Lifetime Concussions and Head Impact Exposure During Collegiate Athletics: A CARE Consortium Study

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OBJECTIVE: Despite a growing interest in the long-term effects of concussion and repetitive head impacts (RHIs) on brain health, understanding is limited regarding the clinical and cognitive changes that may accrue during collegiate athletics. METHODS: Collegiate student-athletes enrolled in the Concussion Assessment, Research, and Education Consortium from 2014 to 2021 (N=3,663) completed baseline (at initial enrollment) and exit (at the end of college) assessments. Proxies for RHIs were estimated with sport contact classification (high exposure, low exposure, and unexposed) and total years of primary sport participation. Multivariable linear regressions were used to examine the effects of these variables and the lifetime number of concussions on change scores across somatic, postural stability, and neurocognitive measures. RESULTS: Both low- and high-exposure sport student-athletes had lower (i.e., better) symptom change scores (symptom total: β=-0.62, 95% CI=-1.01, -0.24, p=0.002 [low exposure]; β=-0.80, 95% CI=-1.20, -0.40, p<0.001 [high exposure], and symptom severity: β=-1.58, 95% CI=-2.47, -0.70, p<0.001 [low exposure]; β=-2.17, 95% CI=-3.09, -1.24, p<0.001 [high exposure]), compared with student-athletes in unexposed sports. High-exposure student-athletes had faster reaction time change scores during neurocognitive testing (β=-0.02, 95% CI=-0.03, -0.01, p=0.001). Student-athletes with one or two previous concussions had improved cognitive change scores (β=0.35, 95% CI=0.14, 0.57, p=0.001), compared with those without concussion. A greater number of total years of primary sport participation was associated with lower symptom total change scores (β=-0.06, 95% CI=-0.10, -0.02, p=0.004). CONCLUSIONS: These findings suggest that RHIs or lifetime number of concussions have no clinical consequences during university athletics. Further longitudinal investigations are warranted to evaluate brain health later in life.