Headache long after pediatric concussion: presence, intensity, interference, and association with cognition

The association between symptom burden and processing speed and executive functioning at 4 and 12 weeks following pediatric concussion

OBJECTIVES

Symptoms and cognition are both utilized as indicators of recovery following pediatric concussion, yet their interrelationship is not well understood. This study aimed to investigate: 1) the association of post-concussion symptom burden and cognitive outcomes (processing speed and executive functioning [EF]) at 4 and 12 weeks after pediatric concussion, and 2) the moderating effect of sex on this association.

METHODS

This prospective, multicenter cohort study included participants aged 5.00-17.99 years with acute concussion presenting to four Emergency Departments of the Pediatric Emergency Research Canada network. Five processing speed and EF tasks and the Post-Concussion Symptom Inventory (PCSI; symptom burden, defined as the difference between post-injury and retrospective [pre-injury] scores) were administered at 4 and 12 weeks post-concussion. Generalized least squares models were conducted with task performances as dependent variables and PCSI and PCSI*sex interaction as the main predictors, with important pre-injury demographic and injury characteristics as covariates.

RESULTS

311 children (65.0% males; median age = 11.92 [IQR = 9.14-14.21 years]) were included in the analysis. After adjusting for covariates, higher symptom burden was associated with lower Backward Digit Span (χ2 = 9.85, p = .043) and Verbal Fluency scores (χ2 = 10.48, p = .033) across time points; these associations were not moderated by sex, ps ≥ .20. Symptom burden was not associated with performance on the Coding, Continuous Performance Test, and Color-Word Interference scores, ps ≥ .17.

CONCLUSIONS

Higher symptom burden is associated with lower working memory and cognitive flexibility following pediatric concussion, yet these associations were not moderated by sex. Findings may inform concussion management by emphasizing the importance of multifaceted assessments of EF.

Application of the CNS vital signs test and WISC-IV in the cognitive assessment of Chinese pediatric patients with intra-cranial space occupying lesion

BACKGROUND

A fast and reliable neurocognitive assessment tool is required for pediatric patients with an intracranial space-occupying lesion (ICSOL).

METHODS

A cross-sectional study was conducted on 41 pediatric patients having ICSOL. Cognitive abilities were assessed using both WISC-IV and CNS Vital Signs (CNS VS). All domains are compared to the normative data. Spearman's correlation analysis is performed between domains in two batteries.

RESULTS

In the WISC-IV, CPI, PSI, and WMI are significantly lower than the normative level. In the CNS VS, NCI, Memory domains, Reaction Time, Social Acuity, and Sustained Attention are significantly lower. Six domains in the CNS VS, including Complex Attention, Sustained Attention, Cognitive Flexibility, Executive Function, Processing Speed, and Social Acuity, positively correlate to the PSI or CPI in the WISC-IV. Sixty percent (9/15) of domains in the CNS VS negatively correlate to the size of ISCOL. The FSIQ in the WISC-IV is significantly associated with patients' parent education level.

CONCLUSION

Compared to the WISC-IV, CNS VS takes less time, but measures more domains. CNS VS is more sensitive to the size of ICSOL but is not affected by patients' parent education level. A healthy control group is warranted for interpreting the results in Chinese participants.