma in a Community-Based Sample of Victims of Intimate Partner Violence: Prevalence, Mechanisms of Injury and Symptom Presentation.

OBJECTIVE: The present study aimed to explore the prevalence of subconcussive head trauma, traumatic brain injury (TBI), potential hypoxic events, and hypoxic brain injury (HBI) in victims of physical intimate partner violence (IPV). The study also aimed to characterize the injury presentation and mechanisms of injury in this population. METHOD: A group of 47 female participants with a history of at least one relationship that included physical violence completed a structured interview assessing for subconcussive hits, TBI, and HBI. Participants ranged in age from 19 to 55, and had an average of 15.3 years of education. Forty-four participants completed the structured interview in person and three participants completed the interview over the phone. RESULTS: The majority of participants reported sustaining at least one impact to the head and approximately half of the participants sustained at least one impact that resulted in a mild TBI. Approximately half of the participants experienced at least one incident of having difficulty breathing due to a violent act from their partner, and approximately one-third of participants reported symptoms consistent with mild HBI. The most common mechanisms of injury were being hit with a closed fist and being strangled. CONCLUSIONS: The high levels of head trauma observed in this study highlight the need for clinical and community providers to screen victims of physical IPV for head trauma. The unique characteristics of this population (female sex, high frequency of injuries, and presence of HBIs) indicate that research evaluating the cognitive effects of injuries in this population is needed.

Loss of Consciousness is Associated with Elevated Cognitive Intra-Individual Variability Following Sports-Related Concussion.

OBJECTIVE: The purpose of this study was to evaluate whether loss of consciousness (LOC), retrograde amnesia (RA), and anterograde amnesia (AA) independently influence a particular aspect of post-concussion cognitive functioning-across-test intra-individual variability (IIV), or cognitive dispersion. METHOD: Concussed athletes (N = 111) were evaluated, on average, 6.04 days post-injury (SD = 5.90; Mdn = 4 days; Range = 1-26 days) via clinical interview and neuropsychological assessment. Primary outcomes of interest included two measures of IIV-an intra-individual standard deviation (ISD) score and a maximum discrepancy (MD) score-computed from 18 norm-referenced variables. RESULTS: Analyses of covariance (ANCOVAs) adjusting for time since injury and sex revealed a significant effect of LOC on the ISD (p = .018, ηp2 = .051) and MD (p = .034, ηp2 = .041) scores, such that athletes with LOC displayed significantly greater IIV than athletes without LOC. In contrast, measures of IIV did not significantly differ between athletes who did and did not experience RA or AA (all p > .05). CONCLUSIONS: LOC, but not RA or AA, was associated with greater variability, or inconsistencies, in cognitive performance acutely following concussion. Though future studies are needed to verify the clinical significance of these findings, our results suggest that LOC may contribute to post-concussion cognitive dysfunction and may be a risk factor for less efficient cognitive functioning.

Financial incentives influence ImPACT validity indices but not cognitive composite scores.

INTRODUCTION: Interpreting change in cognitive performance across baseline and post-concussion evaluations is complicated by poor understanding of how incentives, such as return-to-play, may impact performance. This study examines the influence of an anticipated financial incentive on two sets of outcomes from the ImPACT computerized battery: (a) cognitive composites, meant to serve as measures of cognitive function, and (b) validity indices, proposed as indicators of invalid performance. METHOD: 81 uninjured college students, randomized into two groups, completed a concussion assessment battery including ImPACT. The control group received standard administration instructions. The incentive group was told they would receive $20 if their scores ranked in the top third of students who completed testing. Test examiners were blinded to condition, and participants were debriefed upon study completion. RESULTS: Given the non-normal distribution of the ImPACT cognitive composites and validity indices, non-parametric statistics were used to compare performance between incentive and control groups. Results of Mann-Whitney U tests revealed no significant differences between groups on the ImPACT cognitive composites (all p > .05, r = .04 to .19). In contrast, compared with the control group, the incentive group performed significantly better on all five validity indices: Impulse Control Composite (p = .036, r = .23); Xs and Os Total Incorrect (p = .035, r = .23); Word Memory Learning Percent Correct (p = .036, r = .23); Design Memory Learning Percent Correct (p = .018, r = .26); and Three Letters Total Letters Correct (p = .027, r = .25). CONCLUSIONS: Expectation of financial incentive did not influence performance on the four cognitive composites-the ImPACT's standard metrics of cognitive function. However, the incentive group, relative to controls, exhibited better performance on each of the five validity indices. These results suggest that ImPACT validity indices are more sensitive to incentive-related changes in effort than the ImPACT cognitive composites, providing support for the validity indicator indices as measures of effort toward testing.

