Premorbid anxiety and depression and baseline neurocognitive, ocular-motor and vestibular performance: A retrospective cohort study

  • Author Footnotes
    1 present address for Dr. Jessica Wallace: University of Alabama, 270 Kilgore Lane, 2106 Capital Hall, Tuscaloosa, AL 35487.
    Jessica Wallace
    Footnotes
    1 present address for Dr. Jessica Wallace: University of Alabama, 270 Kilgore Lane, 2106 Capital Hall, Tuscaloosa, AL 35487.
    Affiliations
    Kinesiology & Sport Science Department, Youngstown State University, 1 University Plaza, 307 Beeghly Center, Youngstown, OH 44555, United States of America

    Department of Health Science, Athletic Training, University of Alabama, 270 Kilgore, Lane, Capital Hall, Tuscaloosa, AL 35487, United States of America
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  • Ken Learman
    Affiliations
    Department of Physical Therapy, Youngstown State University, 1 University Plaza, Cushwa Hall B307 Youngstown, OH 44555, United States of America
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  • Ryan Moran
    Affiliations
    Department of Health Science, Athletic Training, University of Alabama, 270 Kilgore, Lane, Capital Hall, Tuscaloosa, AL 35487, United States of America
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  • Tracey Covassin
    Affiliations
    Department of Kinesiology, Michigan State University, 105 IM Sports Circle, East Lansing, MI 48824, United States of America
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  • Jamie McAllister Deitrick
    Affiliations
    Department of Kinesiology, Coastal Carolina University, Conway, SC 29528, United States of America
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  • Danae Delfin
    Correspondence
    Corresponding author at: Doctoral Student – Department of Health Science, University of Alabama, 270 Kilgore Lane, 2121 Capital Hall Tuscaloosa, AL 35487, United States of America.
    Affiliations
    Department of Health Science, Athletic Training, University of Alabama, 270 Kilgore, Lane, Capital Hall, Tuscaloosa, AL 35487, United States of America
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  • James Shina
    Affiliations
    Kinesiology & Sport Science Department, Youngstown State University, 1 University Plaza, 307 Beeghly Center, Youngstown, OH 44555, United States of America
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  • Author Footnotes
    1 present address for Dr. Jessica Wallace: University of Alabama, 270 Kilgore Lane, 2106 Capital Hall, Tuscaloosa, AL 35487.
Published:August 26, 2020DOI:https://doi.org/10.1016/j.jns.2020.117110

      Highlights

      • Athletes reporting premorbid anxiety and/or depression perform worse on visual motor speed components of neurocognitive testing
      • No differences were found between matched controls and athletes reporting premorbid anxiety and/or depression on baseline Vestibular/Ocular Motor Screening and King-Devick assessments
      • Athletes reporting premorbid anxiety and/or depression report higher symptom severity scores than matched controls
      • Poorer visual motor speed performance and higher symptom severity scores are not unusual for athletes with premorbid psychological conditions

      Abstract

      Concussion has become a growing concern among sport and healthcare practitioners. Experts continue to investigate ways to advance the quality of concussion evaluation, diagnosis and management. Psychological conditions have been reported to influence concussion assessment outcomes at baseline and post-concussion; however, little evidence has examined psychological conditions and their effect on multifaceted measures of concussion. A retrospective cohort design was employed to examine differences between those with and without a premorbid psychological condition for high school and collegiate athletes who completed a preseason baseline battery, consisting of symptom reporting, computerized neurocognitive assessment, Vestibular-Ocular Motor Screening (VOMS), and the King-Devick (KD) test. Forty athletes within the sample self-reported a diagnosed psychological risk factor, consisting of depression and/or anxiety, and each were matched with a discordant control. Controls were matched on sex, age, sport, concussion history and ocular history. Athletes with psychological conditions reported higher symptom severity and had worse visual motor speed than controls. There were no differences between groups on other neurocognitive domains, VOMS, or KD. These results suggest that vestibular-ocular tools may be more consistent or less likely to vary between those with and without a premorbid psychological diagnosis, adding value to tools such as the KD and VOMS.

