mark lovell phd

Meet Chemistry Professor and Chair Mark Lovell

Lovell's latest cutting-edge research on head trauma utliizes a finger stick. 

By Madison Dyment

UK’s Dr. Mark Lovell, Chemistry, is one of those teachers. Growing up in Mount Vernon, KY, Lovell stayed close to home and attended Berea College for his undergrad.

Post-grad, Lovell tried his hand at medical school, but found himself ultimately drawn to graduate school at UK. He received his doctorate here working with Dr. William Ehmann, radiochemistry professor, and Dr. William Markesbery, Director of UK Sanders-Brown Center on Aging. It was through these two influential men that Lovell first found his path.

“Working on projects with the two of them, I became fascinated with Alzheimer’s disease and my research became largely focused on Alzheimer’s, head trauma and stroke,” said Lovell. “I just became fascinated with the chemistry and the neuro-chemistry associated with the pathology.”

Lovell found himself completing a post-doc at the Center on Aging and eventually moving to a research faculty line at UK and ultimately a tenure track line, all while also working at the Center.

“Being at UK and Sanders-Brown gives a varied perspective since we have such a wide range of faculty there,” said Lovell. “It makes it really nice. If, as a poor, old chemist, you run into a problem outside of chemistry, there are other folks in the building who are very collaborative and willing to jump in and help.”

UK became a beneficial choice for Lovell. Not only did he meet mentors that corresponded with his personality and cultivated his passions, but Lovell is also able to remain close to his elderly mother and watch out for her.

“I really just developed a love for the campus and the Center and the work we do, so that’s really why I came to stay at UK,” said Lovell.

This love for his work is something that has never left Lovell. To this day, he is still tirelessly working on projects related to Alzheimer’s, head trauma and stroke, including one of his most exciting projects to date. The study examines a circulating marker of head trauma. Lovell and his team have identified a circulating protein that can be picked up in a finger stick and indicates a minor head injury.

“The difficulty with assessing head trauma is that minor injuries typically fail to show up on imaging,” said Lovell. “Unfortunately, if an injury is big enough to show, it’s probably no longer a mild injury.”

Currently, they have worked with the UK emergency department and have moved to conducting the study with UK and EKU athletics.

“We’re actually working with them to determine if we can identify concussive head trauma in football, soccer and volleyball under an NIH award,” said Lovell. “In addition, we just submitted a proposal to the Department of Defense to expand the project to 11 other Universities.   

This expansion could potentially increase enrollment to include approximately 1400 athletes, and potentially 150 -200 concussive injuries.  Among many observations, Lovell and his team have determined that the biomarker is not elevated by basic activity, but that there is a small but significant increase in baseline levels in athletes with repeated contact over the athletic season. This potentially suggests that accumulating minor injuries over time may contribute to neuronal injury. 

Even though the project has presently branched to athletics, military and emergency department purposes, its origins are much more personal for Lovell.

“Back in 2012, my favorite aunt had a transient ischemic attack and went in to the ER, where she was told nothing showed up in imaging,” said Lovell. “After bouncing around trying to decide if there had actually been an ischemic event the physicians decided that they would start her on aggressive clot busters”. 

Lovell’s aunt suffered a massive hemorrhagic stroke and passed away a few weeks later.

“I thought, if there had been a simple device that could have picked up on a marker indicating an ischemic event in the ER, then it might have helped in the decision of whether or not to start these therapies at a more therapeutically beneficial time,” said Lovell. “So that’s when I started working on the device and as the research progressed it became apparent that the approach was better suited for head trauma detection.”

In the future, Lovell hopes to modify the device to add additional lines to identify more severe injuries and possibly use the device for children in the emergency room.

“Based on current guidelines from the American Association of Pediatrics to minimize CT-imaging of children, there is a need for a non-invasive approach to identify children with head injuries who need imaging,” Lovell said. “A classic example is a child who falls off the swing set and hits their head.  Because our device only requires a finger stick, it could potentially provide a non-invasive way to determine if an injury is minor or significant enough to merit imaging.”

Another exciting project for Lovell is the development of a small molecule that is protective in animal models of Alzheimer’s pathology.

“Working with Dr. Bert Lynn in the Chemistry department, we’ve developed a small molecule that appears to interrupt a pathway inside astrocytes that could potentially slow the cascade of events leading to neurodegeneration,” Lovell said.  

