Sports Concussion Symptoms Worse in Female Athletes?

Megan Brooks

July 28, 2015

Female collegiate athletes with a history of concussion may experience greater and more severe symptoms and poorer cognitive performance at preseason testing than their male counterparts, a new study hints.

"More research is needed to confirm these results and to understand why women may have lower performance at preseason baseline. The difference in performance between genders should be of great interest to athletes, coaches, athletic trainers, and doctors who utilize baseline assessments to aide recovery protocols," Kathryn L. O'Connor, from the University of Michigan in Ann Arbor, said in a statement.

She presented the study findings July 27 in Denver, Colorado, at the Sports Concussion Conference hosted by the American Academy of Neurology.

The long-term effects of sports-related concussive injury in amateur athletes and the effect of sex, if any, are relatively unknown, the investigators say.

They assessed the role of sex and previous concussion on long-term neurocognitive performance in 148 Division I college athletes in 11 sports during a single season at the University of Michigan in Ann Arbor. The athletes are participating in the National Sport Concussion Outcome Study (NSCOS).

Sixty-seven (45%) were women, 51% played a contact sport, and 36 (24%) had a history of sports-related concussion (average, 0.32 concussions; range, 0 to 4). Most concussed athletes had a single concussive injury (78%), with the most recent concussion having occurred 42 months previously on average. Men and women were equally likely to have a history of concussion.

Women and men with a history of at least one concussion had similar scores on computerized cognitive baseline testing. "This finding that cognitive skills were not significantly affected by having a concussion for either gender should be reassuring to athletes who have experienced a concussion and wonder about its later effects," O'Connor said.

However, all women, regardless of concussion history, had more symptoms, greater symptom severity, and poorer cognitive performance than men at baseline, she reported.

Women on average had 1.5 more symptoms and scored 3 points higher on symptom severity than men. On a clinical reaction time task, women were 19 milliseconds slower to react than men. Women also scored on average 7% below men on cognitive tasks assessing processing speed, attention, and working memory speed, with the greatest difference on processing speed (8.5%).

"In addition to our analysis, other research groups…have found that females endorse more symptoms at baseline and postinjury," O'Connor told Medscape Medical News. "It is still unclear why females report more symptoms and perform differently at preseason assessment. It is too early to speculate why these baseline gender differences exist. This is another area that requires further investigation," she noted.

"The current study does not have the scope to inform whether clinicians should treat female athletes differently," O'Connor added. "However, results do emphasize the importance of clinicians being aware when assessing female athletes postinjury. This awareness should be especially increased if the female athlete presents without a baseline assessment."

O'Connor said it's also important to note that most athletes reported a single previous concussion. "Thus, results cannot be generalized to those athletes with multiple previous concussions."

The study was supported by the National Collegiate Athletics Association. The authors have disclosed no relevant financial relationships.

Sports Concussion Conference. Oral Presentation 1. Presented July 24, 2015.

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