A-54 Increased Symptoms During a Post-Concussion Neuropsychological Evaluation are Associated with Intraindividual Cognitive Variability and Anxiety

Abstract Purpose To examine the relationship between self-reported affect, cognitive functioning, and increased symptoms during a post-concussion neuropsychological evaluation. Methods 46 collegiate athletes (M=34, F=12) completed a comprehensive neuropsychological evaluation within 14 days of concussion, including measures of depression (Beck Depression Inventory-Fast Screen (BDI-FS)) and anxiety (NEO Five Factor Inventory (NEO-FFI) Anxiety Subscale). Suggested cutoffs for significant depression (BDI-FS ≥4) and anxiety (NEO-FFI Anxiety Subscale ≥10) symptomatology were utilized. The 21-item Post-Concussion Scale (PCS) was administered at the beginning (Pre-PCS) and end (Post-PCS) of testing. A difference score was calculated by subtracting Post-PCS from Pre-PCS. Composites of mean neuropsychological performance and two intraindividual variability (IIV) indices (average standard deviation and maximum discrepancy score) were created separately for two domains: memory and attention/processing speed (APS). Results Cognitive functioning explained a significant amount of the variance in Pre-Post PCS difference scores, F(6,39)=5.13, p<.001, R2=.44. Both IIV indices for memory and APS (all p’s<.02) significantly predicted difference scores, with cognitive variability increasing as Pre-Post PCS difference scores increased, but traditional mean composites did not (p’s>.05). Athletes who reported significant anxiety symptomatology (M=-4.33, SD=4.41) were significantly more likely than those who did not (M=.21, SD=3.75) to experience an increase in PCS symptoms, t(37)=2.66, p=.01, 95% CI [1.09,8.00]. There were no significant Pre-Post PCS symptom changes between athletes reporting significant depression symptomatology (M=.43, SD=5.19) or not (M=-.15, SD=4.61). Conclusions Higher IIV in cognitive functioning and worse anxiety symptomatology, but not traditional mean differences in cognitive functioning or depression symptomatology, were associated with an increase in symptoms during a post-concussion evaluation.