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Journal of Neurologic Physical Therapy... Jul 2015Deficits in motor-cognitive dual tasks (eg, walking while talking) are common in individuals with neurologic conditions. This review was conducted to determine the... (Review)
Review
BACKGROUND AND PURPOSE
Deficits in motor-cognitive dual tasks (eg, walking while talking) are common in individuals with neurologic conditions. This review was conducted to determine the effectiveness of motor-cognitive dual-task training (DTT) compared with usual care on mobility and cognition in individuals with neurologic disorders.
METHODS
Databases searched were Biosis, CINAHL, ERIC, PsychInfo, EBSCO Psychological & Behavioral, PubMed, Scopus, and Web of Knowledge. Eligibility criteria were studies of adults with neurologic disorders that included DTT, and outcomes of gait or balance were included. Fourteen studies met inclusion criteria. Participants were subjects with brain injury, Parkinson disease (PD), and Alzheimer disease (AD). Intervention protocols included cued walking, cognitive tasks paired with gait, balance, and strength training and virtual reality or gaming. Quality of the included trials was evaluated with a standardized rating scale of clinical relevance.
RESULTS
Results show that DTT improves single-task gait velocity and stride length in subjects with PD and AD, dual-task gait velocity and stride length in subjects with PD, AD, and brain injury, and may improve balance and cognition in those with PD and AD. The inclusion criteria of the studies reviewed limited the diagnostic groups included.
DISCUSSION AND CONCLUSIONS
While the range of training protocols and outcome assessments in available studies limited comparison of the results across studies motor-cognitive dual-task deficits in individuals with neurologic disorders appears to be amenable to training. Improvement of dual-task ability in individuals with neurologic disorders holds potential for improving gait, balance, and cognition.Video Abstract available for additional insights from the authors (Supplemental Digital Content, http://links.lww.com/JNPT/A104).
Topics: Cognition; Exercise Therapy; Gait; Humans; Motor Skills; Nervous System Diseases; Postural Balance; Resistance Training; Walking
PubMed: 26079569
DOI: 10.1097/NPT.0000000000000090 -
The Cochrane Database of Systematic... Feb 2020Approximately 60% to 80% of people with Parkinson's disease (PD) experience cognitive impairment that impacts on their quality of life. Cognitive decline is a core... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Approximately 60% to 80% of people with Parkinson's disease (PD) experience cognitive impairment that impacts on their quality of life. Cognitive decline is a core feature of the disease and can often present before the onset of motor symptoms. Cognitive training may be a useful non-pharmacological intervention that could help to maintain or improve cognition and quality of life for people with PD dementia (PDD) or PD-related mild cognitive impairment (PD-MCI).
OBJECTIVES
To determine whether cognitive training (targeting single or multiple domains) improves cognition in people with PDD and PD-MCI or other clearly defined forms of cognitive impairment in people with PD.
SEARCH METHODS
We searched the Cochrane Dementia and Cognitive Improvement Group Trials Register (8 August 2019), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, and PsycINFO. We searched reference lists and trial registers, searched relevant reviews in the area and conference proceedings. We also contacted experts for clarifications on data and ongoing trials.
SELECTION CRITERIA
We included randomised controlled trials where the participants had PDD or PD-MCI, and where the intervention was intended to train general or specific areas of cognitive function, targeting either a single domain or multiple domains of cognition, and was compared to a control condition. Multicomponent interventions that also included motor or other elements were considered eligible.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened titles, abstracts, and full-text articles for inclusion in the review. Two review authors also independently undertook extraction of data and assessment of methodological quality. We used GRADE methods to assess the overall quality of the evidence.
