Neuropsychological Assessment of mTBI in Adults

  • Andrew J. GardnerEmail author
  • James Tonks
  • Seb Potter
  • Philip J. Yates
  • Adam Reuben
  • Helen Ryland
  • Huw Williams


Mild traumatic brain injury (mTBI), comprising 70–80% of all TBIs, is the commonest form of TBI, representing those injuries deemed to be at the lower end of the severity spectrum. In the general population, mTBI may occur as a result of a fall, work-related injury, sport or recreational activity, assault, motor vehicle accident, or any other activity that results in an impact to the head, but in military service, members’ blast-related and combat injuries are a further source of such injuries. There are various classification criteria for determining severity of TBI. mTBI is indicated by a Glasgow Coma Scale (GCS) score of 13–15 at the time of assessment, a duration of loss of consciousness (LOC) of less than 30 minutes, and/or a duration of post-traumatic amnesia (PTA) of less than 24 hours. In terms of the clinical pathology, mTBI is characterized by a diverse range of clinical features, demonstrating tremendous heterogeneity of the underlying pathology. Individuals suffering from mTBI may report a range of enduring1+ symptoms for weeks, months, and even years post-injury. In over 90% of mTBI cases, computed tomography (CT) and structural magnetic resonance imaging (MRI) investigation are unremarkable; however, with the more sophisticated brain function-related techniques abnormalities may be detected. While many mTBIs tend to result in a recovery period of days or weeks, this is not the case for all mTBIs. In some instances, the use of the classification “mild” is a misnomer, particularly for the group of patients that experience a prolonged recovery and meet criteria for persistent concussional symptoms/post-concussion syndrome (PCS). This review will focus on the post-injury cognitive sequelae and neuropsychological assessment in the management of mTBI, in the context of pre-injury characteristics and other post-injury sequelae.


mTBI Mild traumatic brain injury Neuropsychological assessment Cognition 


  1. 1.
    Tellier A, Marshall SC, Wilson KG, Smith A, Perugini M, Stiell IG. The heterogeneity of mild traumatic brain injury: where do we stand? Brain Inj. 2009;23(11):879–87.PubMedCrossRefGoogle Scholar
  2. 2.
    Ruff RM, Iverson GL, Barth JT, Bush SS, Broshek DK. Recommendations for diagnosing a mild traumatic brain injury: a National Academy of neuropsychology education paper. Arch Clin Neuropsychol. 2009;24(1):3–10.PubMedCrossRefGoogle Scholar
  3. 3.
    McCrea M, Kelly JP, Randolph C, Cisler R, Berger L. Immediate neurocognitive effects of concussion. Neurosurgery. 2002;50(5):1032–40.PubMedGoogle Scholar
  4. 4.
    Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Atlanta: Centers for Disease Control and Prevention; 2010.CrossRefGoogle Scholar
  5. 5.
    Arciniegas DB, Anderson CA, Topkoff J, McAllister TW. Mild traumatic brain injury: a neuropsychiatric approach to diagnosis, evaluation, and treatment. Neuropsychiatr Dis Treat. 2005;1(4):311–27.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Ratcliff JJ, Adeoye O, Lindsell CJ, Hart KW, Pancioli A, McMullan JT, et al. TRACK-TBI investigators. Emergency department disposition of the GCS 13-15 traumatic brain injury patient: analysis of the TRACK-TBI Study. Am J Emerg Med. 2014;32(8):844–850.Google Scholar
  7. 7.
    Kraus JF, Nourjah P. The epidemiology of mild, uncomplicated brain injury. J Trauma. 1988;28(12):1637–43.PubMedCrossRefGoogle Scholar
  8. 8.
    Fleminger S, Pondsford J. Long term outcome after traumatic brain injury. Br Med J. 2005;331:1419–20.CrossRefGoogle Scholar
  9. 9.
    Panenka WJ, Lange RT, Bouix S, Shewchuk JR, Heran MKS, Brubacher JR, et al. Neuropsychological outcome and diffusion tensor imaging in complicated versus uncomplicated mild traumatic brain injury. PLoS One. 2015;10(4):e0122746.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Ono K, Wada K, Takahara T, Shirotani T. Indications for computed tomography in patients with mild head injury. Neurol Med Chir (Tokyo). 2007;47(7):291–8.CrossRefGoogle Scholar
  11. 11.
    Thiruppathy SP, Muthukumar N. Mild head injury: revisited. Acta Neurochir. 2004;146(10):1073–5.CrossRefGoogle Scholar
  12. 12.
