Increased anxiety and depression among collegiate athletes with comorbid ADHD and history of concussion.

BACKGROUND: Attention Deficit Hyperactivity Disorder (ADHD) is prevalent among student-athletes when compared to the general population. Mental health disruptions (i.e., depression or anxiety) are common among student-athletes, and risk of experiencing depressive and anxious symptoms may be even greater among student-athletes that have incurred concussion. OBJECTIVE: To examine the influence of pre-existing ADHD and history of concussion on mental health in collegiate student-athletes. DESIGN: Retrospective cross-sectional study. SETTING: National Collegiate Athletic Association Division-I (NCAA) athletics. PATIENTS: Between 2010 and 2017, student-athletes at a Southeastern NCAA Division-I institution were surveyed as part of a Performance, Health, and Wellness Program. Analyses were conducted using a sample of 324 student athletes (212 female) with either a prior diagnosis of ADHD, a prior history of a sport-related concussion, both prior diagnosis of ADHD and a history of sport-related concussion, or neither (controls). MAIN OUTCOME MEASURE(S): Symptomatology associated with ADHD was characterized using the Behavior Assessment System for Children Self-Report of Personality College Version. The State-Trait Anxiety Inventory and the Center of Epidemiological Studies-Depression Scale examined anxious and depressive symptomatology. RESULTS: Student-athletes with ADHD and a history of concussion had 16.4 times greater odds of exhibiting clinically significant symptoms of state anxiety and 7.9 times greater odds of exhibiting clinically significant symptoms of depression, relative to control student-athletes. Every participant with both a diagnosis of ADHD and a history of concussion exhibited clinically significant attentional problems. CONCLUSIONS: Having both ADHD and a history of concussion may have a synergistic effect on mental health beyond that of ADHD and/or concussion alone. Additional longitudinal research is necessary to verify current findings. However, athletic trainers and other health care professionals are encouraged to be mindful of student-athletes with ADHD, as they may be more vulnerable to experiencing symptoms of depression and state anxiety with elevated inattentive behaviors following a concussion.

Hormonal Contraceptives Do Not Influence Concussion Recovery in Collegiate Athletes: Data from the NCAA-DoD CARE Consortium.

INTRODUCTION: The hormonal withdrawal hypothesis suggests that progesterone reduction in women after concussion may lead to greater symptom burden and longer recoveries. Current evidence indicates that hormonal stability after head injury may be an important moderator of postconcussive recovery. Thus, female athletes using hormonal contraceptives (HC) may exhibit better recovery profiles as their hormone levels are artificially stabilized. Our investigation sought to examine the relation between HC use and concussion outcomes in female student-athletes. METHODS: This longitudinal study examined concussion outcomes from female student-athletes participating in the NCAA-DoD CARE Consortium Research Initiative, including academic years 2014 to 2020. Eighty-six female collegiate athletes reporting HC use (HC+) were group matched on age, body mass index, race/ethnicity, sport contact level, concussion history, and current injury characteristics (i.e., amnesia, loss of consciousness) to 86 female collegiate athletes reporting no HC use (HC-). All participants had sustained a concussion and completed the Sport Concussion Assessment Tool, 3rd edition Symptom Scale, Brief Symptom Inventory-18, and Immediate Post-concussion Assessment and Cognitive Testing at preinjury baseline, 24 to 48 h postinjury, and when cleared for unrestricted return to play. To provide an index of recovery trajectory, days between injury and unrestricted return to play were calculated. RESULTS: Groups did not differ on length of recovery, postconcussion symptoms, psychological health, or cognitive assessments. No differences were observed between groups on any measure when accounting for baseline levels of performance. CONCLUSIONS: Our findings suggest that HC use does not influence recovery trajectory, symptoms, or recovery of cognitive function after concussion.

Concussion Exposure and Suicidal Ideation, Planning, and Attempts Among US High School Students.

CONTEXT: Interest is growing in the association between repetitive concussions and mental health. However, studies on the relationship between concussion frequency and adverse mental health outcomes among female and male youth are lacking. OBJECTIVES: To examine the association between self-reported concussion frequency and nonfatal suicidal behaviors among youth and to explore the possible interaction of biological sex. DESIGN: Retrospective cross-sectional survey. SETTING: National Youth Risk Behavior Surveillance System. PATIENTS OR OTHER PARTICIPANTS: United States secondary school students (N = 28 442). MAIN OUTCOME MEASURE(S): Exposure variables were the frequency of self-reported sport- or recreation-related concussion in the previous 12 months (0, 1, ≥2). Outcome variables were feelings of self-reported sadness or hopelessness and suicidal ideation, planning, and attempts. Covariates were age, sex, race and ethnicity, bullying victimization, sexual orientation, and physical activity. RESULTS: Students who reported ≥2 concussions were at significantly greater odds of reporting suicidal attempts (adjusted odds ratio = 2.03; 95% CI = 1.43, 2.88) when compared with students reporting a single concussive event during the past 12 months. However, sex interactions revealed that this finding may have been driven by males; the strength of associations did not increase from single to multiple concussions among females. CONCLUSIONS: Our findings suggest that adolescents who reported concussion were at increased odds of reporting poor mental health and suicidal behaviors. Moreover, an increased number of concussive events may be associated with significantly greater odds of reporting suicidal attempts, particularly among males. Irrespective of sex, health care professionals should closely monitor mental health behaviors in adolescents with repetitive concussions, especially those that occur in close temporal proximity.