MAIN RESULTS
Seven studies with a total of 225 participants met the inclusion criteria for this review. All seven studies compared the effects of a cognitive training intervention to a control intervention at the end of treatment periods lasting four to eight weeks. Six studies included people with PD living in the community. These six studies recruited people with single-domain (executive) or multiple-domain mild cognitive impairment in PD. Four of these studies identified participants with MCI using established diagnostic criteria, and two included both people with PD-MCI and people with PD who were not cognitively impaired. One study recruited people with a diagnosis of PD dementia who were living in long-term care settings. The cognitive training intervention in three studies targeted a single cognitive domain, whilst in four studies multiple domains of cognitive function were targeted. The comparison groups either received no intervention or took part in recreational activities (sports, music, arts), speech or language exercises, computerised motor therapy, or motor rehabilitation combined with recreational activity. We found no clear evidence that cognitive training improved global cognition. Although cognitive training was associated with higher scores on global cognition at the end of treatment, the result was imprecise and not statistically significant (6 trials, 178 participants, standardised mean difference (SMD) 0.28, 95% confidence interval (CI) -0.03 to 0.59; low-certainty evidence). There was no evidence of a difference at the end of treatment between cognitive training and control interventions on executive function (5 trials, 112 participants; SMD 0.10, 95% CI -0.28 to 0.48; low-certainty evidence) or visual processing (3 trials, 64 participants; SMD 0.30, 95% CI -0.21 to 0.81; low-certainty evidence). The evidence favoured the cognitive training group on attention (5 trials, 160 participants; SMD 0.36, 95% CI 0.03 to 0.68; low-certainty evidence) and verbal memory (5 trials, 160 participants; SMD 0.37, 95% CI 0.04 to 0.69; low-certainty evidence), but these effects were less certain in sensitivity analyses that excluded a study in which only a minority of the sample were cognitively impaired. There was no evidence of differences between treatment and control groups in activities of daily living (3 trials, 67 participants; SMD 0.03, 95% CI -0.47 to 0.53; low-certainty evidence) or quality of life (5 trials, 147 participants; SMD -0.01, 95% CI -0.35 to 0.33; low-certainty evidence). There was very little information on adverse events. We considered the certainty of the evidence for all outcomes to be low due to risk of bias in the included studies and imprecision of the results. We identified six ongoing trials recruiting participants with PD-MCI, but no ongoing trials of cognitive training for people with PDD.
AUTHORS' CONCLUSIONS
This review found no evidence that people with PD-MCI or PDD who receive cognitive training for four to eight weeks experience any important cognitive improvements at the end of training. However, this conclusion was based on a small number of studies with few participants, limitations of study design and execution, and imprecise results. There is a need for more robust, adequately powered studies of cognitive training before conclusions can be drawn about the effectiveness of cognitive training for people with PDD and PD-MCI. Studies should use formal criteria to diagnose cognitive impairments, and there is a particular need for more studies testing the efficacy of cognitive training in people with PDD.
Topics: Activities of Daily Living; Aged; Aged, 80 and over; Cognitive Dysfunction; Dementia; Humans; Parkinson Disease; Quality of Life; Randomized Controlled Trials as Topic; Task Performance and Analysis
PubMed: 32101639
DOI: 10.1002/14651858.CD011961.pub2 -
Complementary physical therapies for movement disorders in Parkinson's disease: a systematic review.European Journal of Physical and... Dec 2015The growth and popularity of complementary physical therapies for Parkinson's disease (PD) attempt to fill the gap left by conventional exercises, which does not always... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The growth and popularity of complementary physical therapies for Parkinson's disease (PD) attempt to fill the gap left by conventional exercises, which does not always directly target wellbeing, enjoyment and social participation.
AIM
To evaluate the effects of complementary physical therapies on motor performance, quality of life and falls in people living with PD.
DESIGN
Systematic review with meta-analysis.
POPULATION
Outpatients--adults diagnosed with idiopathic PD, male or female, modified Hoehn and Yahr scale I-IV, any duration of PD, any duration of physical treatment or exercise.
METHODS
Randomized controlled trials, non-randomized controlled trials and case series studies were identified by systematic searching of health and rehabilitation electronic databases. A standardized form was used to extract key data from studies by two independent researchers.
