A young couple embraces on the rocks by a rough ocean.

Any injury involving the head/brain is scary – but is it serious?  A concussion is an injury to the brain that results in a temporary loss of normal brain function.  Some concussions may cause alteration of mental status or loss of consciousness, though this does not occur with many mild injuries.  Similarly, concussions often do not have any obvious, external signs of damage.  Concussions can affect various areas of thinking, including memory, speech, attention, and executive functioning.  Luckily, the vast majority of people with mild injuries recover within a few days or weeks; in fact, recovery that takes more than six months is very rare and is usually related to other co-occurring issues, such as depression and anxiety.  Recovery involves a gradual return to regular activities and avoiding repeated injuries during the recovery period, which can cause more serious damage (Second-Impact Syndrome). A concussion evaluation may help individuals better understand their symptoms.   

Frequently, people ask whether their new-onset memory difficulties are the result of concussions in the remote past.  The answer is, most likely not!  If a person’s thinking has returned to baseline after their concussion (meaning they have fully recovered), it would be highly unusual for them to start experiencing (or re-experiencing) symptoms many years later.  More likely, those new symptoms are the result of another problem – the onset of a dementia syndrome, side effects of a medication, poor health, etc.  People also frequently ask about the possibility of Chronic Traumatic Encephalopathy (CTE).  Research on CTE is relatively new, and there are still unanswered questions.  CTE is a progressive neurodegenerative disease. It causes damage similar to that seen in Alzheimer’s disease it appears to be caused by repeated head traumas, like those sustained in contact sports.  It is present in less than 1% of the general population, and it cannot be diagnosed while a person is still living.  Patients should be assured that their risk of developing CTE is extremely low, especially if they are not an athlete in a contact sport – even if they sustained a concussion or two in their life.  

For those who do play contact sports, baseline testing can be useful to establish a cognitive profile for future comparison if a concussion is sustained.  This allows the provider to determine if there have been any cognitive changes from the concussion, and how significant those changes are.  This can also be helpful in informing return to school/play decisions, determining a treatment plan (if necessary), and estimating level of future risk.  Baseline testing is especially important if there are any other co-occurring cognitive concerns (e.g., ADHD, learning disabilities, etc.) as it can be difficult to identify whether cognitive changes are due to the concussion or the co-occurring disorder.  Computerized software, called ImPACT, is frequently used to complete baseline testing.  However, this software is vulnerable as it does not fully take into account any pre-existing factors.  While ImPACT is quick and easy to administer, these vulnerabilities may make the results unreliable, which could have major impacts on the decision to return to normal activity.  A more thorough baseline evaluation, including an interview to document background and history of any pre-existing conditions and cognitive screening, can help athletes and their families be more confident in their decision-making if/when a concussion is sustained.  

Please see the following resources for additional information:

CDC’s information on TBI:

Concussion symptoms:

Concussion Foundation:

Brain Injury Association of America:

Brain Injury Association of North Carolina:

North Carolina DHHS resources on TBI:

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