• William P Meehan, Jimmy Zhang, Rebekah Mannix, and Michael J Whalen.
• Sports Concussion Clinic, Division of Sports Medicine, Department of Orthopedics and Brain Injury Center, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA. concussion.sportsmed@childrens.harvard.edu
• Neurosurgery. 2012 Oct 1; 71 (4): 885-91.

BackgroundAlthough previous evidence suggests that the cognitive effects of concussions are cumulative, the effect of time interval between repeat concussions is largely unknown.ObjectiveTo determine the effect of time interval between repeat concussions on the cognitive function of mice.MethodsWe used a weight-drop model of concussion to subject anesthetized mice to 1, 3, 5, or 10 concussions, each a day apart. Additional mice were subjected to 5 concussions at varying time intervals: daily, weekly, and monthly. Morris water maze performance was measured 24 hours, 1 month, and 1 year after final injury.ResultsAfter 1 concussion, injured and sham-injured mice performed similarly in the Morris water maze. As the number of concussions increased, injured mice performed worse than sham-injured mice. Mice sustaining 5 concussions either 1 day or 1 week apart performed worse than sham-injured mice. When 5 concussions were delivered at 1-month time intervals, no difference in Morris water maze performance was observed between injured and sham-injured mice. After a 1-month recovery period, mice that sustained 5 concussions at daily and weekly time intervals continued to perform worse than sham-injured mice. One year after the final injury, mice sustaining 5 concussions at a daily time interval still performed worse than sham-injured mice.ConclusionWhen delivered within a period of vulnerability, the cognitive effects of multiple concussions are cumulative, persistent, and may be permanent. Increasing the time interval between concussions attenuates the effects on cognition. When multiple concussions are sustained by mice daily, the effects on cognition are long term.

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