RESULTS
1210 participants from 20 randomized controlled trials, two non-randomized controlled trials and 13 case series studies were included. Most studies had moderately strong methodological quality. Dancing, water exercises and robotic gait training were an effective adjunct to medical management for some people living with PD. Virtual reality training, mental practice, aerobic training, boxing and Nordic walking training had a small amount of evidence supporting their use in PD.
CONCLUSION
On balance, alternative physical therapies are worthy of consideration when selecting treatment options for people with this common chronic disease.
CLINICAL REHABILITATION IMPACT
Complementary physical therapies such as dancing, hydrotherapy and robotic gait training appear to afford therapeutic benefits, increasing mobility and quality of life, in some people living with PD.
Topics: Accidental Falls; Complementary Therapies; Humans; Parkinson Disease; Physical Therapy Modalities; Psychomotor Performance; Quality of Life
PubMed: 26138090
DOI: No ID Found -
BMC Pediatrics May 2018The use of technology to assist in the communication, socialization, language, and motor skills of children with Down's syndrome (DS) is required. The aim of this study...
BACKGROUND
The use of technology to assist in the communication, socialization, language, and motor skills of children with Down's syndrome (DS) is required. The aim of this study was to analyse research findings regarding the different instruments of 'augmentative and alternative communication' used in children with Down's syndrome.
METHODS
This is a systematic review of published articles available on PubMed, Web of Science, PsycInfo, and BVS using the following descriptors: assistive technology AND syndrome, assistive technology AND down syndrome, down syndrome AND augmentative and alternative communication. Studies published in English were selected if they met the following inclusion criteria: (1) study of children with a diagnosis of DS, and (2) assistive technology and/or augmentative and alternative communication analysis in this population.
RESULTS
A total of 1087 articles were identified. Thirteen articles met the inclusion criteria. The instruments most used by the studies were speech-generating devices (SGDs) and the Picture Exchange Communication System (PECS).
CONCLUSION
Twelve instruments that provided significant aid to the process of communication and socialization of children with DS were identified. These instruments increase the interaction between individuals among this population and their peers, contributing to their quality of life and self-esteem.
Topics: Child; Child Language; Communication Aids for Disabled; Down Syndrome; Humans; Motor Skills; Social Skills
PubMed: 29751828
DOI: 10.1186/s12887-018-1144-5 -
JAMA Network Open Sep 2020Falls increase morbidity and mortality in adults 65 years and older. The role of dance-based mind-motor activities in preventing falls among healthy older adults is not... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Falls increase morbidity and mortality in adults 65 years and older. The role of dance-based mind-motor activities in preventing falls among healthy older adults is not well established.
OBJECTIVE
To assess the effectiveness of dance-based mind-motor activities in preventing falls.
DATA SOURCES
Systematic search included the PubMed, Embase, Cochrane Library, Web of Science, CINAHL, PsychINFO, Abstracts in Social Gerontology, AgeLine, AMED, and Scopus databases from database inception to February 18, 2018, using the Medical Subject Headings aged 65 and older, accidental falls, and dancing.
STUDY SELECTION
This systematic review and meta-analysis included 29 randomized clinical trials that evaluated a dance-based mind-motor activity in healthy older adults with regard to fall risk, fall rate, or well-established measures of physical function in the domains of balance, mobility, and strength. The included studies targeted participants without comorbidities associated with higher fall risk. Dance-based mind-motor activities were defined as coordinated upright mind-motor movements that emphasize dynamic balance, structured through music or an inner rhythm (eg, breathing) and distinctive instructions or choreography, and that involve social interaction.
DATA EXTRACTION AND SYNTHESIS
Standardized independent screening, data extraction, and bias assessment were performed. Data were pooled using random-effects models. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline.
MAIN OUTCOMES AND MEASURES
Primary outcomes were risk of falling and rate of falls. For the secondary end points of physical function (balance, mobility, and strength), standardized mean differences (SMDs) were estimated and pooled (Hedges g).