Attention-Deficit/Hyperactivity Disorder-Related Self-Reported Symptoms Are Associated With Elevated Concussion Symptomatology.

The aim of the present investigation was to provide insight into how postconcussion symptomatology may be altered in individuals exhibiting attention-deficit/hyperactivity disorder (ADHD)-related behaviors and examine factors that may be responsible for driving such relationships. A total of 99 individuals were assessed during the subacute phase of concussion recovery. Inattentive symptomatology, but not diagnosis of ADHD, was related to greater concussion-symptom severity and overall symptoms endorsed. Cluster and factor analyses highlighted that the relationship between ADHD symptomatology and concussion symptomatology was not a function of overlapping constructs being assessed (i.e., concussion-related symptomatology was not a proxy of ADHD-related symptomatology). These relationships were not mediated by parental observations of impairments in behaviors associated with executive functioning (i.e., executive dysfunction was not driving the greater concussion-related symptomatology associated with ADHD-related symptomatology). These findings highlight the importance of moving beyond categorical frameworks of ADHD to, instead, consider the continuum of underlying behaviors.

The Influence of Family History of Neurodegenerative Disease on Adolescent Concussion Outcomes.

Evidence suggests that factors associated with a family history of neurodegenerative disease (fhNDD) may influence outcomes following a concussion. However, the relevance of these findings in adolescent populations has not been fully explored. Therefore, the present study sought to evaluate the relationship between fhNDD and neurological outcomes following an adolescent concussion. Data from a local pediatric concussion clinic were used to compare adolescents with (n = 22) and without (n = 44) an fhNDD. Clinical symptom burden, emotional health, cardio-autonomic function, and cognitive performance were assessed at initial (~2 weeks) and follow-up (~5 weeks) post-injury evaluations. Cardio-autonomic function was assessed at rest and during isometric handgrip contraction (IHGC). Results indicated no significant group differences in emotional health or cognitive performance. Across evaluations, those with an fhNDD exhibited greater somatic symptom severity, alterations in HRV at rest, and early blunted cardio-autonomic reactivity during IHGC compared to those without an fhNDD. These findings suggest that positive fhNDD is negatively associated with clinical symptomology and cardio-autonomic functioning following an adolescent concussion. Further, these findings encourage clinicians to utilize a comprehensive neurological evaluation to monitor concussion recovery. Future studies should look into exploring the role of specific neurodegenerative processes and conditions on concussion outcomes in adolescents.

Predictive Value of Subacute Heart Rate Variability for Determining Outcome Following Adolescent Concussion.

Objective assessments of concussion recovery are crucial for facilitating effective clinical management. However, predictive tools for determining adolescent concussion outcomes are currently limited. Research suggests that heart rate variability (HRV) represents an indirect and objective marker of central and peripheral nervous system integration. Therefore, it may effectively identify underlying deficits and reliably predict the symptomology following concussion. Thus, the present study sought to evaluate the relationship between HRV and adolescent concussion outcomes. Furthermore, we sought to examine its predictive value for assessing outcomes. Fifty-five concussed adolescents (12-17 years old) recruited from a local sports medicine clinic were assessed during the initial subacute evaluation (within 15 days postinjury) and instructed to follow up for a post-acute evaluation. Self-reported clinical and depressive symptoms, neurobehavioral function, and cognitive performance were collected at each timepoint. Short-term HRV metrics via photoplethysmography were obtained under resting conditions and physiological stress. Regression analyses demonstrated significant associations between HRV metrics, clinical symptoms, neurobehavioral function, and cognitive performance at the subacute evaluation. Importantly, the analyses illustrated that subacute HRV metrics significantly predicted diminished post-acute neurobehavioral function and cognitive performance. These findings indicate that subacute HRV metrics may serve as a viable predictive biomarker for identifying underlying neurological dysfunction following concussion and predict late cognitive outcomes.

Wheel running for 26 weeks is associated with sustained vascular plasticity in the rat motor cortex.

Vascular pathologies represent the leading causes of mortality worldwide. The nervous system has evolved mechanisms to compensate for the cerebral hypoxia caused by many of these conditions. Vessel dilation and growth of new vessels are two prominent responses to hypoxia, both of which play a critical role in maintaining cerebral homeostasis. One way to facilitate cerebrovascular plasticity, and develop neuroprotection against vascular pathologies, is through aerobic exercise. The present study explored the long-term consequences of aerobic exercise on vascular structure and function in the motor cortex. Rats were assigned to a sedentary condition or were provided access to running wheels for 26 weeks. Rats were then anesthetized, and angiograms were captured using spectral domain optical coherence tomography (SD-OCT) to explore cerebrovascular reactivity in response to altered oxygen and carbon dioxide status. Following this procedure, all rats were euthanized, and unbiased stereological quantification of blood vessel density was collected from sections of the primary motor cortex infused with India ink. Results demonstrated that chronic exercise increased capillary and arteriole surface area densities and enhanced arteriole reactivity in response to hypercapnia-hypoxia, as displayed by increased vasodilation within the motor cortex of exercised animals.

Examining cerebral angiogenesis in response to physical exercise.

Capillary growth and expansion (angiogenesis) is a prerequisite for many forms of neural and behavioral plasticity. It is commonly observed in both brain and muscle of aerobically exercising animals. As such, several histological methods have been used to quantify capillary density, including perfusion with India ink, various Nissl stains, and immunohistochemistry. In this chapter, we will describe these histological procedures and describe the stereological analysis used to quantify vessel growth in response to aerobic exercise.