Date of Award

11-4-2024

Publication Type

Dissertation

Degree Name

Ph.D.

Department

Psychology

Keywords

Concussion;Neuropsychology;Sport

Supervisor

Christopher Abeare

Abstract

In neuropsychology, a crucial aspect when working with people who have a known or suspected brain condition is the accurate estimation of their premorbid cognitive functioning. Within the context of post-concussion assessment for athletes, the primary objective is to determine whether and when a player has returned to their pre-injury cognitive baseline, thus judging their readiness to safely return to sport participation. Therefore, baseline testing is considered to be valuable and worthwhile for high contact sports with a high probability of sustaining a concussion. However, problems with baseline testing have also been identified due to unreliable integrity of baseline data. Hence, there is a growing recognition that the assessment of sport-related concussion could greatly benefit from advancements in the estimation of premorbid cognitive functioning. The objective of this dissertation was to refine the estimation of premorbid cognitive functioning by better understanding the demographic, personal, and educational variables that contribute to cognitive test performance. To accomplish this, 158 athletes (Mage = 20.30, SDage = 1.95, range = 17-25; 70% male; 64% White; Medu = 13.20, SDedu = 1.44) were recruited as a part of the University of Windsor’s varsity athletics baseline testing effort from a range of men and women’s sports (54% men’s football). Each athlete completed a fixed battery of tests, beginning with consent and a questionnaire which asked for self-report of a broad range of demographic, personal, and educational information. Cognitive tests included in this study were the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), the Test of Premorbid Functioning (TOPF), the Trail Making Test A and B (TMT-A and TMT-B), and the Delis-Kaplan Executive Functioning System (D-KEFS) Verbal Fluency subtest (D-KEFS VF). The first study acted as a general exploration of the variables that best related to cognitive test performance. Although several significant correlations were found, those that were between test scores and demographic, personal, and educational variables were generally weak. The second study aimed to understand the contribution of D-KEFS VF word quality (using word frequency values derived from the Corpus of Contemporary American English) produced during the letter fluency subtest, and it was determined that word frequency does not relate to test performance on the TOPF, ImPACT, or TMT-A and B, but personal variables such as GPA and race may play a role. The third study aimed to tie results from Study 1 and 2 together to generate prediction algorithms using standard simple and multiple regression analyses, but due to the weak relationships outlined in Study 1, regression analyses had poor predictive power across cognitive tests. Overall, this dissertation has enriched the knowledge base of sport neuropsychologists by offering insights into the role played by demographic, educational, and personal variables in the interpretation and estimation of cognitive test performances. This research serves as a catalyst for advancing the sophistication and effectiveness of neuropsychological assessment methods and fosters a more personalized approach to evaluating cognitive functioning. It also informs that currently, approaches used to estimate premorbid cognitive functioning are not better than a baseline assessment in sport neuropsychology.

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