    Iverson GL, Lange RT, Waljas M, Liimatainen S, Dastidar P, Hartikainen KM, et al. Outcome from complicated versus uncomplicated mild traumatic brain injury. Rehabil Res Pract. 2012;2012:415740.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Ruff RM, Jamora CW. Myths and mild traumatic brain injury. Psychol Inj Law. 2009;2:34–42.CrossRefGoogle Scholar
  14. 14.
    Williams WH, Potter S, Ryland H. Mild traumatic brain injury and Postconcussion syndrome: a neuropsychological perspective. J Neurol Neurosurg Psychiatry. 2010;81(10):1116–22.PubMedCrossRefGoogle Scholar
  15. 15.
    Rao V, Lyketsos C. Neuropsychiatric sequelae of traumatic brain injury. Psychosomatics. 2000;41(2):95–103.PubMedCrossRefGoogle Scholar
  16. 16.
    Syed AT, Lone NA, Afzai Wani M, Bhat AS. Clinical management of patients with minor head injuries. Int J Health Sci (Qassim). 2007;1(1):131–40.Google Scholar
  17. 17.
    McCrory P. Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004. Br J Sports Med. 2005;39(Supplement 1):i78–86.PubMedCentralCrossRefPubMedGoogle Scholar
  18. 18.
    Alexander MP. Mild traumatic brain injury: pathophysiology, natural history, and clinical management. Neurology. 1995;45(7):1253–60.PubMedCrossRefGoogle Scholar
  19. 19.
    Giza CC, Kutcher JS, Ashwal S, Barth J, Getchius TSD, Gioia GA, et al. Summary of evidence-based guideline update: evaluation and management of concussion in sports. Neurology. 2013;80(24):2250–7.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    McCrory P. Traumatic brain injury: revisiting the AAN guidelines on sport-related concussion. Nat Rev Neurol. 2013;9(7):361–2.PubMedCrossRefGoogle Scholar
  21. 21.
    King NS, Crawford S, Wenden FJ, Moss NE, Wade DT. The Rivermead post concussion symptoms questionnaire: a measure of symptoms commonly experienced after head injury and its reliability. J Neurol. 1995;242(9):587–92.PubMedCrossRefGoogle Scholar
  22. 22.
    McCrea M, Guskiewicz KM, Marshall SW, Barr W, Randolph C, Cantu RC, et al. Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study. JAMA. 2003;290(19):2556–63.PubMedCrossRefGoogle Scholar
  23. 23.
    Giza CC, Hovda DA. The new neurometabolic cascade of concussion. Neurosurgery. 2014;75(Suppl 4):S24–33.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Giza CC, Hovda DA. The neurometabolic cascade of concussion. J Athl Train. 2001;36(3):228–35.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Leddy JJ, Sandhu H, Sodhi V, Baker JG, Willer B. Rehabilitation of concussion and post-concussion syndrome. Sports health: a multidisciplinary approach. Sports Health. 2012;4(2):147–54.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Al Sayegh A, Sandford D, Carson AJ. Psychological approaches to treatment of postconcussion syndrome: a systematic review. J Neurol Neurosurg Psychiatry. 2010;81(10):1128–34.PubMedCrossRefGoogle Scholar
  27. 27.
    Dimberg EL, Burns TM. Management of common neurologic conditions in sports. Clin Sports Med. 2005;24(3):637–62.PubMedCrossRefGoogle Scholar
  28. 28.
    Kutcher J, Eckner JT. At-risk populations in sports-related concussion. Curr Sport Med Rep. 2010;9(1):16–20.CrossRefGoogle Scholar
  29. 29.
    Leddy JJ, Willer B. Use of graded exercise testing in concussion and return-to-activity management. Curr Sports Med Rep. 2013;12(6):370–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Leddy JJ, Baker JG, Merchant A, Picano J, Gaile D, Matuszak J, et al. Brain or strain? Symptoms alone do not distinguish physiologic concussion from cervical/vestibular injury. Clin J Sport Med. 2015;25(3):237–42.PubMedCrossRefGoogle Scholar
  31. 31.
    King N. Permanent post concussion symptoms after mild head injury: a systematic review of age and gender factors. NeuroRehabilitation. 2014;34(4):741–8.PubMedGoogle Scholar
  32. 32.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. Washington, DC: American Psychiatric Association; 2013.CrossRefGoogle Scholar
  33. 33.
    Ommaya AK, Gennarelli TA. Cerebral concussion and traumatic unconsciousness. Correlation of experimental and clinical observations of blunt head injuries. Brain. 1974;97(4):633–54.PubMedCrossRefGoogle Scholar
  34. 34.
    Guskiewicz KM, Weaver NL, Padua DA, Garrett WE. Epidemiology of concussion in collegiate and high school football players. Am J Sports Med. 2000;28(5):643–50.PubMedCrossRefGoogle Scholar
  35. 35.
