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Neurocognitive functioning and symptoms across levels of collision and contact in male high school athletes
  1. Jessie R. Oldham1,
  2. David Howell2,3,
  3. Corey Lanois4,
  4. Paul Berkner5,
  5. Grant L. Iverson6,
  6. Rebekah Mannix7,8,
  7. William Meehan7,9
  1. 1Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
  2. 2Children's Hospital Colorado Sports Medicine Center, Aurora, Colorado, USA
  3. 3Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
  4. 4Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA, USA
  5. 5University of New England College of Osteopathic Medicine, Biddeford, Maine, USA
  6. 6Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
  7. 7Boston Children's Hospital, Boston, Massachusetts, USA
  8. 8Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA, USA
  9. 9Department of Pediatrics and Orthopedics, Harvard Medical School, Boston, MA, USA
  1. Correspondence to Dr Jessie R. Oldham, Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA; jessie.oldham{at}


Objective We sought to determine whether male collision sport athletes perform worse on computerised neurocognitive assessments and report higher symptom burdens than athletes in contact (but not collision) sports and athletes in non-contact sports.

Methods This cross-sectional study used data collected by the Massachusetts Concussion Management Coalition on high school boys who underwent computerised neurocognitive testing between 2009 and 2018. We divided sports participation in three different sport types: (1) collision, (2) contact, non-collision and (3) non-contact. Our outcomes included the four computerised neurocognitive composite scores (verbal memory, visual memory, visual motor speed and reaction time) and the total symptom score. The independent variable was sport type (collision, contact, non-contact), adjusted for age, concussion history and comorbidities.

Results Of the 92 979 athletes (age: 15.59±2.08 years) included in our study, collision sport athletes performed minimally but significantly worse than other athletes on neurocognitive composite scores (verbal memory: β=−1.64, 95% CI −1.85 to –1.44; visual memory: β=−1.87, 95% CI −2.14 to –1.60; visual motor speed: β=−2.12, 95% CI −2.26 to –1.97; reaction time: β=0.02, 95% CI 0.02 to 0.02). Collision and contact sport athletes also had slightly but significantly lower total symptom scores (collision: 3.99±7.17; contact: 3.78±6.81; non-contact: 4.32±7.51, p<0.001, η2=0.001) than non-contact sport athletes.

Conclusion There are minimal observed differences in performance on neurocognitive assessments between collision sport, contact sport and non-contact sport athletes. The repetitive subconcussive head impacts associated with collision sport participation do not appear to negatively affect self-reported symptoms or neurocognitive functioning in current youth athletes.


Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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  • Contributors JRO conceptualised and designed the study, carried out the analyses, drafted the original manuscript, revised and reviewed the final manuscript, and served as the guarantor. WM and GLI assisted with study conceptualisation and design, revised and reviewed the final manuscript, and critically reviewed the manuscript for intellectual content. DH, PB and RM all contributed to the revision and review of the final manuscript and critically reviewed the manuscript for intellectual content. CL contributed to the structure and organisation of the collected data, and revised and reviewed the final manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests WM receives royalties from (1) ABC-Clio publishing for the sale of his books, Kids, Sports and Concussion: A guide for coaches and parents, and Concussions; (2) Springer International for the book Head and Neck Injuries in Young Athlete and (3) Wolters Kluwer for working as an author for UpToDate. His research is funded, in part, by philanthropic support from the National Hockey League Alumni Association through the Corey C. Griffin Pro-Am Tournament and the National Football League. DH receives research support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R03HD094560) and the National Institute of Neurological Disorders And Stroke (R01NS100952 and R41NS103698) of the National Institutes of Health. He has previously received research support from a research contract between Boston Children’s Hospital, Cincinnati Children’s Hospital Medical Center and ElMindA, and the Eastern Athletic Trainers Association. GLI serves as a scientific advisor for NanoDx(formerly BioDirection), Sway Operations, and Highmark. He has a clinical and consulting practice in forensic neuropsychology, including expert testimony, involving individuals who have sustained mild TBIs (including athletes). He has received research funding from several test publishing companies, including ImPACT Applications, CNS Vital Signs and Psychological Assessment Resources (PAR). He has received research funding as a principal investigator from the National Football League, and salary support as a collaborator from the Harvard Integrated Program to Protect and Improve the Health of National Football League Players Association Members. GLI acknowledges unrestricted philanthropic support was provided by the National Rugby League, ImPACT Applications, the Mooney-Reed Charitable Foundation, the Boston Bolts, and the Spaulding Research Institute. Those entities were not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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