The relation between post concussion symptoms and neurocognitive performance in concussed athletes

The objective of this study was to examine differences in neurocognitive performance between symptomatic concussed athletes, a group of concussed athletes with no subjective symptoms, and a non-concussed control group of athletes. All concussed athletes were evaluated within one week of injury using the ImPACT computerized test battery. Results indicate that concussed athletes who denied subjective symptoms demonstrated poorer performance than control subjects on all four composite scores of the ImPACT test batters (Verbal Memory, Visual Memory, Reaction Time and Processing Speed However, the concussed but asymptomatic group demonstrated significantly better performance than did the concussed and symptomatic group. Thus, concussed athletes who did not report subjective symptoms were not fully recovered based on neurocognitive testing. This study underscores the importance of neurocognitive testing in the assessment of concussion sequelae and recovery.     

Reduced brain glutamine in female varsity rugby athletes after concussion and in non‐concussed athletes after a season of play

The purpose of this study was to use non‐invasive proton magnetic resonance spectroscopy (MRS) and diffusion tensor imaging (DTI) to monitor changes in prefrontal white matter metabolite levels and tissue microstructure in female rugby players with and without concussion (ages 18–23, n = 64). Evaluations including clinical tests and 3 T MRI were performed at the beginning of a season (in‐season) and followed up at the end of the season (off‐season). Concussed athletes were additionally evaluated 24–72 hr (n = 14), three months (n = 11), and six months (n = 8) post‐concussion. Reduced glutamine at 24–72 hr and three months post‐concussion, and reduced glutamine/creatine at three months post‐concussion were observed. In non‐concussed athletes (n = 46) both glutamine and glutamine/creatine were lower in the off‐season compared to in‐season. Within the MRS voxel, an increase in fractional anisotropy (FA) and decrease in radial diffusivity (RD) were also observed in the non‐concussed athletes, and correlated with changes in glutamine and glutamine/creatine. Decreases in glutamine and glutamine/creatine suggest reduced oxidative metabolism. Changes in FA and RD may indicate neuroinflammation or re‐myelination. The observed changes did not correlate with clinical test scores suggesting these imaging metrics may be more sensitive to brain injury and could aid in assessing recovery of brain injury from concussion.     

Visual event-related potentials in elite and amateur athletes

In the present study, we tested the hypothesis that the neural synchronization estimated in visual cortex during visuo-spatial demands shows different features in elite karate athletes when compared to amateur karate athletes and non-athletes. EEG recordings (56 channels; EB-Neuro) were performed from 17 elite karate athletes, 14 amateur karate athletes, and 15 non-athletes, during the observation of pictures with basket and karate attacks. They clicked a right (left) keyboard button for basket or karate attacks at right (left) monitor side. Results pointed to no difference of late occipital VEPs/ERPs after basket versus karate attacks in the non-athletes (300-800 ms post-stimulus). In the amateur karate athletes, occipital VEPs/ERPs at 300-450 ms post-stimulus (P3-P4 components) were lower in amplitude for the karate than basket attacks. In the elite karate athletes, the occipital VEPs/ERPs further declined in amplitude at 300-450 ms post-stimulus (P3 and P4 components) and enhanced at about 800 ms post-stimulus ("N2" component) for the karate than basket attacks. A control study showed that in 10 elite fencers, the same was true for the fencing compared to the karate attacks. These results support the hypothesis that peculiar mechanisms of occipital neural synchronization can be observed in elite athletes during visuo-spatial demands, possibly to underlie sustained visuo-spatial attention and self-control.     

Premorbid predictors of postconcussion symptoms in collegiate athletes

Introduction: In recent years, the sports community has been faced with the challenge of determining when it is safe to return concussed athletes to play. Given that return-to-play decisions are partially dependent upon athletes’ endorsement of symptoms, better understanding what factors contribute to the presence of symptoms following concussion is crucial. The purpose of the present study was to better characterize the symptoms that athletes endorse at baseline and to determine what impact various premorbid (or preinjury) characteristics have on the presence and severity of postconcussion symptoms in the acute injury period following concussion. Method: Two groups of participants with similar ages and levels of education were examined: athletes at baseline (N = 702) and postconcussion (N = 55). Athletes were administered a comprehensive battery of neuropsychological tests, consisting of neurocognitive and neurobehavioral measures, at both time periods. The main outcome measure was the Post-Concussion Symptoms Scale (PCSS). A factor analysis was conducted on the participants’ baseline PCSS data to determine the factor structure of the PCSS, and separate logistic regression analyses were conducted that examined the baseline PCSS symptom clusters (derived from the factor analysis), demographic variables, and baseline neurocognitive variables as predictors of dichotomized postconcussion PCSS total scores (i.e., low versus high symptom reporting following concussion). Results: Four distinct clusters emerged from the factor analysis measuring cognitive, physical, affective, and sleep symptoms. Logistic regression results indicated that the physical and affective symptom clusters at baseline reliably predicted athletes’ postconcussion symptom group, as did sex and the neurocognitive composite score. Conclusions: These findings show that certain baseline characteristics of athletes confer risk for greater symptomatology postconcussion. Knowledge of these risk factors can assist the management and treatment of sports-related concussion.     