    Lezak MD, Howieson DB, Bigler ED, Tranel D. Neuropsychological assessment. 4th ed. Oxford: Oxford University Press; 2004.Google Scholar
  36. 36.
    Iverson GL. Outcome from mild traumatic brain injury. Curr Opin Psychiatry. 2005;18(3):301–17.PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Macciocchi SN, Barth JT, Alves W, Rimel RW, Jane JA. Neuropsychological functioning and recovery after mild head injury in collegiate athletes. Neurosurgery. 1996;39(3):510–4.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Davis GA, Iverson GL, Guskiewicz KM, Ptito A, Johnston KM. Contributions of neuroimaging, balance testing, electrophysiology and blood markers to the assessment of sport-related concussion. Br J Sports Med. 2009;43(Suppl 1):i36–45.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed following sports- related concussion validity of ImPACT for measuring processing speed following sports-related concussion. J Clin Exp Neuropsychol. 2005;27(6):683–9.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Cole WR, Arrieux JP, Schwab K, Ivins BJ, Qashu FM, Lewis SC. Test-retest reliability of four computerized neurocognitive assessment tools in an active duty military population. Arch Clin Neuropsychol. 2013;28(7):732–42.PubMedCrossRefGoogle Scholar
  41. 41.
    De Monte VE, Geffen GM, Kwapil K. Test-retest reliability and practice effects of a rapid screen of mild traumatic brain injury. J Clin Exp Neuropsychol. 2005;27(5):624–32.PubMedCrossRefGoogle Scholar
  42. 42.
    Van Dyke SA, Axelrod BN, Schutte C. Test-retest reliability of the traumatic brain injury screening instrument. Mil Med. 2010;175(12):947–50.PubMedCrossRefGoogle Scholar
  43. 43.
    Womble MN, Reynolds E, Schatz P, Shah KM, Kontos AP. Test-retest reliability of computerized neurocognitive testing in youth ice hockey players. Arch Clin Neuropsychol. 2016;31:305–12.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Schatz P. Long-term test-retest reliability of baseline cognitive assessments using ImPACT. Am J Sports Med. 2010;38(1):47–53.PubMedCrossRefGoogle Scholar
  45. 45.
    Schatz P, Ferris CS. One-month test-retest reliability of the ImPACT test battery. Arch Clin Neuropsychol. 2013;28(5):499–504.PubMedCrossRefGoogle Scholar
  46. 46.
    Nakayama Y, Covassin T, Schatz P, Nogle S, Kovan J. Examination of the test-retest reliability of a computerized neurocognitive test battery. Am J Sports Med. 2014;42(8):2000–5.PubMedCrossRefGoogle Scholar
  47. 47.
    Maerlender AC, Masterson CJ, James TD, Beckwith J, Brolinson PG, Crisco J, et al. Test–retest, retest, and retest: growth curve models of repeat testing with immediate post-concussion assessment and cognitive testing (ImPACT). J Clin Exp Neuropsychol. 2016;38(8):869–74.PubMedPubMedCentralCrossRefGoogle Scholar
  48. 48.
    Iverson GL, Schatz P. Advanced topics in neuropsychological assessment following sport-related concussion. Brain Inj. 2015;29(2):263–75.PubMedCrossRefGoogle Scholar
  49. 49.
    Collie A, Maruff P, McStephen M, Darby DG. Psychometric issues associated with computerised neuropsychological assessment of concussed athletes. Br J Sports Med. 2003;37(6):556–9.PubMedPubMedCentralCrossRefGoogle Scholar
  50. 50.
    Hinton-Bayre AD, Geffen G. Severity of sports-related concussion and neuropsychological test performance. Neurology. 2002;59(7):1068–70.PubMedCrossRefGoogle Scholar
  51. 51.
    Collie A, Darby DG, Maruff P. Computerised cognitive assessment of athletes with sports related head injury. Br J Sports Med. 2001;35(5):297–302.PubMedPubMedCentralCrossRefGoogle Scholar
  52. 52.
    Van Kampen D, Lovell MR, Pardini JE, Collins MW, Fu FH. The “value added” of neurocognitive testing after sports-related concussion. Am J Sports Med. 2006;34(10):1630–5.PubMedCrossRefGoogle Scholar
  53. 53.
    Schatz P, Pardini JE, Lovell MR, Collins MW, Podell K. Sensitivity and specificity of the ImPACT test battery for concussion in athletes. Arch Clin Neuropsychol. 2006;21(1):91–9.PubMedCrossRefGoogle Scholar
  54. 54.
    Broglio SP, Macciocchi SN, Ferrara MS. Sensitivity of the concussion assessment battery. Neurosurgery. 2007;60(6):1050–7.PubMedCrossRefGoogle Scholar
  55. 55.