RESULTS
In this systematic review and meta-analysis of 29 randomized clinical trials, dance-based mind-motor activities were significantly associated with reduced (37%) risk of falling (risk ratio, 0.63; 95% CI, 0.49-0.80; 8 trials, 1579 participants) and a significantly reduced (31%) rate of falls (incidence rate ratio, 0.69; 95% CI, 0.53-0.89; 7 trials, 2012 participants). In addition, dance-based mind-motor activities were significantly associated with improved physical function in the domains of balance (standardized mean difference [SMD], 0.62; 95% CI, 0.33-0.90; 15 trials, 1476 participants), mobility (SMD, -0.56; 95% CI, -0.81 to -0.31; 13 trials, 1379 participants), and lower body strength (SMD, 0.57; 95% CI, 0.23-0.91; 13 trials, 1613 participants) but not upper body strength (SMD, 0.18; 95% CI, -0.03 to 0.38; 4 trials, 414 participants).
CONCLUSION AND RELEVANCE
Among healthy older adults, dance-based mind-motor activities were associated with decreased risk of falling and rate of falls and improved balance, mobility, and lower body strength. This type of activity may be useful in preventing falls in this population.
Topics: Accidental Falls; Aged; Aged, 80 and over; Dance Therapy; Dancing; Female; Healthy Volunteers; Humans; Independent Living; Male; Muscle Strength; Physical Functional Performance; Postural Balance; Psychomotor Performance; Randomized Controlled Trials as Topic; Risk Factors
PubMed: 32975570
DOI: 10.1001/jamanetworkopen.2020.17688 -
Jornal de Pediatria 2017Premature newborns are considered at risk for motor development deficits, leading to the need for monitoring in early life. The aim of this study was to systematically... (Review)
Review
OBJECTIVE
Premature newborns are considered at risk for motor development deficits, leading to the need for monitoring in early life. The aim of this study was to systematically review the literature about gross motor development of preterm infants, assessed by the Alberta Infant Motor Scale (AIMS) to identify the main outcomes in development.
DATA SOURCE
Systematic review of studies published from 2006 to 2015, indexed in Pubmed, Scielo, Lilacs, and Medline databases in English and Portuguese. The search strategy included the keywords: Alberta Infant Motor Scale, prematurity, preterm, motor development, postural control, and follow-up.
DATA SUMMARY
A total of 101 articles were identified and 23 were selected, according to the inclusion criteria. The ages of the children assessed in the studies varied, including the first 6 months up to 15 or 18 months of corrected age. The percentage variation in motor delay was identified in the motor outcome descriptions of ten studies, ranging from 4% to 53%, depending on the age when the infant was assessed. The studies show significant differences in the motor development of preterm and full-term infants, with a description of lower gross scores in the AIMS results of preterm infants.
CONCLUSIONS
It is essential that the follow-up services of at-risk infants have assessment strategies and monitoring of gross motor development of preterm infants; AIMS is an assessment tool indicated to identify atypical motor development in this population.
Topics: Child Development; Humans; Infant, Newborn; Infant, Premature; Motor Skills; Motor Skills Disorders
PubMed: 28506665
DOI: 10.1016/j.jped.2017.03.003 -
Alternative Therapies in Health and... 2015Physical inactivity is commonly observed among individuals aged ≥ 60 y. Identified barriers to sedentary older adults beginning activity include low self-efficacy,... (Review)
Review
BACKGROUND
Physical inactivity is commonly observed among individuals aged ≥ 60 y. Identified barriers to sedentary older adults beginning activity include low self-efficacy, pre-existing medical conditions, physical limitations, time constraints, and culture. Dancing has the potential to be an attractive physical activity that can be adjusted to fit a target population's age, physical limitations, and culture.
OBJECTIVES
This review examined the benefits to physical health of dance interventions among older adults.
METHODS
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search using the PubMed database was conducted. Eighteen studies met the inclusion and exclusion criteria and were analyzed for type of intervention, the study's design, participants' demographics, and outcomes, including attrition.
