Concussion Recovery and Skilled Performance in Working-Aged Adults: Sex Differences in the Neural Correlates of Persisting Symptoms After Concussion

Abstract

Cognitive-motor integration (CMI) refers to the ability to follow rules that guide perception and action. Following a concussion, CMI neural networks are often disrupted, impairing complex movement. We previously identified links between white matter integrity and visuomotor performance in working-age adults with persistent post-concussion symptoms (PPCS). We investigated the impact of sex, age, and CMI processes on visuomotor performance in PPCS. Forty-two adults (47.5 ± 9.87 years; 25 females, 17 males) completed a direct hand-to-target task and an indirect CMI task (plane-change and feedback reversal). Symptom severity, dizziness, cortical volumes and thickness, and resting-state functional connectivity (RSFC) were assessed. Females demonstrated slower CMI task performance, reduced cortical volume (left cuneus and superior frontal), thinner cortex (left precuneus), greater RPQ-3 symptom severity, and lower RSFC across multiple brain networks. Regression showed female sex and older age predicted poorer CMI performance. Findings highlight sex- and age-related neural factors underlying post-concussion motor deficits.