Neurocognitive performance of concussed athletes when symptom free.

CONTEXT Concussed athletes may underreport concussion-related symptoms in order to expedite return to play. Whether neurocognitive impairments persist once concussion-related symptoms resolve has yet to be determined. Reliance on athlete-reported, postconcussion symptoms when making return-to-play decisions may expose athletes to subsequent injury if complete recovery has not occurred. OBJECTIVE To evaluate the presence of neurocognitive decrements in concussed athletes no longer reporting concussion-related symptoms. DESIGN Within-groups design. SETTING University research laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty-one National Collegiate Athletic Association Division I collegiate athletes (16 men, 5 women). Age = 19.81 +/- 1.25 years, height = 180.95 +/- 10.62 cm, mass = 93.66 +/- 27.60 kg, and previous concussions = 1.76 +/- 2.02. MAIN OUTCOME MEASURE(S) The ImPACT concussion assessment test was administered to concussed athletes at baseline, when symptomatic (within 72 hours of injury), and when asymptomatic. Index scores of verbal memory, visual memory, visual-motor speed, reaction time, and concussion-related symptoms were recorded at each session. The Symptom Assessment Scale was administered daily after injury to establish when the athlete became asymptomatic. RESULTS When assessed within 72 hours of concussion, 81% of the athletes showed deficits on at least 1 ImPACT variable. At the asymptomatic time point, 38% of the concussed athletes continued to demonstrate neurocognitive impairment on at least 1 ImPACT variable. CONCLUSIONS Neurocognitive decrements may persist when athletes no longer report concussion-related symptoms. The exclusive use of symptom reports in making a return-to-play decision is not advised. A multifaceted approach to concussion assessment that includes evaluation of a myriad of functions is warranted.