RESULTS
The 18 articles reported on studies conducted in North America, South America, Europe, and Asia. Of the styles of dancing, 6 studies used ballroom, 5 used contemporary, 4 used cultural, 1 used pop, and 2 used jazz. Two studies targeted older adults with pre-existing medical conditions. The average age of participants ranged from 52-87 y. Researchers used a variety of measures to assess effectiveness: (1) 3 of 5 (60%) that used measures to assess flexibility showed significant positive results; (2) 23 of 28 (82%) that used measures of muscular strength and endurance showed significant positive changes; (3) 8 of 9 (89%) that used measures of balance showed significant positive changes; (4) 8 of 10 (80%) that used measures of cognitive ability showed significant positive changes; and (5) the one that measured cardiovascular endurance showed significant positive changes. Only 6 studies reported participation, and they found low attrition.
CONCLUSIONS
The findings suggest that dance, regardless of its style, can significantly improve muscular strength and endurance, balance, and other aspects of functional fitness in older adults. Future researchers may want to analyze the effects of dance on mental health and explore ways to make this intervention attractive to both genders. Standardizing outcome measures for dance would facilitate meta-analysis.
Topics: Accidental Falls; Aged; Aged, 80 and over; Dance Therapy; Dancing; Exercise; Female; Health Behavior; Humans; Male; Middle Aged; Motor Skills; Muscle Strength; Postural Balance; Psychomotor Performance
PubMed: 26393993
DOI: No ID Found -
The Cochrane Database of Systematic... Jul 2017Delayed motor development may occur in children with Down syndrome, cerebral palsy, general developmental delay or children born preterm. It limits the child's... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Delayed motor development may occur in children with Down syndrome, cerebral palsy, general developmental delay or children born preterm. It limits the child's exploration of the environment and can hinder cognitive and social-emotional development. Literature suggests that task-specific training, such as locomotor treadmill training, facilitates motor development.
OBJECTIVES
To assess the effectiveness of treadmill interventions on locomotor development in children with delayed ambulation or in pre-ambulatory children (or both), who are under six years of age and who are at risk for neuromotor delay.
SEARCH METHODS
In May 2017, we searched CENTRAL, MEDLINE, Embase, six other databases and a number of trials registers. We also searched the reference lists of relevant studies and systematic reviews.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) and quasi-RCTs that evaluated the effect of treadmill intervention in the target population.
DATA COLLECTION AND ANALYSIS
Four authors independently extracted the data. Outcome parameters were structured according to the International Classification of Functioning, Disability and Health model.
MAIN RESULTS
This is an update of a Cochrane review from 2011, which included five trials. This update includes seven studies on treadmill intervention in 175 children: 104 were allocated to treadmill groups, and 71 were controls. The studies varied in population (children with Down syndrome, cerebral palsy, developmental delay or at moderate risk for neuromotor delay); comparison type (treadmill versus no treadmill; treadmill with versus without orthoses; high- versus low-intensity training); study duration, and assessed outcomes. Due to the diversity of the studies, only data from five studies were used in meta-analyses for five outcomes: age of independent walking onset, overall gross motor function, gross motor function related to standing and walking, and gait velocity. GRADE assessments of quality of the evidence ranged from high to very low.The effects of treadmill intervention on independent walking onset compared to no treadmill intervention was population dependent, but showed no overall effect (mean difference (MD) -2.08, 95% confidence intervals (CI) -5.38 to 1.22, 2 studies, 58 children; moderate-quality evidence): 30 children with Down syndrome benefited from treadmill training (MD -4.00, 95% CI -6.96 to -1.04), but 28 children at moderate risk of developmental delay did not (MD -0.60, 95% CI -2.34 to 