Age of First Concussion and Cognitive, Psychological, and Physical Outcomes

Objective This study examined the association between age of first concussion (AFC) and neurocognitive performance, psychological distress, postural stability, and concussion symptoms in healthy collegiate student athletes.

Background Concussions are common among youth athletes, yet the long-term clinical consequences are largely unknown. We hypothesized that earlier AFC (younger age at first injury) would be associated with worse clinical outcomes.

Design/Methods Participants included 4,267 collegiate athletes with a positive concussion history from various contact, limited-contact, and non-contact sports (1,818 women and 2,449 men) who completed baseline assessments as part of the Concussion Assessment, Research and Education (CARE) Consortium. Self-reported AFC included both sport- and non-sport-related concussions. Participants completed the Brief Symptom Inventory-18 (assessing psychological distress), the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT, assessing neurocognitive performance and symptoms), the Sport Concussion Assessment Tool symptom evaluation, and the Balance Error Scoring System (assessing postural stability). Generalized linear models were implemented for men and women separately to examine the effects of AFC on clinical outcomes.

Results Median time from AFC to assessment was four years. After correcting for multiple comparisons, earlier AFC was associated with greater somatic (Exp(B) = 0.96, p = 0.001) and global (Exp(B) = 0.96, p < 0.001) psychological distress on the Brief Symptom Inventory-18, and slower ImPACT reaction time (B = −0.003, p = 0.001) in women. After correcting for multiple comparisons, AFC was not associated with any clinical outcomes in men.

Conclusions Earlier AFC appears to have some long-term clinical consequences in women but not men, which is consistent with work suggesting that women report greater overall symptoms than men following concussion. These results underscore the importance of minimizing the risk of and properly managing concussions in youth sports, as they may have lasting effects. Future work should examine mechanisms of the AFC sex effects as well as longer-term clinical outcomes in middle and older adulthood.