    Iverson GL, Brooks BL, Collins MW, Lovell MR. Tracking neuropsychological recovery following concussion in sport. Brain Inj. 2006;20(3):245–52.PubMedCrossRefGoogle Scholar
  56. 56.
    Nelson LD. False-positive rates of reliable change indices for concussion test batteries: a Monte Carlo simulation. J Athl Train. 2015;50(12):1319–22.PubMedPubMedCentralCrossRefGoogle Scholar
  57. 57.
    Schatz P, Neidzwski K, Moser RS, Karpf R. Relationship between subjective test feedback provided by high-school athletes during computer-based assessment of baseline cognitive functioning and self-reported symptoms. Arch Clin Neuropsychol. 2010;25(4):285–92.PubMedCrossRefGoogle Scholar
  58. 58.
    Hunt T, Ferrara M, Miller L, Macciocchi S. The effect of effort on baseline neuropsychological test scores in high school football athletes. Arch Clin Neuropsychol. 2007;22(5):615–21.PubMedCrossRefGoogle Scholar
  59. 59.
    Schatz P. Long-term test-retest reliability of baseline cognitive assessments using the ImPACT. Am J Sports Med. 2010;38(1):47–52.PubMedCrossRefGoogle Scholar
  60. 60.
    Solomon G, Haase R. Biopsychosocial characteristics and neurocognitive test performance in National Football League players: an initial assessment. Arch Clin Neuropsychol. 2008;23(5):563–77.PubMedCrossRefGoogle Scholar
  61. 61.
    Erdal K. Neuropsychological testing for sports-related concussion: how athletes can sandbag their baseline testing without detection. Arch Clin Neuropsychol. 2012 Aug;27(5):473–9.PubMedCrossRefGoogle Scholar
  62. 62.
    Moser RS, Iverson GL, Echemendia RJ, Lovell MR, Schatz P, Webbe FM, et al. Neuropsychological evaluation in the diagnosis and management of sports-related concussion. Arch Clin Neuropsychol. 2007;22(8):909–16.PubMedCrossRefGoogle Scholar
  63. 63.
    Lovell M. The management of sports-related concussion: current status and future trends. Clin Sports Med. 2009;28(1):95–111.PubMedCrossRefGoogle Scholar
  64. 64.
    Kontos AP, Collins M, Russo SA. An introduction to sports concussion for the sport psychology consultant. J Appl Sport Psychol. 2004;16(3):220–35.CrossRefGoogle Scholar
  65. 65.
    Lau BC, Collins MW, Lovell MR. Cutoff scores in neurocognitive testing and symptom clusters that predict protracted recovery from concussions in high school athletes. Neurosurgery. 2012;70(2):371–9.PubMedCrossRefGoogle Scholar
  66. 66.
    Hoge CW, McGurk D, Thomas JL, Cox AL, Engel CC, Castro CA. Mild traumatic brain injury in U.S. soldiers returning from Iraq. N Engl J Med. 2008;358(5):453–63.PubMedCrossRefPubMedCentralGoogle Scholar
  67. 67.
    Mac Donald CL, Johnson AM, Wierzechowski L, Kassner E, Stewart T, Nelson EC, et al. Prospectively assessed clinical outcomes in concussive blast vs nonblast traumatic brain injury among evacuated US military personnel. JAMA Neurol. 2014;71(8):994–1002.PubMedCrossRefGoogle Scholar
  68. 68.
    Tsao JW, Stentz LA, Rouhanian M, Howard RS, Perry BN, Haran FJ, et al. Effect of concussion and blast exposure on symptoms after military deployment. Neurology. 2017;89:2010–6.PubMedCrossRefPubMedCentralGoogle Scholar
  69. 69.
    Karr JE, Areshenkoff CN, Duggan EC, Garcia-Barrera MA. Blast-related mild traumatic brain injury: a Bayesian random-effects meta-analysis on the cognitive outcomes of concussion among military personnel. Neuropsychol Rev. 2014;24(4):428–44.PubMedCrossRefGoogle Scholar
  70. 70.
    Lange RT, Brickell TA, French LM, Merritt VC, Bhagwat A, Pancholi S, et al. Neuropsychological outcome from uncomplicated mild, complicated mild, and moderate traumatic brain injury in US military personnel. Arch Clin Neuropsychol. 2012;27(5):480–94.PubMedCrossRefGoogle Scholar
  71. 71.
    French LM, Lange RT, Brickell TA. Subjective cognitive complaints and neuropsychological test performance following military-related traumatic brain injury. JRRD. 2014;51(6):933–50.CrossRefGoogle Scholar
  72. 72.
