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Neurocognitive-Concussion-Test Results Found to Be Inconsistent

Evidence regarding the reliability and validity of computerized neurocognitive testing used to evaluate sports-related concussions remains inconsistent, according to a paper published last month in the online journal Neuropsychology Review.

The paper's authors examined more than two dozen peer-reviewed articles that specifically involve four computerized neurocognitive tests used in the assessment of sports-related concussions: Automated Neuropsychological Assessment Metrics (ANAM), CogSport/State (known as Axon Sports in the U.S.), HeadMinder, and ImPACT.

During their review of these articles, they discovered a high amount of variability in terms of the tests' reliability. Factors such as sample composition and test-retest time intervals were partially to blame for the inconsistency, the authors wrote.

The tests didn't fare much better in terms of validity and sensitivity, as the authors discovered "highly variable evidence" for each of the four examined. They note that subject effort could be partially responsible for the range of validity, as some student-athletes may intentionally provide inadequate effort to lower their baseline scores. In doing so, they would lower the threshold they must pass following a sports-related concussion to be cleared to return to play.

"Limited data has been published since 2005 to assist clinicians in determining the clinical value of this form of testing," said Jacob Resch, the lead author on the paper and the director of the Brain Injury Laboratory at The University of Texas at Arlington, in a statement. "While these products are an important component of concussion management, their development, marketing, and sales seem to have outpaced the evidence. So, some caution is needed."

Based on their findings, the authors offered a number of recommendations to clinicians, including:

  • Making an informed decision when using a computerized neurocognitive test and understanding its limitations when managing a sports-related concussion;
  • Recognizing that any computerized neurocognitive test should only be one aspect of a multi-faceted approach to concussion management, and should not be the sole basis for a diagnosis or return-to-play decision;
  • Incorporating a clinical neuropsychologist into the concussion-management team to assist with the interpretation of results; and
  • Ensuring proper training for those who administer the computerized neurocognitive tests.

"Neurocognitive testing is an important component of the concussion assessment, but should not be used as a standalone method to diagnose injury or determine an athlete's level of recovery and fitness to return to play," said Michael McCrea, a co-author of the review and director of brain injury research at the Medical College of Wisconsin, in a statement. "A multi-dimensional approach is supported by the evidence as best practice."

This paper builds upon Resch's past research of computerized neurocognitive testing. His May 2013 study in the Journal of Athletic Training found that the ImPACT test misidentifies healthy participants as impaired in certain circumstances up to 46 percent of the time.

In an Oct. 2013 study published online in the journal The Clinical Neuropsychologist, Resch and his colleagues found that the alternative forms of the ImPACT test weren't necessarily reliable when evaluating whether someone had sustained a concussion.

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