Evaluating the test-retest reliability of symptom indices associated with the ImPACT post-concussion symptom scale (PCSS).

OBJECTIVE: The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a commonly used tool in sports concussion assessment. While test-retest reliabilities have been established for the ImPACT cognitive composites, few studies have evaluated the psychometric properties of the ImPACT's Post-Concussion Symptom Scale (PCSS). The purpose of this study was to establish the test-retest reliability of symptom indices associated with the PCSS. PARTICIPANTS AND METHODS: Participants included 38 undergraduate students (50.0% male) who underwent neuropsychological testing as part of their participation in their psychology department's research subject pool. The majority of the participants were Caucasian (94.7%) and had no history of concussion (73.7%). All participants completed the ImPACT at two time points, approximately 6 weeks apart. The PCSS was the main outcome measure, and eight symptom indices were calculated (a total symptom score, three symptom summary indices, and four symptom clusters). RESULTS: Pearson correlations (r) and intraclass correlation coefficients (ICCs) were computed as measures of test-retest reliability. Overall, reliabilities ranged from low to high (r = .44 to .80; ICC = .44 to .77). The cognitive symptom cluster exhibited the highest test-retest reliability (r = .80, ICC = .77), followed by the positive symptom total (PST) index, an indicator of the total number of symptoms endorsed (r = .71, ICC = .69). In contrast, the commonly used total symptom score showed lower test-retest reliability (r = .67, ICC = .62). Paired-samples t tests revealed no significant differences between test and retest for any of the symptom variables (all p > .01). Finally, reliable change indices (RCI) were computed to determine whether differences observed between test and retest represented clinically significant change. RCI values were provided for each symptom index at the 80%, 90%, and 95% confidence intervals. CONCLUSION: These results suggest that evaluating additional symptom indices beyond the total symptom score from the PCSS is beneficial. Findings from this study can be applied to athlete samples to assess reliable change in symptoms following concussion.

Normative Data for a Comprehensive Neuropsychological Test Battery used in the Assessment of Sports-Related Concussion.

OBJECTIVE: The use of normative data is a hallmark of the neuropsychological assessment process. Within the context of sports-related concussion, utilizing normative data is especially essential when individualized baseline data are unavailable for comparison. The primary purpose of this study was to establish normative data for a comprehensive neuropsychological test battery used in the assessment of sports-related concussion. A secondary aim was to provide normative data for pertinent demographic variables relevant to the assessment of college athletes, including sex, previous head injuries (PHI), and history of attention deficit hyperactivity disorder (ADHD)/learning disability (LD). METHOD: Participants included male and female college athletes (N = 794) who were involved in a concussion management program at an NCAA Division I university between 2002 and 2015. Athletes were administered a comprehensive neuropsychological test battery at baseline designed to assess the following cognitive domains: learning and memory, attention and concentration, processing speed, and executive functioning. The test battery primarily comprises paper-and-pencil measures. RESULTS: Normative data are presented for the overall athlete sample. Additional sub-norms are then provided for specified demographic populations (i.e., sex, PHIs, and history of ADHD/LD). Findings indicate that there are mild cognitive differences between men and women, as well as between those athletes with and without a history of ADHD/LD. Given these findings, additional norms are provided for men and women with and without a history of ADHD/LD. CONCLUSIONS: In the absence of baseline testing, the normative data presented here can be used clinically to assess athletes' cognitive functioning post-concussion.

Beyond binary: Exploring the merits of three depression groups in multiple sclerosis.

