Athletes worsen after recovering from concussion and returning to exercise

A study showed that athletes who have recovered from a concussion can worsen after returning to exercise.

Athletes who seem to have recovered from a concussion may actually show a subtle worsening in a particular mental ability after they return to exercise, a small study suggests.

The findings come from a study of 19 high school athletes who suffered a concussion and then got medical clearance to return to physical activity -- most often football, although a few were on soccer, wrestling or volleyball teams.

Researchers found that for 12 of those athletes, a particular mental ability that had been improving post-concussion reversed course once they were up and moving again.

Specifically, the athletes' ability to simultaneously walk and do simple mental tasks "regressed," the researchers report in the journal Medicine & Science in Sports & Exercise.

In real-life terms, that means walking down the street while talking to a friend would be a bit harder, explained Li-Shan Chou, one of the researchers on the study.

The shift would be too subtle for a person to actually notice, said Chou, a professor of human physiology at the University of Oregon in Eugene.

But he and his colleagues were able to detect the regression in lab tests where the athletes walked while performing basic mental tasks -- like listening to a spoken word, then saying whether it was a high or low pitch.

What does it all mean? That's not clear, said Kenneth Podell, a concussion expert who was not involved in the study.

For one, since the study group was so small, the findings need to be replicated in larger studies to know whether they are "real," according to Podell, co-director of the Houston Methodist Concussion Center in Texas.

He also questioned how the athletes could show an improvement in their test performance early on, when they were "most concussed," but then worsen after all their other signs and symptoms had improved.

Chou agreed that the implications of his findings are unclear. For now, he said the study highlights the importance of giving concussions time to heal.

"Have patience, and give the brain time to recover," Chou added.

According to the American Academy of Neurology (AAN), more than 1 million athletes in the United States suffer a concussion each year.

Concussion symptoms include headache, dizziness, nausea, ringing in the ears, fatigue and confusion -- though these problems may not become noticeable until hours after the jolt to the head. And contrary to popular belief, concussions usually do not cause unconsciousness.

When athletes are recovering from a concussion, the "standard of care" is to gradually return them to physical activity before they can get back on the field, Podell said.

In fact, all 50 states and the District of Columbia now have some kind of law on youth concussions, protecting athletes from returning to the playing fields too soon.

But there is no "set timeline" for safe return to play, according to the AAN. And judging recovery is subjective, Chou said, because it involves asking patients how they feel.

The current findings are based on 19 high school athletes who were periodically assessed for two months after sustaining a concussion. All returned to physical activity, with medical clearance, during that time.

Chou's team found that once they were active again, 12 of the athletes showed some reversal in their ability to walk and perform mental tasks simultaneously. The problem showed up as a subtle change in their walking speed or balance.

Still, Podell said, it's not clear what to make of that. Even if the athletes' gait did regress when they first started physical activity, it might have been "fine" by the time they got back into their sport, he noted.

"The take-away for parents is, the return from concussion is complex, and the best clinical practice calls for a slow and gradual return to activity under the guidance of professionals," Podell said.

But it's not only physical activity that matters, he added. Concussed kids should also take a break from mental stress and only gradually return to schoolwork.

"Just because a student-athlete is ready to exercise does not mean they are 100-percent ready for a full load at school," Podell said.

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Blood pressure and cognitive decline

High blood pressure as an adult may indicate a weaker brain with more cognitive decline later in life.

Let your blood pressure get too high in midlife, and you might pay the price in mental decline later on, a new study suggests.

The study of almost 14,000 people found that high blood pressure in those aged 48 to 67 was tied to a late-life drop in mental ability. Over 20 years, people with high blood pressure in midlife experienced a modest but significant 6.5 percent decline in scores on tests of mental function, compared with people with normal blood pressure.

"High blood pressure might be an important risk factor for dementia, since mental decline is a known risk factor," said lead researcher Dr. Rebecca Gottesman, an associate professor of neurology and epidemiology at Johns Hopkins University School of Medicine in Baltimore.

However, she stressed that because "we know how to treat high blood pressure," bringing it under control might also cut a person's risk for dementia.

For the study, Gottesman's team collected data on people taking part in a major U.S. heart disease study. The participants were followed for as long as 23 years and their mental abilities were tested three separate times.

Gottesman's group found that people whose blood pressure was controlled with medication had less mental decline than those with uncontrolled high blood pressure. The effect was stronger among whites than blacks, the researchers noted.

Blood pressure levels in middle age may be especially important to later-life mental acuity, Gottesman said.

"This may be why some clinical trials that have studied the role of blood pressure medications [in older people] have failed to find a benefit in reducing mental decline and dementia," she reasoned. "The trials may simply not be long enough -- it may be most important to start treatment of high blood pressure when people are middle-aged."

However, the jury is still out on whether blood pressure medication given in middle age can help boost late-life thinking and memory.

"In our study, people who were on medications to treat high blood pressure did have less mental decline than did people not on medications," Gottesman said. "But it's possible those people had been on medications for years."

Still, "our data suggest that, overall, being on any medications for high blood pressure may be protective," Gottesman said.

The report was published online Aug. 4 in JAMA Neurology.

Dr. Philip Gorelick is medical director of the Hauenstein Neuroscience Center at Michigan State University College of Human Medicine in Grand Rapids.

He believes that the new study "provides some evidence that those who were observed and treated for high blood pressure were better off in the long run from a mental standpoint than those who were not treated for high blood pressure."

Gorelick, who authored an accompanying journal editorial, said that doctors have long known that treating high blood pressure is key to cutting people's odds for stroke and heart attack.

Now "another, but less well-documented benefit, of blood pressure lowering may be the preservation of mental function as we age," he said. "With additional study, we may be better positioned to tell our patients whether control of blood pressure not only prevents stroke and heart attack, but also helps to preserve their brain."

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