      Keywords

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      References

        • Rosenbaum S.B.
        • Lipton M.L.
        Embracing chaos: the scope and importance of clinical and pathological heterogeneity in mTBI.
        Brain Imaging Behav. 2012; 6: 255-282
        • Collins M.W.
        • et al.
        Statements of agreement from the targeted evaluation and active management (TEAM) approaches to treating concussion meeting held in Pittsburgh, October 15-16, 2015.
        Neurosurgery. 2016; 79: 912-929
        • Henry L.C.
        • et al.
        Examining recovery trajectories after sport-related concussion with a multimodal clinical assessment approach.
        Neurosurgery. 2016; 78: 232-241
        • Kutcher J.S.
        • Eckner J.T.
        At-risk populations in sports-related concussion.
        Curr Sports Med Rep. 2010; 9: 16-20
        • Broglio S.P.
        • et al.
        National Athletic Trainers’ association position statement: management of sport concussion.
        J. Athl. Train. 2014; 49: 245-265
        • McCrory P.
        • et al.
        Consensus statement on concussion in sport-the 5(th) international conference on concussion in sport held in Berlin, October 2016.
        Br. J. Sports Med. 2017; 51: 838-847
        • Solomon G.S.
        • Kuhn A.W.
        • Zuckerman S.L.
        Depression as a modifying factor in sport-related concussion: a critical review of the literature.
        Phys. Sportsmed. 2016; 44: 14-19
        • Albanese B.J.
        • et al.
        Anxiety sensitivity mediates gender differences in post-concussive symptoms in a clinical sample.
        Psychiatry Res. 2017; 252: 242-246
        • Covassin T.
        • et al.
        Sex differences in baseline neuropsychological function and concussion symptoms of collegiate athletes.
        Br. J. Sports Med. 2006; 40 (discussion 927): 923-927
        • Sufrinko A.M.
        • et al.
        Sex differences in vestibular/ocular and neurocognitive outcomes after sport-related concussion.
        Clin. J. Sport Med. 2017; 27: 133-138
      1. Moran, R.N., T. Covassin, and J. Wallace, Premorbid migraine history as a risk factor for vestibular and oculomotor baseline concussion assessment in pediatric athletes. J Neurosurg Pediatr, 2019: p. 1–6.

        • Seifert T.
        The relationship of migraine and other headache disorders to concussion.
        Handb. Clin. Neurol. 2018; 158: 119-126
        • Iverson G.L.
        • et al.
        High school athletes with ADHD and learning difficulties have a greater lifetime concussion history.
        J. Atten. Disord. 2016; 24: 1095-1101
      2. Moran, R.N., et al., Effects of attention deficit hyperactivity disorder and learning disability on vestibular and ocular baseline concussion assessment in pediatric athletes. Appl. Neuropsychol. Child, 2019: p. 1–7.

        • Elbin R.J.
        • et al.
        Individual and combined effects of LD and ADHD on computerized neurocognitive concussion test performance: evidence for separate norms.
        Arch. Clin. Neuropsychol. 2013; 28: 476-484
        • Sufrinko A.
        • et al.
        The effect of preinjury sleep difficulties on neurocognitive impairment and symptoms after sport-related concussion.
        Am. J. Sports Med. 2015; 43: 830-838
      3. Health, N.I.o.M. 2019 February 2019 March 4, 2020]; Available from: https://www.nimh.nih.gov/health/statistics/mental-illness.shtml.

      4. Health, N.I.o.M. Anxiety Disorders. 2019 March 4, 2020]; Available from: https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml.

      5. Health, N.I.o.M. Depression. 2019 March 4, 2020]; Available from: https://www.nimh.nih.gov/health/topics/depression/index.shtml.