1.14). We found no evidence regarding walking onset in two studies that compared treadmill intervention with and without orthotics in 17 children (MD 0.10, 95% CI -5.96 to 6.16), and high- versus low-intensity treadmill interventions in 30 children with Down syndrome (MD -2.13, 95% -4.96 to 0.70).Treadmill intervention did not improve overall gross motor function (MD 0.88, 95% CI -4.54 to 6.30, 2 studies, 36 children; moderate-quality evidence) or gross motor skills related to standing (MD 5.41, 95% CI -1.64 to 12.43, 2 studies, 32 children; low-quality evidence), and had a negligible improvement in gross motor skills related to walking (MD 4.51, 95% CI 0.29 to 8.73, 2 studies, 32 children; low-quality evidence). It led to improved walking skills in 20 ambulatory children with developmental delay (MD 7.60, 95% CI 0.88 to 14.32, 1 study) and favourable gross motor skills in 12 children with cerebral palsy (MD 8.00, 95% CI 3.18 to 12.82). A study which compared treadmill intervention with and without orthotics in 17 children with Down syndrome suggested that adding orthotics might hinder overall gross motor progress (MD -8.40, 95% CI -14.55 to -2.25).Overall, treadmill intervention showed a very small increase in walking speed compared to no treadmill intervention (MD 0.23, 95% CI 0.08 to 0.37, 2 studies, 32 children; high-quality evidence). Treadmill intervention increased walking speed in 20 ambulatory children with developmental delay (MD 0.25, 95% CI 0.08 to 0.42), but not in 12 children with cerebral palsy (MD 0.18, 95% CI -0.09 to 0.45).
AUTHORS' CONCLUSIONS
This update of the review from 2011 provides additional evidence of the efficacy of treadmill intervention for certain groups of children up to six years of age, but power to find significant results still remains limited. The current findings indicate that treadmill intervention may accelerate the development of independent walking in children with Down syndrome and may accelerate motor skill attainment in children with cerebral palsy and general developmental delay. Future research should first confirm these findings with larger and better designed studies, especially for infants with cerebral palsy and developmental delay. Once efficacy is established, research should examine the optimal dosage of treadmill intervention in these populations.
Topics: Body Weight; Cerebral Palsy; Child Development; Child, Preschool; Dependent Ambulation; Down Syndrome; Exercise Movement Techniques; Humans; Infant; Locomotion; Motor Skills; Motor Skills Disorders; Randomized Controlled Trials as Topic; Walking
PubMed: 28755534
DOI: 10.1002/14651858.CD009242.pub3 -
Developmental Medicine and Child... Nov 2021To systematically review and meta-analyse the measurement properties of the Gross Motor Function Classification System (GMFCS), Gross Motor Function Classification... (Meta-Analysis)
Meta-Analysis
Measurement properties of the Gross Motor Function Classification System, Gross Motor Function Classification System-Expanded & Revised, Manual Ability Classification System, and Communication Function Classification System in cerebral palsy: a systematic review with meta-analysis.
AIM
To systematically review and meta-analyse the measurement properties of the Gross Motor Function Classification System (GMFCS), Gross Motor Function Classification System-Expanded & Revised (GMFCS-E&R), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS) in children with cerebral palsy (CP).
METHOD
Six databases were searched. Articles on the measurement properties of the GMFCS, GMFCS-E&R, MACS, and CFCS administered to children with CP were included. Quality was assessed by means of the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias checklist. The level and grading of evidence were defined for each measurement property.
RESULTS
Forty-four articles were included in the systematic review and 37 articles were included in the meta-analysis. The level (grading) of evidence was strong (positive) for reliability and construct validity. Content validity displayed an unknown level of evidence for the GMFCS, limited evidence (positive) for the MACS, and moderate evidence (positive) for the CFCS. There was moderate (positive) evidence for measurement error in the GMFCS and MACS. The level of evidence for responsiveness was unknown. No studies investigated cross-cultural validity.