The prevalence of depressive symptoms in college students

Summary The prevalence and manifestations of depressive symptomatology in a sample of 424 adolescents, aged 16–19, were assessed by means of the CES-D, a widely used screening instrument. The results were compared to those reported for adults. The pattern of symptoms was also assessed for study subjects who did and did not meet criteria for depressive symptoms. The overall prevalence of depressive symptoms was 33% based on the standard criterion, but fell to 16% and 2% when more stringent criteria for symptom duration were applied. The composition of depressive symptoms was similar for adolescents and adults with some exceptions possibly related to age and role specific demands.     

Visual augmenting/reducing and P300 in autistic children

Visual event-related potentials were recorded from five male autistics and five matched controls. Sensory effects were investigated by having subjects passively view flashes of three different but equiprobable intensities (augmenting/reducing paradigm). Cognitive effects were examined by having subjects count infrequent, target, flashes of one intensity embedded within a series of frequent, nontarget, flashes of a different intensity (oddball paradigm). In the augmenting/reducing paradigm, the sensory N100 wave of autistic but not controls showed a significant increase in amplitude (augmenting) as flash intensity increased. The cognitive P300 wave of autistics did not differ from controls in the oddball paradigm. Unlike controls, autistics had an equally large P300 in the no-task augmenting/reducing paradigm. It is concluded that autistics may experience a degree of stimulus overload in the visual modality.A preliminary version of these data was presented at the Twenty-Fourth Annual Meeting of the Society for Psychophysiological Research, Milwaukee, October 1984. The work was supported in part by a grant from the Moody Foundation.     

The effects of repetitive transcranial magnetic stimulation on depressive symptoms and the P300 event-related potential

Changes in the Hamilton Depression Rating Scale and the P₃₀₀ auditory event-related potential were assessed in 10 patients with depression before and after a treatment course of five daily sessions of 10?Hz repetitive transcranial magnetic stimulation (rTMS) over the left prefrontal cortex. The patients were initially randomly allocated either to an active or a placebo rTMS treatment. All patients received both types of treatment separated by an interval of 4?weeks. The median Hamilton score decreased by 7 points following active rTMS and by 1?point after sham (p=0.075). Active rTMS was associated with a significant increase in the P₃₀₀ amplitude compared with sham (p=0.02). There was no correlation between changes in P₃₀₀ measurements and the Hamilton scores after active treatment. We conclude that five daily sessions of left prefrontal rTMS treatment is not of sufficient duration to make a significant improvement in depressive symptoms.     

精神分裂症患者事件相关电位P300与临床症状关系的研究

目的　探讨精神分裂症P3 0 0 主要指标尤峰间潜伏期的变化及其与临床症状的关系。方法　检测 4 0例精神分裂症患者 (患者组 )和 36名正常人 (对照组 )CZ、C3 、C4电极位置的P3 0 0 ,并用阳性和阴性症状量表 (PANSS)评定患者临床症状。结果　与正常对照组相比 ,在CZ、C3 、C4三点 ,患者组P3波幅低 (P <0 0 1) ,并与阴性症状分呈负相关 (r=- 0 4 0 3,- 0 4 30 ,- 0 35 7) ;N2 潜伏期长 (P <0 0 1) ;P2 N2 峰间潜伏期长 (P <0 0 5和P <0 0 1) ,并与PANSS量表总分、阳性症状、思维障碍、激活性等多种症状分呈负相关 (P <0 0 1～ 0 0 5 ) ;N2 P3 峰间潜伏期短 (P <0 0 1) ,在CZ 点与PANSS量表总分(r=- 0 36 3)和一般症状分 (r=- 0 392 )呈负相关。结论　精神分裂症患者的P3 波幅、N2 潜伏期、P2 N2 、N2 P3 峰间潜伏期有明显异常 ,其中P3 波幅、P2 N2 、N2 P3 峰间潜伏期与多种临床症状呈相关性     