        • Bailey C.M.
        • et al.
        The relationship between psychological distress and baseline sports-related concussion testing.
        Clin. J. Sport Med. 2010; 20: 272-277
        • Custer A.
        • et al.
        High baseline Postconcussion symptom scores and concussion outcomes in athletes.
        J. Athl. Train. 2016; 51: 136-141
        • Weber M.L.
        • et al.
        Influences of mental illness, current psychological state, and concussion history on baseline concussion assessment performance.
        Am. J. Sports Med. 2018; 46: 1742-1751
        • Asken B.M.
        • et al.
        Concussion-like symptom reporting in non-concussed collegiate athletes.
        Arch. Clin. Neuropsychol. 2017; 32: 963-971
        • Yang J.
        • et al.
        Post-concussion symptoms of depression and anxiety in division I collegiate athletes.
        Dev. Neuropsychol. 2015; 40: 18-23
        • Covassin T.
        • et al.
        Sex and age differences in depression and baseline sport-related concussion neurocognitive performance and symptoms.
        Clin. J. Sport Med. 2012; 22: 98-104
        • Oride M.K.
        • et al.
        Reliability study of the Pierce and king-Devick saccade tests.
        Am. J. Optom. Physiol. Optic. 1986; 63: 419-424
        • Mucha A.
        • et al.
        A brief vestibular/ocular motor screening (VOMS) assessment to evaluate concussions: preliminary findings.
        Am. J. Sports Med. 2014; 42: 2479-2486
        • Moran R.
        • Covassin T.
        Risk factors associated with baseline king-Devick performance.
        J. Neurol. Sci. 2017; 383: 101-104
        • Vartiainen M.V.
        • et al.
        King-Devick test normative reference values for professional male ice hockey players.
        Scand. J. Med. Sci. Sports. 2015; 25: e327-e330
        • Kontos A.P.
        • et al.
        Reliability and associated risk factors for performance on the vestibular/ocular motor screening (VOMS) tool in healthy collegiate athletes.
        Am. J. Sports Med. 2016; 44: 1400-1406
        • Elbin R.J.
        • et al.
        Motion sickness susceptibility and baseline vestibular and ocular-motor performance in adolescent athletes.
        J. Athl. Train. 2019; 54: 939-944
        • Schatz P.
        • Sandel N.
        Sensitivity and specificity of the online version of ImPACT in high school and collegiate athletes.
        Am. J. Sports Med. 2013; 41: 321-326
        • Brett B.L.
        • et al.
        Long-term stability and reliability of baseline cognitive assessments in high school athletes using ImPACT at 1-, 2-, and 3-year test-retest intervals.
        Arch. Clin. Neuropsychol. 2016; 31: 904-914
        • Scheiman M.
        • et al.
        Treatment of accommodative dysfunction in children: results from a randomized clinical trial.
        Optom. Vis. Sci. 2011; 88: 1343-1352
        • Cohen J.
        A power primer.
        Psychol. Bull. 1992; 112: 155-159
        • Cottle J.E.
        • et al.
        Concussion baseline testing: preexisting factors, symptoms, and neurocognitive performance.
        J. Athl. Train. 2017; 52: 77-81
      6. Trinh, L.N., S.M. Brown, and M.K. Mulcahey, The Influence of Psychological Factors on the Incidence and Severity of Sports-Related Concussions: A Systematic Review. Am. J. Sports Med., 2019: p. 363546519882626.

      7. Lariviere, K., et al., Interaction between Age, Sex, and Mental Health Status as Precipitating Factors for Symptom Presentation in Concussed Individuals. J Sports Med (Hindawi Publ Corp), 2019. 2019: p. 9207903.

        • Guerriero R.M.
        • et al.
        The association between premorbid conditions in school-aged children with prolonged concussion recovery.
        J. Child Neurol. 2018; 33: 168-173
        • Iverson G.L.
        • et al.
        Predictors of clinical recovery from concussion: a systematic review.
        Br. J. Sports Med. 2017; 51: 941-948
        • Cicerone K.D.
        • Kalmar K.
        Does premorbid depression influence post-concussive symptoms and neuropsychological functioning?.
        Brain Inj. 1997; 11: 643-648
      8. Matthews, K., D. Coghill, and S. Rhodes, Neuropsychological functioning in depressed adolescent girls. J. Affect. Disord., 2008. 111(1): p. 113–8.

        • Tsourtos G.
        • Thompson J.C.
        • Stough C.
        Evidence of an early information processing speed deficit in unipolar major depression.
        Psychol. Med. 2002; 32: 259-265
        • Clugston J.R.
        • et al.
        Relationship between the king-Devick test and commonly used concussion tests at baseline.
        J. Athl. Train. 2019; 54: 1247-1253
        • Irwin D.E.
        • et al.
        An item response analysis of the pediatric PROMIS anxiety and depressive symptoms scales.
        Qual. Life Res. 2010; 19: 595-607
        • Yengo-Kahn A.M.
        • Solomon G.
        Are psychotropic medications associated with differences in baseline neurocognitive assessment scores for young athletes? A pilot study.
        Phys. Sportsmed. 2015; 43: 227-235