INTERPRETATION
These instruments can be used by health care professionals and caregivers to quantify the constructs needed to measure ability in children with CP. Current high-quality evidence supports the use of these tools to classify ability in children with CP. Adopting the COSMIN guidelines, content, and cross-cultural validity should be investigated further. What this paper adds Strong evidence supports the reliability and construct validity of the GMFCS, GMFCS-E&R, MACS, and CFCS as functional classification systems in children with cerebral palsy. The GMFCS, GMFCS-E&R, MACS, and CFCS can be used by both health care professionals and caregivers. The GMFCS, GMFCS-E&R, MACS, and CFCS should not be used to detect change.
Topics: Cerebral Palsy; Disability Evaluation; Humans; Motor Skills; Severity of Illness Index
PubMed: 34028793
DOI: 10.1111/dmcn.14910 -
Journal of Athletic Training Feb 2020Sport-related concussions (SRCs) are known to have short-term effects on cognitive processes, which can result in diverse clinical presentations. The long-term effects...
BACKGROUND
Sport-related concussions (SRCs) are known to have short-term effects on cognitive processes, which can result in diverse clinical presentations. The long-term effects of SRC and repeated exposure to head impacts that do not result in SRC on specific cognitive health outcomes remain unclear.
OBJECTIVES
To synthesize and appraise the evidence base regarding cognitive health in living retired athletes with a history of head-impact exposure or SRC.
DATA SOURCES
A systematic search of the EMBASE, PsycINFO, MEDLINE/PubMed, CINAHL, Cochrane Central Register of Controlled Trials, and Web of Science databases was conducted from inception to April 2018 using common key words and medical subject headings related to 3 components: (1) the participant (eg, retired athlete), (2) the primary outcome measure (eg, cognitive test used), and (3) the secondary outcome measure (eg, history of sport concussion).
STUDY SELECTION
Cross-sectional studies of living retired male or female athletes in which at least 1 cognitive test was used as an outcome measure were included. Two reviewers independently screened studies.
DATA EXTRACTION
Data extraction was performed using Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Methodologic quality was assessed independently by 2 reviewers using the Downs and Black tool.
DATA SYNTHESIS
The search yielded 46 cross-sectional observational studies that were included in a qualitative synthesis. Most included studies (80%, n = 37) were published in the 5 years before our review. A large proportion of these studies (n = 20) included retired American National Football League players. The other research investigated professional, university, high school, and amateur retired athletes participating in sports such as American and Australian football, boxing, field and ice hockey, rugby, and soccer. The total sample consisted of 13 975 participants: 7387 collision-sport athletes, 662 contact-sport athletes, 3346 noncontact-sport athletes, and 2580 participants classified as controls. Compared with control participants or normative data, retired athletes displayed worse performance in 17 of 31 studies (55%) of memory, 6 of 11 studies (55%) of executive function, and 4 of 6 studies (67%) of psychomotor function and increased subjective concerns about cognitive function in 11 of 14 studies (79%). The authors of 13 of 46 investigations (28%) reported a frequency-response relationship, with poorer cognitive outcomes in athletes who had greater levels of exposure to head impacts or concussions. However, these results must be interpreted in light of the lack of methodologic rigor and moderate quality assessment of the included studies.
CONCLUSIONS
Evidence of poorer cognitive health among retired athletes with a history of concussion and head-impact exposure is evolving. Our results suggest that a history of SRC may more greatly affect the cognitive domains of memory, executive function, and psychomotor function. Retired athletes appeared to have increased self-reported cognitive difficulties, but the paucity of high-quality, prospective studies limited the conclusions that could be drawn regarding a cause-and-effect relationship between concussion and long-term health outcomes. Future researchers should consider a range of cognitive health outcomes, as well as premorbid ability, in diverse samples of athletes with or without a history of concussion or head-impact exposure to delineate the long-term effects of sport participation on cognitive functioning.
Topics: Athletic Injuries; Australia; Boxing; Brain Concussion; Cognition; Executive Function; Football; Hockey; Humans; Memory; Psychomotor Performance; Retirement; Soccer
PubMed: 31935139
DOI: 10.4085/1062-6050-297-18