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Cognitive Testing for Concussion

What is a Concussion?

 

If you have had a blow to the head or body, a fall, or another injury jarring or shaking the brain inside your skull, then you may have suffered a concussion, or traumatic brain injury. A concussion is not something that can be seen - although there may be cuts or bruises on the head or face, there may be no other visible signs of a brain injury. For example, Magnetic Resonance Imaging (MRI) or Computerized Tomography (CT) scans cannot see a concussion.

 

It is not necessary to pass out (lose consciousness) to have a concussion, people that pass out with a head injury can have a more severe concussion. Some people will have obvious symptoms of a concussion, such as passing out or forgetting what happened right before the injury (amnesia), but other people will not have this happen.

 

What is the cause of concussion?

 

Your brain has a consistency of toothpaste - it is very soft. The brain is protected by our very hard skull. Also, our brain surrounded by spinal fluid which acts like a cushion that keeps your brain from striking the skull. However, after your head or your body is hit hard, your brain can smash into your skull and be injured, like soft skin striking concrete.

 

Concussion can occur from many injuries, including fights, falls, playground injuries, car crashes, and bike crashes. Concussions commonly occur while participating in any sport or activity such as hockey, soccer, football, boxing, skiing, or snowboarding.

 

What will happen after concussion?

 

After you have had a concussion, your brain is more sensitive to damage. So when you are recovering from a concussion, it is important to avoid activities that could injure you again, leading to a second, more severe, concussion.

 

With rest, most people fully recover from a concussion over days - weeks. Some people can even recover within a few hours. However, in rare cases, concussions cause more serious and long-lasting problems, especially with repeated concussions. Problems with movement, learning, or speaking can develop.

 

What are the symptoms of concussion?

 

It is not easy to know if someone has a concussion. Symptoms range from mild to severe and can last for hours, days, weeks, or even months. Not everyone passes out with concussion.

 

Concussion is a difficult to diagnose condition which can lead to months-years of cognitive issues. Concussion has no one diagnostic test - there is no blood test, and this condition cannot be seen on brain scans such as with MRI.

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There are four main categories for concussion symptoms:

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Memory and Thinking

Fuzzy thinking or not thinking clearly

Feeling slowed

Poor concentration

Not being able to remember new information

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Emotional and mood

Feeling tired or having no energy

Easily upset or angered

Sad

Nervous or anxious

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Physical Features

Nausea and vomiting

Headache

Fuzzy or blurry vision

Dizziness

Sensitivity to light or noise

Balance problems

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Sleep

Sleeping more than usual

Sleeping less than usual

Having a hard time falling asleep

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What is the danger with concussions?

 

A concussion will limit the function of an adult to perform in regular situations, such as with work, social settings, and relationships. Repeated concussions can lead to slowing down of brain function in older ages, possibly even leading to a form of dementia or other degenerative brain condition.

 

Concussions in older adults are also be dangerous, and often can be missed. Head injuries for an older adult age 65 or older, who takes a form of blood thinner, can sometimes lead to further brain injury and even bleeding in the brain sometimes.

What is post-concussion syndrome?

 

After a concussion occurs, some persons will return to normal quickly. However, for many patients, even days to weeks after a concussion, it may still feel as though  functioning is limited as compared to before the injury. This is called post-concussive syndrome. New symptoms may develop, or patients may continue to be bothered by symptoms from the injury, including:

 

  • Changes in your ability to think, concentrate, or memory

  • Headaches

  • Blurry vision

  • Changes in your sleep patterns, with little sleep or excessive sleep

  • Changes in your personality with anger or anxiety

  • Lack of interest in performing usual activities

  • Changes in your sex drive

  • Dizziness, light-headedness, or unsteadiness affecting standing or walking

 

What should I do if I have a concussion?

 

It is important for patients to see their doctor and receive appropriate testing. Management of issues like headache, sleep and mood is important for patients with post-concussion syndrome or post-traumatic migraines after a concussion has occurred. Management for each patient is different, depending upon the issues being experienced.

 

How do we test for problems in the brain due to concussion?

 

We perform a full assessment of both functions within certain regions of the brain as well as overall brain function. This uses standard concussion assessments followed by a computer automated testing system.

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Standard Concussion Assessments

 

These forms are completed using paper and pencil prior to the automated testing being performed:

  1. Concussion history, medical history, learning disabilities, psychiatric history

  2. Post-Concussion Symptom Score (PCSS) - this is most widely used concussion symptom inventory used around the world. The PCSS is the most sensitive and specific measure for concussion at the time of injury

  3. Headache Impact Test (HIT-6) - this will give a sense about the severity of headaches associated with concussion.

  4. PTSD CheckList – Civilian Version (PCL-C) - this will provide an assessment of features that sometimes occur in response to stressful life experiences like an accident or trauma

  5. GAD-7 (General Anxiety Disorder-7) - this scores the symptoms severity associated with anxiety

  6. PHQ-9 (Patient Health Questionnaire-9) - this instrument helps determine if depression is present, and its severity

  7. Sleep and Concussion Questionnaire - this questionnaire scores the severity of sleep issues associated with a head injury

 

These are the tests completed using automated computer systems to determine your brain’s overall cognitive performance. They are divided into two modules to organize the testing into different categories:

Module One

Attention

  1. Visual digit span test forward

Executive Function

  1. Trail making test part A

  2. Trail making test part B

Memory

  1. Auditory Verbal Learning Test

  2. Corsi block task

  3. Word List Recall

Reaction Time

  1. Visual Reaction Time - this is a test of attention and reaction time

  2. Go/No-go Visual Reaction Time - this is a test of attention and reaction time, but also inhibition

  3. Auditory Reaction Time - this is a test of auditory reaction time, but also attention

Speed of Processing

  1. The Paced Auditory Serial Addition Task (PASAT) - this examines speed of information processing after the impact of a traumatic brain injury. This test relies on working memory, attention, and arithmetic abilities

 

Module Two

Attention

  1. Auditory digit span test forward

Concentration

  1. Continuous Concentration

Executive Function

  1. Stroop test - this is a measure of executive function, examining linguistic information and color information and measuring attention

  2. Eriksen flanker test - this is a test of problem solving, attention and reaction time

Memory

  1. Visual Memory test - this is a test of visuospatial memory and attention

  2. Item Recognition - this is a test of visuospatial functioning which depends upon working memory and concentration

Reaction Time

  1. Fast Choice Test - this is a test of attention, delayed recall and reaction time

  2. Find the Flickering Dot - this is a test of attention and reaction time

  3. Fast Reactions Test - this is a test of attention and reaction time

Problem Solving

  1. Matching Shapes and Numbers - this is a test of visuospatial functioning, concentration and problem solving

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