Characterizing the Effects of Concussion and Head Impact Exposure: Design, Methods, and Participant Traits of the CARE 2.0 Study
Publication: The Journal of Neuropsychiatry and Clinical Neurosciences
Abstract
Objective:
This article describes the design, methods, and participant characteristics of the second phase of the Concussion Assessment, Research, and Education (CARE) Consortium study (“CARE 2.0”) of the effects of concussion and repetitive head impact exposure on neuropsychiatric health.
Methods:
The authors conducted a prospective multisite observational study of male and female collegiate athletes and military service academy cadets and midshipmen participating in the CARE study. Participants were assessed at three time points: undergraduate baseline (UB), before departure from university or service academy (exit), and up to 6 years following graduation (postgrad) via an online battery of brain health assessments. Participant characteristics were compared across the three time points and four levels of head impact exposure.
Results:
A total of 4,643 participants completed the exit assessment, and 3,981 completed the postgrad assessment. Relative to the UB assessment cohort, the exit and postgrad assessment cohorts differed with respect to the percentage of women, baseline Wechsler Test of Adult Reading scores, National Collegiate Athletic Association division category, sport contact level, and number of previous concussions. The median standardized difference across balancing variables, assessment time points, and degree of head impact exposure was 0.12 (with 90% of effect sizes ≤0.29).
Conclusions:
Although there were some statistically significant differences between participants across assessments, the effect sizes were modest, and overall the data suggest that the exit and postgrad cohorts reflect the characteristics of the baseline cohort. The CARE study design and its large, richly characterized sample provide an opportunity to answer important questions about cumulative and persistent effects of concussion and repetitive head impact exposure on neuropsychiatric health.
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History
Received: 24 January 2024
Revision received: 1 May 2024
Accepted: 6 May 2024
Published online: 10 October 2024
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Competing Interests
Dr. McAllister has received research funding from the NCAA, NIH, and the DoD; he has received royalties from American Psychiatric Association Publishing; and he has received support for teaching a Harvard Medical School, Mass General Brigham Neuropsychiatry CME course. Dr. Broglio has received research funding from the Centers for Disease Control and Prevention (CDC), the DoD–U.S. Army Medical Research Acquisition Activity, ElMindA, GE, the National Athletic Trainers’ Association Foundation, the National Football League (NFL), the NCAA, NIH, Simbex, and Under Armour; he has served as a consultant for U.S. Cycling, U.S. Soccer, and the University of Calgary SHRed Concussions external advisory board; he is president-elect of the Concussion in Sport Group; he serves on the scientific advisory board for C3Logix; he has received compensation for medico-legal litigation and speaker honorarium as well as travel reimbursements for talks; he has received royalties from Human Kinetics; he is a patent holder on device used to assess brain metabolism; and he has served on the editorial boards for a number of journals. Dr. McCrea has received research funding to the Medical College of Wisconsin from Abbott Laboratories, the CDC, the Department of Veterans Affairs, the DoD, the NCAA, the NFL, and NIH; he has served as a consultant to Neurotrauma Sciences and is a clinical consultant to the Green Bay Packers professional football club; and he has received honoraria and travel support for professional speaking engagements. The other authors report no financial relationships with commercial interests.
Funding Information
Supported by the Grand Alliance Concussion Assessment, Research, and Education Consortium, funded in part by the National Collegiate Athletic Association (NCAA) and the U.S. Department of Defense (DoD). The U.S. Army Medical Research Acquisition Activity is the awarding and administering acquisition office. This work was also supported by the Office of the Assistant Secretary of Defense for Health Affairs, through the Combat Casualty Care Research Program, endorsed by the DoD, through the Joint Program Committee 6/Combat Casualty Care Research Program–Psychological Health and Traumatic Brain Injury Program (award numbers W81XWH1420151 and W81XWH1820047).
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