College athletes have lasting brain changes after concussion

College athletes who suffer concussions may experience changes in their brains for up to a year after being cleared to play, according to new research.

A concussion is a form of mild traumatic brain injury (TBI) that can interfere with normal brain function.

While symptoms like headaches, fatigue, and balance issues may fade, brain scans reveal that recovery at the neurological level may take much longer.

Tracking brain recovery after concussion

Researchers used brain scans over the course of a year to track biomarkers of brain injury in athletes.

“Concussion can have long-term effects on brain health, and there is growing evidence that brain recovery may persist months to years, even after symptoms like headache, fatigue and balance problems resolve,” said Dr. Nathan Churchill of St. Michael’s Hospital in Toronto.

“Our study followed athletes before and after concussion for over a year, using multiple brain scans to examine biomarkers that signify brain injury. Our results provide strong evidence, suggesting incomplete recovery of brain function when returning to play and beyond.”

Brain changes over time

The experts evaluated 187 college athletes, 25 of whom experienced concussions during the regular season. They played high-impact sports like basketball, football, hockey, lacrosse, rugby, soccer, and volleyball.

All of the athletes underwent pre-season testing that assessed balance, thinking, and memory in order to set a baseline. They also had a magnetic resonance imaging (MRI) brain scan prior to the start of the season.

Participants who later experienced concussions were given additional brain scans at important intervals: about five days following their concussion, upon clearance to resume playing, one to three months after resuming play, and one year after resuming play.

As a comparison, 27 athletes who did not have concussions had similar scans at their subsequent pre-season evaluation.

The researchers then contrasted the pre- and post-injury scans of the concussed players, with additional examination of how these changes compared to those of healthy players.

Blood flow and white matter changes

The tests revealed that despite being cleared medically, athletes who had experienced concussions continued to exhibit evidence of brain damage.

The most significant finding was a reduction in blood flow to the fronto-insular cortex – a region of the brain involved in thinking, memory, emotions, and social behavior.

At the time of their return to play, concussed athletes showed an average decrease of nine milliliters of blood per 100 grams per minute compared to healthy athletes.

A year later, the difference was even greater, with an average decrease of 11 milliliters per 100 grams per minute. These changes were more pronounced than those seen in uninjured athletes.

The researchers also looked at how water molecules flowed through the brain’s white matter. These scans indicated that, even a year after the injury, concussed athletes continued to display possible signs of residual brain injury.

Impacts of repeated concussions

“The presence of significant, long-lasting brain changes after injury reinforces concerns about the consequences of repeated concussions, and to what extent these effects accumulate over time,” said Churchill.

“More studies are needed in larger groups of people to further investigate the long-term effects to the brain.”

One limitation of the study is that it only included young athletes. Future research should look at how concussions affect non-athletes and people in other age groups to understand the broader impact.

What this means for athletes

The results of the study contribute to the increasing concern regarding the management of concussions in athletes, especially when they are young. Although symptoms resolve within weeks, brain recovery might take many more months.

All stakeholders, including athletes, coaches, and clinicians, should consider these residual effects when deciding whether it will be safe to return to play.

Concussions are more than just temporary setbacks – they can have lasting effects. Monitoring brain health even after symptoms subside is crucial for long-term well-being.

The research was supported by the Canadian Institutes of Health Research, the Canadian Institute for Military and Veterans Health Research, and Siemens Healthineers Canada.

The full study was published in the journal of the American Academy of Neurology.

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