Long-term cognitive outcomes in male and female athletes following sport-related concussions

Int J Psychophysiol. 2018 Oct;132(Pt A):3-8. doi: 10.1016/j.ijpsycho.2018.03.011. Epub 2018 Mar 20.


Despite concussion being a serious public health concern and the increasing participation of female athletes in sport, the comparative long-term outcomes of male and female athletes are poorly understood, potentially limiting the scientific understanding and clinical management of these injuries. We examined whether sex influences the long-term cognitive outcomes in athletes with a history of concussion (HOC; 6+ months from injury). Accordingly, 196 asymptomatic student-athletes participated in the study (98 with a HOC; 98 matched controls). The sample included both male (n = 98) and female athletes (n = 98). Participants completed the Cogstate brief battery, to which we added a 2-Back condition to increase cognitive load. As predicted, the results revealed sex differences on the N-back Task, a measure of executive functions, with female athletes having a HOC responding significantly more slowly than their male counterparts on the 2-Back condition (p = 0.02). Moreover, irrespective of sex, athletes with a HOC were slower and less accurate relative to controls on the N-back Task (p = 0.01). Analyses failed to reveal any significant sex or group difference on tasks that measure lower-level cognition (ps > 0.05). The current results reaffirm the presence of subtle, yet long-term alterations in aspects of executive functions following a sport-related concussion. More importantly, our results highlight that female athletes exhibit alterations of greater magnitude than their male counterparts. Therefore, the sex difference observed in the days or weeks following a concussion may persist well into the chronic phase of injury.

Keywords: Computerized neuropsychological testing; Concussion; Executive functions; Persistent deficits; Sex differences; Traumatic brain injury.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Athletes
  • Athletic Injuries / complications
  • Athletic Injuries / physiopathology*
  • Brain Concussion / complications
  • Brain Concussion / physiopathology*
  • Chronic Disease
  • Cognitive Dysfunction / etiology
  • Cognitive Dysfunction / physiopathology*
  • Executive Function / physiology*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Psychomotor Performance / physiology*
  • Sex Characteristics*
  • Young Adult