Incidence of concussion and recovery of neurocognitive dysfunction on ImPACT assessment among youth athletes with premorbid depression or anxiety taking antidepressants
| Autor: | Mark A. Lovell, Tanvir F. Choudhri, Nek Asghar, Adam Y Li, John R. Durbin, Alex Gometz, Muhammad Ali, Nickolas Dreher, Zachary Spiera, Theodore C Hannah, Naoum Fares Marayati |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
business.industry Incidence (epidemiology) Poison control General Medicine medicine.disease 03 medical and health sciences 0302 clinical medicine 030220 oncology & carcinogenesis Internal medicine Cohort Concussion medicine Anxiety medicine.symptom Verbal memory business Neurocognitive 030217 neurology & neurosurgery Depression (differential diagnoses) |
| Zdroj: | Journal of Neurosurgery: Pediatrics. 28:69-75 |
| ISSN: | 1933-0715 1933-0707 |
| DOI: | 10.3171/2020.11.peds20821 |
| Popis: | OBJECTIVE Concussions in youth sports comprise an estimated 1.6–3.8 million annual injuries in the US. Sex, age, and attention-deficit hyperactivity disorder (ADHD) have been identified as salient risk factors for concussion. This study seeks to evaluate the role of premorbid depression or anxiety (DA), with or without antidepressant use, on the incidence of concussion and the recovery of symptoms and neurocognitive dysfunction after concussion. METHODS Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) was administered to 7453 youth athletes at baseline. Throughout the season, concussions were examined by physicians and athletic trainers, followed by readministration of ImPACT postinjury (PI) and again at follow-up, a median of 7 days PI. Individuals were divided into three categories: 1) unmedicated athletes with DA (DA-only, n = 315), athletes taking antidepressants (DA-meds, n = 81), and those without DA or antidepressant use (non-DA, n = 7039). Concussion incidence was calculated as the total number of concussions per total number of patient-years. The recovery of neurocognitive measures PI was calculated as standardized deviations from baseline to PI and then follow-up in the 5 composite ImPACT scores: symptom score, verbal memory, visual memory, visual motor skills, and reaction time. Univariate results were confirmed with multivariate analysis. RESULTS There was no difference in concussion incidence between the DA-only cohort and the non-DA group. However, the DA-meds group had a significantly greater incidence of concussion than both the DA-only group (OR 2.67, 95% CI 1.88–7.18, p = 0.0001) and the non-DA group (OR 2.19, 95% CI 1.16–4.12, p = 0.02). Deviation from baseline in PI symptom scores was greater among the DA-meds group as compared to the non-DA group (OR 1.14, 95% CI 1.01–1.28, p = 0.03). At follow-up, the deviation from baseline in symptom scores remained elevated among the DA-meds group as compared to the non-DA group (OR 1.62, 95% CI 1.20–2.20, p = 0.002) and the DA-only group (OR 1.87, 95% CI 1.12–3.10, p = 0.02). Deviation from baseline in follow-up verbal memory was also greater among the DA-meds group as compared to both the non-DA group (OR 1.57, 95% CI 1.08–2.27, p = 0.02) and the DA-only group (OR 1.66, 95% CI 1.03–2.69, p = 0.04). CONCLUSIONS Premorbid DA itself does not seem to affect the incidence of concussion or the recovery of symptoms and neurocognitive dysfunction PI. However, antidepressant use for DA is associated with 1) increased concussion incidence and 2) elevated symptom scores and verbal memory scores up to 7 days after concussion, suggesting impaired symptomatic and neurocognitive recovery on ImPACT. |
| Databáze: | OpenAIRE |
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