This study reports poorer cognitive outcome of National Football players who started playing before versus after the age of 12, noting an astonishing self-reported history of nearly 400 concussions using a "modern" definition in which "seeing stars" qualifies as concussion. [1] Would a neurologist actually record this number of concussions in a patient medical record? Without explanation, the authors report having a noncontact sport control group but chose not to include it. Their claim that reduced intelligence has been reported following concussion in children is inaccurate based on the references cited (references 4-6 in [1]). Intelligence generally refers to IQ and achievement tests. Reference 4 found an attention deficit in those self-reporting concussions. Reference 5 is a review of brain injury with demonstrable lesions, including moderate to severe head injury. Reference 6 refers to severe head injury. None conclude an intellectual decline following concussion. While litigation is mentioned, the authors did not fulfill their obligation outlined in neuropsychology practice guidelines to formally assess for malingering [2, 3]. In view of these significant problems, the decision to issue a press release on this study three days before the Super Bowl unnecessarily alarmed a public already misinformed about the consequences of concussion.
1. Stamm JM, Bourlas AP, Baugh CM, et al. Age of first exposure to football and later-life cognitive impairment in former NFL players.
Neurology 2015;84:xxx-xxx.
2. Heilbronner, RL, Sweet, JJ, Morgan, JE, Larrabee, GJ, & Millis, S. American Academy of Clinical Neuropsychology Consensus Conference Statement on the neuropsychological assessment of effort, response bias, and malingering. The Clinical Neuropsychologist 2009; 23;1093-1129.
3. Bush, SS, Ruff, RM, Troster, AI., Barth, JT., Koffler, SP, Pliskin, NH, Silver, CH. (2005). Symptom validity assessment: Practice issues and medical necessity NAN Policy & Planning Committee. Archives of Clinical Neuropsychology 2005;20:419-426.
For disclosures, please contact the editorial office at journal@neurology.org.
This study reports poorer cognitive outcome of National Football players who started playing before versus after the age of 12, noting an astonishing self-reported history of nearly 400 concussions using a "modern" definition in which "seeing stars" qualifies as concussion. [1] Would a neurologist actually record this number of concussions in a patient medical record? Without explanation, the authors report having a noncontact sport control group but chose not to include it. Their claim that reduced intelligence has been reported following concussion in children is inaccurate based on the references cited (references 4-6 in [1]). Intelligence generally refers to IQ and achievement tests. Reference 4 found an attention deficit in those self-reporting concussions. Reference 5 is a review of brain injury with demonstrable lesions, including moderate to severe head injury. Reference 6 refers to severe head injury. None conclude an intellectual decline following concussion. While litigation is mentioned, the authors did not fulfill their obligation outlined in neuropsychology practice guidelines to formally assess for malingering [2, 3]. In view of these significant problems, the decision to issue a press release on this study three days before the Super Bowl unnecessarily alarmed a public already misinformed about the consequences of concussion.
1. Stamm JM, Bourlas AP, Baugh CM, et al. Age of first exposure to football and later-life cognitive impairment in former NFL players. Neurology 2015;84:xxx-xxx.
2. Heilbronner, RL, Sweet, JJ, Morgan, JE, Larrabee, GJ, & Millis, S. American Academy of Clinical Neuropsychology Consensus Conference Statement on the neuropsychological assessment of effort, response bias, and malingering. The Clinical Neuropsychologist 2009; 23;1093-1129.
3. Bush, SS, Ruff, RM, Troster, AI., Barth, JT., Koffler, SP, Pliskin, NH, Silver, CH. (2005). Symptom validity assessment: Practice issues and medical necessity NAN Policy & Planning Committee. Archives of Clinical Neuropsychology 2005;20:419-426.
For disclosures, please contact the editorial office at journal@neurology.org.