Word-reading ability as a “hold test” in cognitively normal young adults with history of concussion and repetitive head impact exposure: A CARE Consortium Study

Abstract

Objective: Neuropsychological evaluations include hold tests like word-reading ability as estimates of premorbid intellect thought to be resilient to the effects of neurologic insult. We tested the alternative hypothesis that exposure to concussion or repetitive subclinical head impacts throughout early life may stunt acquisition of word-reading skills.

Method: Data were obtained from student–athletes within the CARE Consortium that completed the Wechsler Test of Adult Reading (WTAR). Measures of head trauma burden included self-reported concussion history and cumulative years of exposure to collision sports. We evaluated the effects of head trauma, sociodemographic (race, SES), and academic (SAT/ACT scores, learning disorder) variables on WTAR standard score using linear regression. Analyses were repeated in a football-only subsample estimating age of first exposure to football as a predictor.

Results: We analyzed data from 6,598 participants (72.2% white, 39.6% female, mean ± SD age = 18.8 ± 1.2 years). Head trauma variables collectively explained 0.1% of the variance in WTAR standard scores, with years of collision sport exposure weakly predicting lower WTAR standard scores (β = .026–.035, very small effect). In contrast, sociodemographic and academic variables collectively explained 20.9–22.5% of WTAR standard score variance, with strongest effects noted for SAT/ACT scores (β = .313–.337, medium effect), LD diagnosis (β = –.115 to –.131, small effect), and SES (β = .101–.108, small effect). Age of first exposure to football did not affect WTAR scores in a football-only sample.

Conclusion: Wechsler Test of Adult Reading performance appears unrelated to history of self-reported concussion(s) and/or repetitive subclinical head trauma exposure in current collegiate athletes. Sociodemographic and academic variables should be incorporated in test score interpretations for diverse populations like athletes.

Keywords:

• Concussion
• brain injury
• WTAR
• repetitive head impact exposure
• word reading

Acknowledgements

The authors thank student–athletes across the CARE Consortium for their willingness to participate in research. They also thank Dr. April Reed (Azusa Pacific University), Dr. Diane Langford (Temple University), Dr. Luis Feigenbaum (University of Miami), Dr. Jeffrey Bazarian (University of Rochester), and Dr. Brian Dykhuizen (Wilmington College) for contributing data to this study.

Disclosure statement

No declarations relevant to the completion of this study.

Additional information

Funding

This publication was supported in part by the Grand Alliance Concussion Assessment, Research, and Education Consortium, which receives funding from the National Collegiate Athletic Association and the Department of Defense. The US Army Medical Research Acquisition Activity is the awarding and administering acquisition office. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Psychological Health and Traumatic Brain Injury Program (award W81XWH-14-2-0151). Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds).