The Impact of Concussion on Processing Speed and Attention in Athletes: A Systematic Review

Moraes, Raquel Melo dos Santos; Barcelos, Gabrielle Candido de Oliveira; Toribio, Pedro Paulo Coutinho; Landeira-Fernandez, Jesus; Gonçalves, Alberto José Filgueiras

doi:10.1590/1982-4327e3527

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Psychology of Health • Paidéia (Ribeirão Preto) 35 • 2025 • https://doi.org/10.1590/1982-4327e3527 linkcopy

The Impact of Concussion on Processing Speed and Attention in Athletes: A Systematic Review

O Impacto da Concussão Cerebral na Velocidade de Processamento e Atenção de Atletas: Uma Revisão Sistemática

El Impacto de la Conmoción Cerebral en la Velocidad de Procesamiento y Atención de los Atletas: Una Revisión Sistemática

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The present study investigated if concussions would be associated with decreases in cognitive performance, especially attention and processing speed. A systematic review of the literature was conducted in the PubMed, PsycInfo and ScienceDirect databases. The aim of this review is to ascertain the quality of the evidence in parallel with seeking a convergent answer to the guiding research question. The results showed that attention and processing speed are compromised at least one week after the concussion occurs. However, two problems were indicated by the judges: the heterogeneity of the instruments used in the studies, and the bias of the results, given that most of them did not use blind data collection or blind compilation of the results of the evaluations. Although solid evidence was found, further meta-analyses will be needed to increase homogeneity and validity, and ensure the size of the effect of concussion on the cognitive functions of athletes.

Keywords:
brain concussion; attention; processing speed; review; sports

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Universidade de São Paulo, Faculdade de Filosofia Ciências e Letras de Ribeirão Preto, Programa de Pós-Graduação em Psicologia Av.Bandeirantes 3900 - Monte Alegre, 14040-901 , Tel.: (55 16) 3315-3829 - Ribeirão Preto - SP - Brazil
E-mail: paideia@usp.br

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[TFN1] Note. ↑ = increase / larger; ↓ = decrease/smaller; NS = not specified; BVMT = Brief Visuospatial Memory Test-Revised; HVLT = Hopkins Verbal Learning Test-Revised; SDMT = Symbol Digit Modalities Test; ImPACT = Immediate Post-Concussion Assessment and Cognitive Testing; NP Battery = consists of a series of five short NP subtests with multiple trials, each assessing information processing speed, working memory, and executive function; SART = Sustained Attention to Response Task; WAIS-III = Wechsler Adult Scale; RBANS = Assessment of Neuropsychological Status; SWAIS = South African Wechsler Adult Intelligence Scale.

[TFN2] Note. ↑ = increase / larger; ↓ = decrease/smaller; NS = not specified; BVMT = Brief Visuospatial Memory Test-Revised; HVLT = Hopkins Verbal Learning Test-Revised; SDMT = Symbol Digit Modalities Test; ImPACT = Immediate Post-Concussion Assessment and Cognitive Testing; NP Battery = consists of a series of five short NP subtests with multiple trials, each assessing information processing speed, working memory, and executive function; SART = Sustained Attention to Response Task; WAIS-III = Wechsler Adult Scale; RBANS = Assessment of Neuropsychological Status; SWAIS = South African Wechsler Adult Intelligence Scale.

Author and year	Sample characteristics
Author and year	n	Age	Sex	Modality
Guty & Arnett, 2018	122	m = 19.5	M and F	Football, wrestling, lacrosse, ice hockey, basketball, baseball, softball, rugby, swimming, diving, and golf
Iverson et al., 2005	72	m = 17	M	Soccer, hockey, basketball, wrestling
Fickling et al., 2019	47	m = 18.49	M	Ice hockey
Espinoza et al., 2021	123	m = 17	M	American football
Ray et al., 2022	12	m = 16	M and F	Soccer, basketball and volleyball
Terpstra et al., 2019	61	NS	M	Soccer
Gardner et al., 2010	73	m = 24,5	M	Rugby
Peterson et al., 2003	350	NS	M and F	Men’s and women’s soccer, softball, basketball, and cheerleading
Fields et al., 2019	35	m = 65.49	M	American football
Kontos et al., 2011	63	m = 15.89	M and F	Soccer
Killam et al., 2005	28	m = 20	M	Ice hockey, field hockey, lacrosse, and soccer
Schatz et al., 2006	138	NS	M	Tennis and soccer
Shuttleworth-Rdwards & Radloff, 2008	124	NS	M	Rugby
Pearce et al., 2014	43	m = 24.1	M	Soccer
Barr, 2003	100	m = 15.9	M and F	Soccer and field hockey
Solomon & Haase, 2008	168	NS	M	American football
Thomas et al., 2021	831	m = 18.50	M and F	Men’s and women’s soccer, wrestling, men’s and women’s lacrosse, women’s ice hockey, men’s and women’s basketball, baseball, softball, volleyball, and rugby

Author and year	Type of study	Cognitive assessment instruments	Main results
Guty & Arnett, 2018	correlational	BVMT-R / HVLT-R / SDMT / Stroop	Attention and processing speed↓
Iverson et al., 2005	longitudinal	Go / No-Go Symbol-Digit Modalities Test	Processing speed and reaction time↓
Fickling et al., 2019	longitudinal	ImPACT	Basic attention and processing speed ↓
Espinoza et al., 2021	longitudinal	NP Battery N-back	Divided attention and processing speed ↓
Ray et al., 2022	case-control study	Teste de King-Devick (K-D)	Processing Speed, attention, and Reaction time ↓
Terpstra et al., 2019	correlational	SART	Sustained Attention ↓
Gardner et al., 2010	correlational	WAIS-III PSI	Processing Speed ↓
Peterson et al., 2003	cohort study	Symbol Digit Modality Test Digit Span test	Attention - Processing Speed ↓
Fields et al., 2019	correlational	WAIS-IV Coding Trail making A & B	Attention - Processing Speed -
Kontos et al., 2011	cohort study	NE	Processing Speed ↓
Killam et al., 2005	correlational	STROOP / RBANS	Attention - Processing Speed ↑
Schatz et al., 2006	correlational	NE	Processing Speed ↓
Shuttleworth-Rdwards & Radloff, 2008	correlational	SAWAIS / TMT Trail Making Test A and B	Visuomotor Processing Speed ↓
Pearce et al., 2014	case study	IED test	Attention↓
Barr, 2003	longitudinal	Digit Span Digit Symbol WAIS-III	Attention ↓ Processing Speed -
Solomon & Haase, 2008	longitudinal	ImPACT	Processing Speed ↓
Thomas et al., 2021	correlational	Stroop Color-Word Test Symbol-Digit Modalities Test	Processing Speed and Attention↓