OBJECTIVE: Depression has been traditionally explored in the context of multiple sclerosis (MS) as a binary construct (depressed, not depressed). However, given the 50% lifetime prevalence rate of depression in MS, it may be useful to consider not only currently depressed versus nondepressed patients, but to evaluate groups that better characterize the complexity of MS depression. The objective of the current study was to examine demographic, cognitive, illness, and psychosocial variables thought to associate with depression in MS across 3 groups: currently depressed, remitted depression, and never been depressed. METHOD: Fifty-four individuals with MS were examined. Current depression status was measured using the Beck Depression Inventory-Fast Screen (BDI-FS; Beck, Steer, & Brown, 2000). Past depression was evaluated using the Structured Clinical Interview for DSM-IV Disorders (SCID-IV; First, Spitzer, Gibbon, & Williams, 1998) and a semistructured psychosocial interview. RESULTS: The results of the current study show that evaluating depression in 3 groups is useful for exploring risk, protective, and compensatory factors of depression in MS. A consistent grouping pattern (e.g., the remitted depression group always functioning the same as the never been depressed group) was not found among the variables examined; rather, several different patterns were observed. Several of these patterns revealed differences between the remitted depression and never been depressed groups; these differences would not have been observed had these 2 groups been combined into a "not currently depressed" group. CONCLUSIONS: These different patterns yield important information about the complex relationships of depression in MS that may be obscured when depression is viewed as a binary construct. (PsycINFO Database Record

A novel approach to classifying postconcussion symptoms: The application of a new framework to the Post-Concussion Symptom Scale.

INTRODUCTION: Self-report measures such as the Post-Concussion Symptom Scale (PCSS) are frequently used during baseline and postconcussion testing to evaluate athletes' symptom profiles. However, the common approach of evaluating the total symptom score and/or symptom clusters may not allow for a complete understanding of the nature of athletes' symptom reporting patterns. The primary objective of this study was to apply three "global indices of distress" variables, derived from the Symptom Checklist-90-Revised (SCL-90-R) framework, to the PCSS at baseline and postconcussion. We aimed to evaluate the utility of these symptom indices in relation to four PCSS symptom clusters and the total PCSS symptom score. METHOD: Participants included college athletes evaluated at baseline (N = 846) and postconcussion (N = 86). Athletes underwent neuropsychological testing at both time points, including completion of the PCSS and a paper/pencil and computerized test battery. Eight symptom indices were derived from the PCSS, and a postconcussion neurocognitive composite score was calculated. RESULTS: Results showed that there were significant mean increases from baseline to postconcussion on four of the eight symptom indices evaluated. Furthermore, a significant proportion of athletes showed no change from baseline to postconcussion when evaluating the total symptom score, but showed at least a one standard deviation increase in symptom reporting from baseline to postconcussion when evaluating at least one other symptom index (i.e., a global index of distress or symptom cluster). Finally, the three global indices of distress variables, two of the four symptom clusters, and the total symptom score significantly predicted a postconcussion neurocognitive composite score, such that greater postconcussion symptoms were associated with lower postconcussion neurocognitive performance. CONCLUSIONS: These findings suggest that, in addition to evaluating the postconcussion total symptom score, there may be value in examining more specific symptom indices such as the global indices of distress variables and symptom clusters.

Validation of the Affective Word List as a measure of verbal learning and memory.

INTRODUCTION: This study evaluated the Affective Word List (AWL), a measure designed to assess affective bias, as a measure of verbal learning and memory in the context of baseline concussion evaluations. The AWL was developed to assess affective bias in order to circumvent the tendency of some examinees to minimize self-report of depression symptoms. However, because it is designed as a traditional list-learning task, the cognitive indices of the AWL have the added potential to be used as measures of verbal learning and memory. It would be useful to have a performance-based measure that is sensitive to both the affective and cognitive consequences of concussion. METHOD: Participants from a university-based sports concussion program were used to evaluate the descriptive statistics and distribution of the AWL and its convergent and discriminant validity. A separate sample of undergraduate students, active in intramural or club athletics, served as participants for a delayed alternate-form reliability study. All reliability and validity results were compared with those of the Hopkins Verbal Learning Test-Revised (HVLT-R) and the Immediate Post-Concussion Assessment and Cognitive Testing Verbal Memory Composite (ImPACT-VM). RESULTS: Results of this study showed that the cognitive indices of the AWL have normal distributions, and its four forms are equivalent. The AWL demonstrated moderate delayed alternate-form reliability, moderate convergent validity with other measures of verbal learning and memory, and strong discriminant validity with measures of processing speed and reaction time. CONCLUSIONS: Results of this study suggest that the AWL may have clinical utility as a measure of verbal learning and memory in concussion management and research.

Changes in symptoms in concussed and non-concussed athletes following neuropsychological assessment.

Collegiate athletes tested at baseline and post-concussion were administered a self-report measure of post-concussion symptoms pre- and post-testing. Athletes tested post-concussion were significantly more likely to demonstrate an increase in symptoms post-testing, suggesting that the cognitive exertion involved in neuropsychological assessment may exacerbate symptoms in some athletes.