Visuospatial recall vulnerability in former contact-sport athletes with persistent post-concussion symptoms: Limited correspondence with structural brain age.

A minority of individuals develop persistent post-concussion symptoms (PCS) after sport-related concussion, including lasting cognitive difficulties. We previously reported an elevated brain age gap (BAG) in former contact-sport athletes with PCS, but such a marker is clinically useful only if it relates to their cognitive difficulties. We examined episodic memory in former athletes with (PCS+) and without (PCS-) PCS, and tested whether the BAG-memory relationship differed by symptomatic status. Fifty former contact-sport athletes (24 PCS+, 26 PCS-) contributed MRI and cognitive data; 21 non-concussed control athletes completed the cognitive assessment only. Verbal and visuospatial memory were compared across groups. PCS+ athletes showed lower immediate and delayed recall on the Rey-Osterrieth Complex Figure Test (RCFT), reflecting a significant Group x Process interaction (F(4,128) = 6.74, p < .001, η2p = .17) that persisted with education covaried and was unrelated to depressive or anxiety symptoms. Groups did not differ on recognition or verbal memory, indicating a difference specific to visuospatial recall. The BAG-memory relationship did not differ by symptomatic status, and within-group associations were small and did not survive correction for multiple comparisons. A sensitive, process-level measure such as the RCFT captured a memory difference that structural brain age did not reflect.