Neuropsychological Testing

Neuropsychological Testing

Neuropsychological tests are functional cognitive instruments that are used to assess changes in attention, concentration, memory, information-processing speed, and motor speed or coordination. These tests provide a validated means to quantify cognitive weakness, and it is increasingly clear that neuropsychological assessment is a useful tool for measuring both the initial and recovery stages of athletes after concussive events.

Traditionally, these tests have been administered to a patient by a neuropsychologist or technician. More recently, computerized neurocognitive assessment tools have been developed that facilitate large-scale testing and tracking of athletes. Neuropsychological data should be interpreted by a board-certified neuropsychologist.

Neuropsychological tests are most useful when baseline data on the athlete exist and can be longitudinally compared to serial tests after concussive episodes. For example, Kutner et al.They have used a computerized neurocognitive assessment to track concussive injuries for the New York Giants football team since 1995 and have compared postinjury test results with baseline data to help with return-to-play decision making.

Large-scale studies using standardized baseline and postconcussive neuropsychological tests have begun to elucidate the neurocognitive manifestations of postconcussive symptoms as well as the time course of neurocognitive dysfunction after MTBI. It was demonstrated that high school athletes with the postconcussive symptom of headache had significantly worse performance on reaction time and memory neurocognitive scores compared to athletes without headache after concussion (28). Lovell et al. (33) found that high school athletes with an AAN grade 1 concussion demonstrated a decline in memory and a dramatic increase in self-reported symptoms at 36 hours after injury compared to a preinjury evaluation.

Neuropsychological testing completely normalized by 6 days after the concussion. These data suggest that some current return-to-play recommendations, which allow athletes with grade 1 concussions to return to the game after the symptoms resolve, may be too liberal and permit athletes to return to competition before complete recovery from injury.

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