    Proctor SP, Nieto K, Heaton KJ, Dillon CC, Schlegel RE, Russell ML, et al. Neurocognitive performance and prior injury among U.S. Department of Defense Military Personnel. Mil Med. 2015;180(6):660–9.PubMedCrossRefGoogle Scholar
  73. 73.
    Echemendia RJ. Sports neuropsychology: assessment and management of traumatic brain injury. New York: Guilford Press; 2006.Google Scholar
  74. 74.
    Walton GL. Possible cerebral origin of symptoms usually classed under “railway spine”. Bost Med Surg J. 1883;109:337–40.CrossRefGoogle Scholar
  75. 75.
    Rimel RW, Giordani B, Barth JT, Boll TJ, Jane JA. Disability caused by minor head injury. Neurosurgery. 1981;9(3):221–8.PubMedGoogle Scholar
  76. 76.
    Barth J, Alves W, Ryan T, Macciocchi S, Rimel R, Jane J, et al. Mild head injury in sports: neuropsychological sequelae and recovery of function. In: Levin EH, Benton A, editors. Mild head injury. New York: Oxford University Press; 1989. p. 257–75.Google Scholar
  77. 77.
    Guskiewicz KM, Ross SE, Marshall SW. Postural stability and neuropsychological deficits after concussion in collegiate athletes. J Athl Train. 2001;36(3):263–73.PubMedPubMedCentralGoogle Scholar
  78. 78.
    Collins MW. Relationship between concussion and neuropsychological performance in college football players. JAMA. 1999;282(10):964.PubMedCrossRefGoogle Scholar
  79. 79.
    Echemendia RJ, Putukian M, Mackin RS, Julian L, Shoss N. Neuropsychological test performance prior to and following sports-related mild traumatic brain injury. Clin J Sport Med. 2001;11(1):23–31.PubMedCrossRefGoogle Scholar
  80. 80.
    Moser RS, Schatz P, Jordan BD. Prolonged effects of concussion in high school athletes. Neurosurgery. 2005;57(2):300–6.PubMedCrossRefGoogle Scholar
  81. 81.
    Belanger HG, Vanderploeg RD. The neuropsychological impact of sports-related concussion: a meta-analysis. J Int Neuropsychol Soc. 2005;11(4):345–57.PubMedCrossRefGoogle Scholar
  82. 82.
    Bleiberg J, Cernich AN, Cameron K, Sun W, Peck K, Ecklund J, et al. Duration of cognitive impairment after sports concussion. Neurosurgery. 2004;54(5):1073–80.PubMedCrossRefGoogle Scholar
  83. 83.
    Carroll L, Cassidy JD, Peloso P, Borg J, von Holst H, Holm L, et al. Prognosis for mild traumatic brain injury: results of the WHO collaborating centre task force on mild traumatic brain injury. J Rehabil Med. 2004;36(43 Suppl):84–105.CrossRefGoogle Scholar
  84. 84.
    Collins MW. Current issues in managing sports-related concussion. JAMA. 1999;282(24):2283.PubMedCrossRefGoogle Scholar
  85. 85.
    Collins MW, Hawn KL. The clinical management of sports concussion. Curr Sports Med Rep. 2002;1(1):12–22.PubMedCrossRefGoogle Scholar
  86. 86.
    Pellman EJ, Lovell MR, Viano DC, Casson IR, Tucker AM. Concussion in professional football: neuropsychological testing part 6. Neurosurgery. 2004;55(6):1290–305.PubMedCrossRefGoogle Scholar
  87. 87.
    Covassin T, Schatz P, Swanik CB. Sex differences in neuropsychological function and post-concussion symptoms of concussed collegiate athletes. Neurosurgery. 2007;61(2):345–50.PubMedCrossRefGoogle Scholar
  88. 88.
    Covassin T, Swanik CB, Sachs M, Kendrick Z, Schatz P, Zillmer E, et al. Sex differences in baseline neuropsychological function and concussion symptoms of collegiate athletes. Br J Sports Med. 2006;40(11):923–7.PubMedPubMedCentralCrossRefGoogle Scholar
  89. 89.
    Covassin T, Swanik CB, Sachs ML. Epidemiological considerations of concussions among intercollegiate athletes. Appl Neuropsychol. 2003;10(1):12–22.PubMedCrossRefGoogle Scholar
  90. 90.
    Broglio SP, Ferrara MS, Piland SG, Anderson RB, Collie A. Concussion history is not a predictor of computerised neurocognitive performance. Br J Sports Med. 2006;40(9):802–5.PubMedPubMedCentralCrossRefGoogle Scholar
  91. 91.
    Collie A, McCrory P, Makdissi M. Does history of concussion affect current cognitive status? Br J Sports Med. 2006;40(6):550–1.PubMedPubMedCentralCrossRefGoogle Scholar
  92. 92.
