Identifying and Addressing Cognitive Impairment after Concussion

In the aftermath of a concussion, individuals often grapple with a range of issues, which can vary widely in severity and duration. These can include emotional, cardiovascular, visual, balance, and cognitive issues. These are some of the different phenotypes of concussion, the subcategories of symptoms commonly observed after concussion. In this article, we’ll briefly explore the cognition phenotype and how it can impact daily life.

Cognition encompasses our ability to think, strategize, plan, remember, and behave. Some of the symptoms and issues experienced with post-concussion disturbance to cognition are evident. You may recognize it as taking longer than usual to complete tasks or struggling to understand instructions you’ve been given. Colleagues, friends, and family may notice it in you becoming irritated more quickly or not recalling information as well or quickly. Let’s look at the ways concussion impacts cognitive function so we can understand what may be affecting you or a friend so we can identify a need for professional help.

Memory Problems

Short-term memory deficits are a hallmark of concussions. Individuals may struggle to recall recent events, conversations, or instructions, leading to frustration and disorientation in everyday tasks. Becoming more irritable or having a shorter fuse than normal can be a sign of frustration due to cognitive issues. This can overlap with some of the other aspects of the cognitive phenotype, as well as some of the other phenotypes of concussion. The important step is identifying that the issue exists so help can be sought.

Attention and Concentration Difficulties

Concussions can disrupt the brain’s ability to sustain attention and focus on tasks. This can result in increased distractibility, making it challenging to stay engaged and productive. In children, this might be seen in incomplete homework assignments, taking much longer to complete tasks in school or uncharacteristic behavior during activities that require concentration. For adults, similar issues can pop up at work or home with assignments, jobs or chores going incomplete or taking longer than usual to accomplish.

Slowed Processing Speed

Cognitive processing speed may be compromised after a concussion, leading to delays in understanding and responding to information. Tasks that once felt effortless may now require more time and effort to complete. Of course, this can lead to frustration, but others may experience a sense of depression or disappointment in their declining ability. While mood changes are a separate concussion phenotype, this helps illustrate the overlap of these categories.

Executive Dysfunction

Executive functions, such as planning, organizing, problem-solving, and decision-making, may be impaired post-concussion. Individuals may struggle with tasks that demand complex thinking and strategic planning, affecting their ability to navigate daily responsibilities. Like with some of the other areas already looked at, this can lead to children and adults taking longer to complete assignments or performing poorly at tasks that involve strategizing. New or worsened issues with what seems like time management may also be experienced.

Language and Communication Issues

Some individuals may experience difficulties with language processing after a concussion. Finding the right words, understanding speech, and expressing thoughts coherently can become challenging, impacting communication with others. This can also lead to difficulties in following or understanding instructions. People experiencing this may express frustration with not being able to get their ideas across or feeling like they can’t articulate their thoughts as well as usual. Again, some emotional and mood changes may also be experienced as a consequence.

Visual Disturbances

Concussions can disrupt visual processing, which is a separate phenotype of concussion we’ll be covering in more depth later. However, aspects of vision are closely related to cognition, which can lead to problems with focusing or tracking moving objects after brain injury. These visual disturbances can be a sign of cognitive issues or further exacerbate cognitive difficulties and hinder daily activities. This is just another example of that close overlap between phenotypes, which illustrates how interdependent seemingly distinct tasks and functions can be.

Impaired Judgment and Impulse Control

Changes in behavior, impulsivity, and poor decision-making abilities may surface post-concussion. Individuals may struggle to regulate their actions and impulses, leading to potentially risky or inappropriate behavior. While some of this may also bleed into the mood/affective phenotype of concussion, the important takeaway is that people who are experiencing cognitive impairment after concussion may also start making bad or risky decisions.

Why Does This Happen?

The chemical and physical changes that occur in the brain during and after concussion can lead to cognitive issues, as well as the other 6 phenotypes we discussed previously. One of the key chemical changes experienced after concussion involves impaired delivery of the brain’s energy source, ATP (1). This impact on ATP is part of a metabolic change in the brain that can lead to some of the cognitive symptoms discussed above and takes about one month to return to normal levels (2).

Symptoms and/or cognitive function may not recover within the first month, leading to persistent concussion symptoms (PCS). In the US, PCS has been found to occur in 35% of children (3) and in 21-46% of adults (Langevin et al.) after concussion. In fact, a review of the literature by McInnes et al. concludes, “Results indicate that, in contrast to the prevailing view that most symptoms of concussion are resolved within 3 months post-injury, approximately half of individuals with a single mTBI demonstrate long-term cognitive impairment.” In the case of children, one known factor in developing PPCS is delaying assessment with a concussion specialist.

What to Do?

Concussions are a treatable condition and you can overcome symptoms with individualized care that addresses your specific needs. The best thing to do if a concussion is suspected is to see a concussion specialist within the first few days of injury. This helps reduce the likelihood of developing PCS, shortens your recovery timeline, and can provide valuable information on how to manage your rehabilitation and symptoms, including cognitive difficulties.

Cognitive issues can persist for a month or longer without any symptoms, making it difficult for individuals themselves to know if it’s safe to return to activities. That’s why we use a range of specialized tools at Jackupuncture to assess cognitive function, including SportGait, electroencephalograph (EEG), and neurocognitive surveys. As discussed in previous articles, the objective data that tools like these supply is key to ensuring patients return to work, sport, and life in a safe and timely manner. Working with a specialist who understands and can evaluate the various phenotypes of concussion, including the cognitive phenotype, helps you get the objective data you need for the care and information necessary to recover from concussion and PCS. We are always happy to support patients at every part of their recovery, so feel free to reach out with questions or to book your initial consultation.