A preliminary investigation of cognitive intolerance and neuroimaging among adolescents returning to school after concussion

ABSTRACT

Primary objective

To introduce the concept of cognitive intolerance. A test is proposed to measure this concept and pilot data are presented to support this measure and future research to develop this concept into a construct. Research design: Three-group comparison to protect larger study blinding. Methods and procedures: Two groups of student athletes (n = 13, n = 13) between 13 and 17 (mean 15.1 ± 1.1 years; 58% male) who sustained a sport-related concussion within 10 days and one group (n = 13) of age-matched healthy controls were recruited for a comparison of correlations between self and observer ratings of cognitive difficulties and DTI fractional anisotropy (FA) using tract-based spatial statistics (TBSS) analysis at two time points. Main outcomes and results: Significant negative only associations (higher cognitive difficulty and lower FA) with DTI FA were found in white matter tracts. These included the anterior corpus callosum, frontal–parietal longitudinal fasciculi, and cortical-subcortical pathways at only the second time point. Several working memory networks would likely involve connections using the above-identified white matter tracts. Conclusions: Cognitive intolerance can be defined as symptom exacerbation from prolonged cognitive activity. Cognitive intolerance could be measured by the n-back working memory task and time to symptom exacerbation.

KEYWORDS:

• Concussion
• cognitive intolerance
• neuroimaging
• neuropsychology
• return to learn

Acknowledgments

Tom A. Fuchs, Ph.D., Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, assisted with the TBSS analysis.

Disclosure of interest

The authors report no conflict of interest.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work was supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health [under grant number 1R01NS094444] and the National Center for Advancing Translational Sciences of the National Institutes of Health under [grant number UL1TR001412 to the University at Buffalo].