    Iverson GL, Brooks BL, Lovell MR, Collins MW. No cumulative effects for one or two previous concussions. Br J Sport Med. 2006;40:72–5.CrossRefGoogle Scholar
  93. 93.
    Gardner A, Shores EA, Batchelor J. Reduced processing speed in rugby union players reporting three or more previous concussions. Arch Clin Neuropsychol. 2010;25(3):174–81.PubMedCrossRefGoogle Scholar
  94. 94.
    Gosselin N, Lassonde M, Petit D, Leclerc S, Mongrain V, Collie A, et al. Sleep following sport-related concussions. Sleep Med. 2009;10(1):35–46.PubMedCrossRefGoogle Scholar
  95. 95.
    Belanger HG, Curtiss G, Demery JA, Lebowitz BK, Vanderploeg RD. Factors moderating neuropsychological outcomes following mild traumatic brain injury: a meta-analysis. J Int Neuropsychol Soc. 2005;11(3):215–27.PubMedCrossRefGoogle Scholar
  96. 96.
    Aubry M, Cantu R, Dvorak J, Graf-Baumann T, Johnston K, Kelly J, et al. Summary and agreement statement of the first international conference on concussion in sport, Vienna 2001. Phys Sportmed. 2002;30(2):57–63.CrossRefGoogle Scholar
  97. 97.
    Barr WB, McCrea M. Sensitivity and specificity of standardized neurocognitive testing immediately following sports concussion. J Int Neuropsychol Soc. 2001;7(6):693–702.PubMedCrossRefGoogle Scholar
  98. 98.
    Barr WB, McCrea M, Randolph C. No neuropsychology of sports-related injuries. In: Morgan J, Ricker JH, editors. Textbook of clinical neuropsychology. New York: Psychology Press; 2008. p. 660–78.Google Scholar
  99. 99.
    Boutin D, Lassonde M, Robert M, Vanassing P, Ellemberg D. Neurophysiological assessment prior to and following sports-related concussion during childhood: a case study. Neurocase. 2008;14(3):239–48.PubMedCrossRefGoogle Scholar
  100. 100.
    Casson IR, Pellman EJ, Viano DC. Concussion in the national football league: an overview for neurologists. Phys Med Rehabil Clin N Am. 2009;20(1):195–214.PubMedCrossRefGoogle Scholar
  101. 101.
    Covassin T, Stearne D, Elbin R III. Concussion history and Postconcussion neurocognitive performance and symptoms in collegiate athletes. J Athl Train. 2008;43(2):119–24.PubMedPubMedCentralCrossRefGoogle Scholar
  102. 102.
    Erlanger DM, Kutner KC, Barth JT, Barnes R. Neuropsychology of sports-related head injury: dementia pugilistica to post concussion syndrome. Clin Neuropsychol. 1999;13(2):193–209.PubMedCrossRefGoogle Scholar
  103. 103.
    Goldberg LD, Dimeff RJ. Sideline management of sport-related concussions. Sport Med Arthrosc Rev. 2006;14(4):199–205.CrossRefGoogle Scholar
  104. 104.
    Henry GK, Gross HS, Herndon CA, Furst CJ. Nonimpact brain injury: neuropsychological and behavioral correlates with consideration of physiological findings. Appl Neuropsychol. 2000;7(2):65–75.PubMedCrossRefGoogle Scholar
  105. 105.
    Mrazik M. Neuropsychological assessment of college athletes. Arch Clin Neuropsychol. 2000;15(8):813–4.CrossRefGoogle Scholar
  106. 106.
    Roebuck-Spencer T, Sun W, Cernich AN, Farmer K, Bleiberg J. Assessing change with the automated neuropsychological assessment metrics (ANAM): issues and challenges. Arch Clin Neuropsychol. 2007;22(Suppl 1):S79–87.PubMedCrossRefGoogle Scholar
  107. 107.
    Lovell M. The neurophysiology and assessment of sports-related head injuries. Phys Med Rehabil Clin N Am. 2009;20(1):39–53.PubMedCrossRefGoogle Scholar
  108. 108.
    Yarnell PR, Lynch S. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Lancet. 1970;295(7652):863–4.CrossRefGoogle Scholar
  109. 109.
    Bruce JM, Echemendia RJ. History of multiple self-reported concussions is not associated with reduced cognitive abilities. Neurosurgery. 2009;64(1):100–6.PubMedCrossRefGoogle Scholar
  110. 110.
    Lezak MD. Neuropsychological assessment. Oxford: Oxford University Press; 1995.Google Scholar
  111. 111.
    Smith A. Symbol digit modalities test manual. Los Angeles: Western Psychological Services; 1982.Google Scholar
  112. 112.
    Lovell MR. Is neuropsychological testing useful in the management of sport-related concussion? J Athl Train. 2006;41(2):137–8.PubMedPubMedCentralGoogle Scholar
  113. 113.
    Lovell MR, Collins MW. Neuropsychological assessment of the college football player. J Head Trauma Rehabil. 1998;13(2):9–26.PubMedCrossRefGoogle Scholar
  114. 114.
    Collins M, Stump J, Lovell MR. New developments in the management of sports concussion. Curr Opin Orthop. 2004;15(2):100–7.CrossRefGoogle Scholar
  115. 115.
    Randolph C, McCrea M, Barr WB. Is neuropsychological testing useful in the management of sport-related concussion? J Athl Train. 2005;40(3):139–54.PubMedPubMedCentralGoogle Scholar
  116. 116.
    Lovell M. The neurophysiology and assessment of sports-related head injuries. Neurol Clin. 2008;26(1):45–62.PubMedCrossRefGoogle Scholar
  117. 117.
    Maroon JC, Lovell MR, Norwig J, Podell K, Powell JW, Hartl R. Cerebral concussion in athletes: evaluation and neuropsychological testing. Neurosurgery. 2000;47(3):659–72.PubMedGoogle Scholar
  118. 118.
    Collie A, Maruff P, Makdissi M, McCrory P, McStephen M, Darby D. CogSport: reliability and correlation with conventional cognitive tests used in postconcussion medical evaluations. Clin J Sport Med. 2003;13(1):28–32.PubMedCrossRefGoogle Scholar
  119. 119.
    Cernich A, Reeves D, Sun W, Bleiberg J. Automated neuropsychological assessment metrics sports medicine battery. Arch Clin Neuropsychol. 2007;22(SUPPL. 1):101–14.CrossRefGoogle Scholar
  120. 120.
    Randolph C, Kirkwood MW. What are the real risks of sport-related concussion, and are they modifiable? J Int Neuropsychol Soc. 2009;15(4):512–20.PubMedCrossRefGoogle Scholar
  121. 121.
    Kirkwood MW, Randolph C, Yeates KO. Returning pediatric athletes to play after concussion: the evidence (or lack thereof) behind baseline neuropsychological testing. Acta Paediatr. 2009;98(9):1409–11.PubMedCrossRefGoogle Scholar
  122. 122.
    Collins MW, Iverson GL, Lovell MR, McKeag DB, Norwig J, Maroon J. On-field predictors of neuropsychological and symptom deficit following sports-related concussion. Clin J Sport Med. 2003;13(4):222–9.PubMedCrossRefGoogle Scholar
  123. 123.
    Delaney JS, Abuzeyad F, Correa JA, Foxford R. Recognition and characteristics of concussion in the emergency department population. J Emerg Med. 2005;29(2):189–97.PubMedCrossRefGoogle Scholar
  124. 124.
    Delaney JS, Al-Kashmiri A, Drummond R, Correa JA. The effect of protective headgear on head injuries and concussions in adolescent football (soccer) players. Br J Sports Med. 2008;42(2):110–5.PubMedCrossRefGoogle Scholar
  125. 125.
    McCrory P, Johnston KM, Mohtadi NG, Meeuwisse W. Evidence-based review of sport-related concussion: basic science. Clin J Sport Med. 2001;11(3):160–5.PubMedCrossRefGoogle Scholar
  126. 126.
    Thunnan DJ, Branche CM, Sneizek JE. The epidemiology of sports related concussion in the United States: recent developments. J Head Trauma Rehabil. 1998;12(2):1–8.CrossRefGoogle Scholar
  127. 127.
    Broglio SP, Macciocchi SN, Ferrara MS. Neurocognitive performance of concussed athletes when symptom free. J Athl Train. 2007;42(4):504–8.PubMedPubMedCentralGoogle Scholar
  128. 128.
    Collie A, Makdissi M, Maruff P, Bennell K, McCrory P. Cognition in the days following concussion: comparison of symptomatic versus asymptomatic athletes. J Neurol Neurosurg Psychiatry. 2006;77(2):241–5.PubMedPubMedCentralCrossRefGoogle Scholar
  129. 129.
    Jeret JS, Mandell M, Anziska B, Lipitz M, Vilceus AP, Ware JA, et al. Clinical predictors of abnormality disclosed by computed tomography after mild head trauma. Neurosurgery. 1993;32(1):6–9.CrossRefGoogle Scholar
  130. 130.
    Stein SC, Ross SE. Clinical predictors of abnormality disclosed by computed tomography after mild head trauma. Neurosurgery. 1993;33(2):339–40.PubMedCrossRefGoogle Scholar
  131. 131.