Nutrition and eating in female college athletes: a survey of coaches

The purpose of the present study was to gather information from coaches regarding their monitoring/management of athlete eating and weight, knowledge of nutritional health issues, availability of prevention/intervention services for athletes at their school, expience with athletes exhibiting symptoms of eating and body image disturbances, and their attitudes toward eating and weight in the sport. A total of 303 coaches (51% response rate) involved in six sports (i.e., gymnastics, swimming, basketball, softball, track, and volleyball) at all levels of collegiate competition (NCAA Divisions I, II, III, and NAIA) completed a 40-item survey. Gender was found to be related to differential responding on only one of the 40 items, while sport and level of competition were related to responses on multiple items. Gymnastics coaches and NCAA Division I coaches differed significantly from coaches of other sports and divisions in that they reported more monitoring/management behaviors, had more experience with athletes exhibiting eating disturbances, and had more resources available for preventing and treating athletes with eating disorders. Gymnastics coaches also differed from other coaches on a number of items related to their attitudes toward eating and weight in the sport. Many coaches have encountered disturbed eating among their athletes, and some of their coaching attitudes and behaviors may inadvertently increase the risk for such disturbances. Implications for clinical and sport psychologists providing prevention or intervention services to intercollegiate athletes are discussed.     

Therapeutic changes beyond the symptoms - effects of inpatient treatment according to the Heidelberg Structural Change Scale

The question is discussed how changes concerning the patient's ability to recognize and obtain insight into dysfunctional relationship patterns, life-determining conflicts, and structural vulnerability as well as the readiness to take on the responsibility for the negative effects caused by these may be conceptualized. A model has been developed based on Operationalized Psychodynamic Diagnosis (OPD) in which individual problem areas for each patient may be chosen from a list of foci. Changes in these foci are evaluated using the Heidelberg Structural Change Scale which is presented and discussed in detail. This concept is applied to a sample of patients who had been treated in an in-patient setting. It is demonstrated that this method of measuring changes can be used reliably. Furthermore, the changes registered with the structural change scale correlate on an absolute level quite high to the global assessment of outcome through the therapeutic team; this correlation is even higher than the correlation between symptomatic changes and the global assessments. How this concept may be applied in planning, evaluating, and ensuring the quality of psychotherapy is presented in conclusion.     

Visual evoked responses and visual symptoms in multiple sclerosis

Absolute latency, interocular difference in latency, and waveform of visual evoked responses (VER) to checkerboard reversal stimuli recorded from the midline of the skull were studied in 104 multiple sclerosis patients, 25 to 50 years of age, classified according to visual symptomatology. Group 1 had strong evidence of past or present optic neuritis. Patients with blurring of vision, diplopia, and undefined visual complaints were assigned to group 2, while group 3 contained patients with no visual symptoms but suspected diagnosis of multiple sclerosis on other grounds. The three parameters explored showed consistent association with the degree of visual involvement, as assessed by clinical impression, but their discriminatory power was diverse. Absolute latency was significantly longer in group 1 patients compared with groups 2 and 3, but it did not discriminate between the last two, whereas interocular difference in latency proved to be sensitive to differences between symptomatic (diplopia, blurring) and asymptomatic groups (2 and 3). Waveshapes were grouped into three categories based upon degree of distortion of the major positive peak, and their relative distribution among the three patient groups was found to be associated with symptomatology. We suggest that, in the production of symptoms such as diplopia, a temporal disparity of afferent impulses might be involved in much the same way that spatial incongruities between both eyes lead to impaired function. In this regard, interocular difference in latency rather than absolute latency would be a more accurate predictor of symptom development. The analysis of VER waveshape suggests, in addition, the importance of inhomogeneous involvement of the visual pathways in the production of symptoms during the evolution of multiple sclerosis.     

Changes in p300 following two yoga-based relaxation techniques

Cyclic meditation (CM) is a technique that combines "stimulating" and "calming" practices, based on a statement in ancient yoga texts suggesting that such a combination may be especially helpful to reach a state of mental equilibrium. The changes in the peak latency and peak amplitude of P300 auditory event-related potentials were studied before and after the practice of cyclic meditation compared to an equal duration of supine rest in 42 volunteers (group mean age +/- SD, 27 +/- 6.3 years), from Fz, Cz, and Pz electrode sites referenced to linked earlobes. The sessions were one day apart and the order was alternated. There was reduction in the peak latencies of P300 after cyclic meditation at Fz, Cz, and Pz compared to the "pre" values. A similar trend of reduction in P300 peak latencies at Fz, Cz, and Pz was also observed after supine rest, compared to the respective "pre" values, although the magnitude of change in each case was less after supine rest compared to after cyclic meditation. The P300 peak amplitudes after CM were higher at Fz, Cz, and Pz sites compared to the "pre" values. In contrast, no significant changes were observed in the P300 peak amplitudes at Fz, Cz, and Pz after supine rest compared to the respective "pre" state. The present results support the idea that "cyclic" meditation enhances cognitive processes underlying the generation of the P300.     

