The Influence of Musculoskeletal Injury on Cognition Implications for Concussion Research

Background: Safe return-to-play decisions after concussion can be challenging for sports medicine specialists. Neuropsychological testing is recommended to objectively measure concussion-related cognitive impairments. Purpose: The objective of this study was to measure cognitive functioning among 3 specific athletic groups: (1) athletes with no injuries (n = 36), (2) athletes with musculoskeletal injuries (n = 18), and (3) athletes with concussion (n = 18). Study Design: Case-control study; Level of evidence, 3. Methods: Seventy-two intercollegiate athletes completed preseason baseline cognitive testing and follow-up assessment using the Automated Neuropsychological Assessment Metrics (ANAM) test battery. Injured athletes were tested within 72 hours of injury. A 1-way analysis of covariance adjusted for baseline scores was performed to determine if differences existed in cognitive test scores among the 3 groups. Results: A group of athletes with concussion performed significantly worse than a group of athletes with no injuries on the following subtests of the ANAM at follow-up: Code Substitution Learning, Match to Sample, and Simple Reaction. Athletes with musculoskeletal injuries performed significantly worse than those with no injury on the Match to Sample subtest. No significant differences between athletes with concussion and athletes with musculoskeletal injuries were found on all ANAM subtests. Conclusion: Concussion produces cognitive impairment in the acute recovery period. Interestingly, athletes with musculoskeletal injuries also display a degree of cognitive impairment as measured by computerized tests. Clinical Relevance: Although these findings support previous research that neuropsychological tests can effectively measure concussion-related cognitive impairment, this study provides evidence that athletic injury, in general, also may produce a degree of cognitive disruption. Therefore, a narrow interpretation of scores of neuropsychological tests in a sports concussion context should be avoided.