    Mu W, Catenaccio E, Lipton ML. Neuroimaging in blast-related mild traumatic brain injury. J Head Trauma Rehabil. 2017;32(1):55–69.PubMedCrossRefGoogle Scholar
  132. 132.
    Gardner A, Kay-Lambkin F, Stanwell P, Donnelly J, Williams WH, Hiles A, et al. A systematic review of diffusion tensor imaging findings in sports-related concussion. J Neurotrauma. 2012;29(16):2521–38.PubMedCrossRefGoogle Scholar
  133. 133.
    Henry LC, Tremblay S, De Beaumont L. Long-term effects of sports concussions: bridging the neurocognitive repercussions of the injury with the newest neuroimaging data. Neurosci. 2017;23(5):567–78.Google Scholar
  134. 134.
    Gardner A, Iverson GL, Stanwell P. A systematic review of proton magnetic resonance spectroscopy findings in sport-related concussion. J Neurotrauma. 2014;31(1):1–18.PubMedCrossRefGoogle Scholar
  135. 135.
    Conder R, Conder AA. Neuropsychological and psychological rehabilitation interventions in refractory sport-related post-concussive syndrome. Brain Inj. 2015;29(2):249–62.PubMedCrossRefGoogle Scholar
  136. 136.
    Mittenberg W, Canyock EM, Condit D, Patton C. Treatment of post-concussion syndrome following mild head injury. J Clin Exp Neuropsychol. 2001;23(6):829–36.PubMedCrossRefGoogle Scholar
  137. 137.
    Ponsford J, Willmott C, Rothwell A, Cameron P, Kelly A-M, Nelms R, et al. Impact of early intervention on outcome following mild head injury in adults. J Neurol Neurosurg Psychiatry. 2002;73(3):330–2.PubMedPubMedCentralCrossRefGoogle Scholar
  138. 138.
    Mittenberg W, Tremont G, Zielinski RE, Fichera S, Rayls KR. Cognitive-behavioral prevention of postconcussion syndrome. Arch Clin Neuropsychol. 1996;11(2):139–45.PubMedCrossRefGoogle Scholar
  139. 139.
    Ghaffar O, McCullagh S, Ouchterlony D, Feinstein A. Randomized treatment trial in mild traumatic brain injury. J Psychosom Res. 2006;61(2):153–60.PubMedCrossRefGoogle Scholar
  140. 140.
    Iverson GL, Lange RT, Brooks BL, Rennison VLA. “Good old days” bias following mild traumatic brain injury. Clin Neuropsychol. 2010;24(1):17–37.PubMedCrossRefGoogle Scholar
  141. 141.
    Hou R, Moss-Morris R, Peveler R, Mogg K, Bradley BP, Belli A. When a minor head injury results in enduring symptoms: a prospective investigation of risk factors for postconcussional syndrome after mild traumatic brain injury. J Neurol Neurosurg Psychiatry. 2012;83(2):217–23.PubMedCrossRefGoogle Scholar
  142. 142.
    Whittaker R, Kemp S, House A. Illness perceptions and outcome in mild head injury: a longitudinal study. J Neurol Neurosurg Psychiatry. 2007;78(6):644–66.PubMedPubMedCentralCrossRefGoogle Scholar
  143. 143.
    Tiersky LA, Anselmi V, Johnston MV, Kurtyka J, Roosen E, Schwartz T, et al. A trial of neuropsychologic rehabilitation in mild-spectrum traumatic brain injury. Arch Phys Med Rehabil. 2005;86(8):1565–74.PubMedCrossRefGoogle Scholar
  144. 144.
    Potter SD, Brown RG, Fleminger S. Randomised, waiting list controlled trial of cognitive-behavioural therapy for persistent postconcussional symptoms after predominantly mild-moderate traumatic brain injury. J Neurol Neurosurg Psychiatry. 2016;87(10):1075–83.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Andrew J. Gardner
    • 1
    Email author
  • James Tonks
    • 2
    • 3
    • 4
  • Seb Potter
    • 5
  • Philip J. Yates
    • 6
  • Adam Reuben
    • 7
  • Helen Ryland
    • 8
  • Huw Williams
    • 8
  1. 1.Priority Research Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of NewcastleCallaghanAustralia
  2. 2.University of Exeter Medical SchoolExeterUK
  3. 3.Haven Clinical Psychology PracticeCornwallUK
  4. 4.University of LincolnLincolnUK
  5. 5.Institute of Psychiatry, Psychology, and Neuroscience, Department of Psychology, King’s College LondonLondonUK
  6. 6.Royal Devon and Exeter Hospital, Mardon Neuro-Rehabilitation CenterExeterUK
  7. 7.Royal Devon and Exeter NHS Foundation Trust, Emergency DepartmentExeterUK
  8. 8.University of ExeterExeterUK

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