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Duration of cognitive dysfunction after concussion, and cognitive dysfunction as a risk factor: a population study of young men

Abstract Objectives: To establish how long cognitive dysfunction lasts after concussion, and the extent to which it may be a predisposing risk factor for concussion, by examining the prevalence of cognitive dysfunction among young men who have sustained concussion. Design: Observational study. Setting: Denmark. Subjects: 1220 young men who had been admitted to hospital for concussion between the ages of 16 and 24 (identified in a national register of admissions) and who had also been cognitively tested by the Danish conscription draft board. Main outcome measure: Score on the draft board's cognitive screening test, dichotomised as dysfunctional or non-dysfunctional (20.4% of the general population of Danish men appearing before the draft board had a dysfunctional score). Results: 700 of the 1220 men had been tested after sustaining concussion; 520 had been tested before concussion. Four (50%) of the eight men who were tested less than seven days after the injury had a dysfunctional score. Among groups of the remaining 692 men who were tested at later time points after injury, the rates were only marginally raised (range 21.4% to 26.5%) above the population level. Among men tested before injury, the rate of dysfunctional scores was higher (30.4% (158/520)). Apart from suggesting cognitive dysfunction as a risk factor for concussion, this higher proportion seems to relate to the fact that they were typically injured as young adults, whereas those men who were tested after concussion had more often been injured as adolescents. The relative risk for concussion in the presence of cognitive dysfunction is estimated to be 1.57 (95% confidence interval 1.32 to 1.86). Conclusions: Cognitive dysfunction is not only a short term consequence of concussion but also a predisposing risk factor for concussion, more so for young adults than for adolescents. Key messages How should academic medicine look in the 21st century Cognitive dysfunction is also a risk factor for sustaining concussion The risk factor is greater among young adults than among adolescents