Visual symptoms in Parkinson's disease and Parkinson's disease dementia

Visual symptoms are common in PD and PD dementia and include difficulty reading, double vision, illusions, feelings of presence and passage, and complex visual hallucinations. Despite the established prognostic implications of complex visual hallucinations, the interaction between cognitive decline, visual impairment, and other visual symptoms remains poorly understood. Our aim was to characterize the spectrum of visual symptomatology in PD and examine clinical predictors for their occurrence. Sixty-four subjects with PD, 26 with PD dementia, and 32 age-matched controls were assessed for visual symptoms, cognitive impairment, and ocular pathology. Complex visual hallucinations were common in PD (17%) and PD dementia (89%). Dementia subjects reported illusions (65%) and presence (62%) more frequently than PD or control subjects, but the frequency of passage hallucinations in PD and PD dementia groups was equivalent (48% versus 69%, respectively; P = 0.102). Visual acuity and contrast sensitivity was impaired in parkinsonian subjects, with disease severity and age emerging as the key predictors. Regression analysis identified a variety of factors independently predictive of complex visual hallucinations (e.g., dementia, visual acuity, and depression), illusions (e.g., excessive daytime somnolence and disease severity), and presence (e.g., rapid eye movement sleep behavior disorder and excessive daytime somnolence). Our results demonstrate that different "hallucinatory" experiences in PD do not necessarily share common disease predictors and may, therefore, be driven by different pathophysiological mechanisms. If confirmed, such a finding will have important implications for future studies of visual symptoms and cognitive decline in PD and PD dementia.     

Long-term olanzapine treatment and p300 parameters in schizophrenia

The well-known amplitude reduction of the P300 appears to be unaffected by the treatment with classical antipsychotics in schizophrenia, whereas the effects of atypical neuroleptics on this event-related potential are less understood. The study of these changes could help in deciding whether the P300 amplitude reduction in schizophrenia is a trait or state marker of that illness and in better describing the effect of atypical antipsychotics on altered cognitive functions. We present a prospective longitudinal study of P300 amplitude and latency before and after 6 months' treatment with olanzapine in 11 patients with schizophrenia. A healthy control group (n = 30) was also studied. Overall, no significant changes, either in amplitude or in latency as measured at Pz and Fz electrodes, were found when comparing the pre- and postolanzapine conditions, despite the overall improvement in positive and negative symptoms. Nevertheless a direct specific association was observed between a P300 amplitude increase with olanzapine and the improvement in negative symptoms. These data would suggest that P300 amplitude reduction in schizophrenia may be relatively independent from clinical state and treatment, thus constituting a trait marker of schizophrenia. Our data also suggest that, in addition to this, some further changes in P300 amplitude might depend on the clinical state of the patients.     

Basic symptoms and P300 abnormalities in young schizophrenic patients.

Among the reasons for the relatively limited number of investigations of self-knowledge phenomena should be included, in addition to theoretical motives, the difficulties regarding the use of instruments available for this kind of approach and their content validity. This study investigates the relationship between subjective and objective deficits in schizophrenia, taking into account subjective experiences of cognitive impairment, clinical symptoms, and cognitive evoked potentials (P300 component). A group of 36 young schizophrenic patients (29 on neuroleptic treatment and seven drug-naive) were considered, together with a comparison group of 36 healthy subjects. Auditory event-correlated potentials (ERPs) were obtained using a simple "oddball" paradigm. Clinical symptoms were rated with the Brief Psychiatric Rating Scale (BPRS) and Scales for the Assessment of Positive and Negative Symptoms (SAPS and SANS), and while subjective disturbances were assessed by the Frankfurter Beschwerde Fragebogen (FBF, also called the Complaint Questionnaire). Correlation analysis showed that P300 amplitude was inversely correlated with subjective experiences of cognitive deficit, especially in the area of automatic skills and overstimulation. No relationship emerged between BPRS, SANS, and SAPS scores and P300 alterations. The results suggest that subjective cognitive disturbances, more than objective symptoms, are related to P300 alterations in schizophrenia, and that the FBF questionnaire appropriately covers the domain of schizophrenic cognitive disorders.