title: Symptom Network Comparisons Between Pre- and Post-Concussion
Creators: name: Salva, Christine
Publisher: name: University of Nevada, Las Vegas
publisherIdentifier: https://ror.org/0406gha72
publisherIdentifierScheme: ROR
Year: 2024

description: Increased awareness about the short and long-term negative outcomes associated with sport-related concussion has resulted in active monitoring of cognitive and symptom profiles of athletes using a variety of assessments. The traditional approach to interpretation of cognitive and symptom measures has been based on a latent construct framework where domain scores reflecting latent constructs representing cognitive or symptom domains are collected at baseline and then compared to those obtained after concussion during the acute injury phase, with repeated additional assessments to determine when cognitive and symptom alterations have resolved. More recently, network approaches have been used to examine changes in cognition and symptoms following a sport-related concussion. Rather than focusing on latent constructs, network analysis examines relationships among individual symptoms and how these symptoms influence each other. Network analysis has provided some new and potentially important insights into disruption caused by injury and recovery processes. For example, network analysis has revealed that while cognitive domain scores may return to pre-concussion levels following injury, the cognitive networks may continue to vary significantly from baseline levels, suggesting persisting neurobiological dysfunction. Current research has identified these abnormalities in network structure from baseline to acute post-concussion for concussion symptoms, but little information currently exists about whether changes in network structure are also present during the post-concussion recovery phase. The current study examined baseline, acute post-concussion, and recovery post-concussion symptom scores (Post-Concussion Symptom Scale [PCSS]) from a commonly used concussion screening tool (ImPACT) to examine changes in network structure and connectivity of post-concussion symptoms to determine whether symptom networks continue to be disrupted following recovery (as judged by improvement in scores derived through a latent construct approach). Participants were high school athletes who completed the PCSS at baseline, acute post-concussion, and in recovery (approximately 2 weeks post-concussion, n = 1,256). We conducted network analysis on PCSS scores at each time point, with each symptom’s expected influence value calculated to determine their centrality and importance within each network. We then conducted network comparisons between each time point to determine if differences in network connectivity (global strength), structure (distribution of edge weights), and symptoms’ expected influence exist between different time points in concussion management and recovery. Network comparison results showed the structure significantly differed between baseline and acute post-concussion networks, but did not when comparing the recovery network with the acute and baseline networks. The overall connectivity or global strength did not significantly differ between the baseline and acute post-concussion networks, but did between the recovery network and both the baseline and acute post-concussion networks. Expected influence results suggested “difficulty concentrating” and “dizziness” were most central at all three points, with additional most central symptoms including “sadness” at baseline, “feeling mentally foggy” at acute post-concussion, and “feeling more emotional” at recovery. Multiple symptoms’ expected influence values significantly differed between each time point. Results suggest that, while changes in PCSS network structure observed directly following a concussion return to the baseline structure in recovery, the overall connectivity is elevated at recovery, potentially making athletes more vulnerable to the development of symptoms. Additionally, results suggest concentration and dizziness concerns may be important to treat at all three time points in order to see a reduction across all symptoms, with affective concerns at baseline and recovery and mental fogginess at acute post-concussion. Future research should conduct network comparisons with more generalizable samples based on pre-existing factors (i.e., psychiatric history, neurodevelopmental disorder) as well as compare symptom network comparison results to neuroimaging results to determine if they are reflective of neurobiological dysfunction.