“Our ultimate goal is to move toward clinical trials in humans. The compound is poorly water soluble and we’re currently working to modify the chemistry to increase solubility but keep the drug activity. I’m realistically hopeful!”

Despite his personal success, Lovell credits many people who have helped him along the way.

“Dr. Markesbery was a big influence for me in a variety of ways, even from little physical gestures I’ve picked up from him. Over the years I’ve noticed that aspects of my lecture style in class were really influenced by both Dr. Ehmann and also by Dr. Steven Yates (Chemistry).”

One of his largest influences has been Dr. Mark Meier, the Chair of Chemistry, whose position Lovell will be taking over this July.

“It’s a big pair of shoes to fill. Following Dr. Meier is like being the guy who follows Nick Saban,” Lovell joked. “You never want to be the one to follow Nick Saban, you want to be the one who follows the guy who follows Nick Saban.”

Regardless, Lovell intends to pursue his studies and projects in the near future and will never diminish the importance of his work.

“Currently the biggest segment of the US population includes folks who are moving into the age of onset of Alzheimer’s disease. So this is going to be a substantial health issue for this country unless something can be developed,” Lovell said. “My biggest hope is that something we work on may some day be beneficial to patients.”

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Interview with Mark Lovell-ImPACT Founder, Concussion Testing

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• Concussions
• Mark Lovell
• League of Denial
• Pittsburgh Steelers

Mark Lovell PhD is an internationally recognized concussion expert for his development of neurocognitive testing programs and groundbreaking research.  His experience with concussions began first-hand with a car accident in high school and an undiagnosed concussion. After graduating from Northern Michigan University with a B.S. in psychology/biology, he earned a Ph.D. in neuropsychology from the Chicago Medical School. Lovell is founder of ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing).

Developed in the early 1990's by Dr. Mark Lovell and Dr. Joseph Maroon, ImPACT has become a standard tool used in clinical management of concussions for athletes. Dr. Maroon, the Pittsburgh Steelers' neurosurgeon, sought with Lovell to devise a test that could be used to establish baseline data for the Steelers.  Maroon wanted a test to assess brain function after a concussion. Existing neuropsyche exams took hours to complete, but the new pencil/paper test took only 20 minutes to administer. Known at the time as the Pittsburgh Steelers Battery Test, in 1993 Maroon and Lovell baseline tested 27 Pittsburgh Steelers.  With ongoing research to evolve and refine the test and software development to computerize it, ImPACT Applications, Inc. was co-founded by Mark Lovell, Joseph Maroon and Michael Collins in 2002.

Dr. Lovell developed the first league wide neuropsychological testing programs for the NFL and the NHL. Dr. Lovell remains a neuropsychological consultant for several organizations througout the world including, but not limited to, the NFL Players Association, NHL, Irish Rugby, USA Women's Olympic Hockey team, the WWE and the US Ski and Snowboard team.

From 2000-2011 Lovell was founding director of the University of Pittsburgh Medical Center's Sports Medicine Concussion Program. He currently serves as Chairman and Chief Scientific Officer for Impact Applications, Inc. in Pittsburgh, Pennsylvania.

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Mark A. Lovell, PhD

• Professor & Chair, Department of Chemistry

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• Sanders-Brown Center on Aging

Increasing evidence suggests alterations in zinc (Zn) homeostasis may contribute to neurodegeneration observed in the pathogenesis of Alzheimer’s disease (AD). Current studies from our laboratory show there are significant alterations in proteins responsible for the transport and sequestration of Zn (ZnT proteins) that occur early in the progression of AD. Our data also suggest that alterations of ZnT proteins and the corresponding disruption of Zn balance can contribute to increased oxidative damage in AD. Our current research centers around the use of Western blot analysis, immunohistochemistry/laser confocal microscopy and genetic manipulation of neuronal cell lines to study alterations of ZnT proteins. We also use GC-MS, HPLC, cell culture techniques and transgenic animals to correlate altered ZnT levels and markers of oxidative damage including oxidized DNA adducts and neurotoxic by-products of lipid peroxidation (4-hydroxynonenal, acrolein). Additional studies include analysis of by-products of RNA oxidation in the progression of AD and evaluation of the biological impact of RNA oxidation using primary rat cortical neuron cultures.

Representative composite of cells from a subject with mild cognitive impairment (MCI) double labeled for ZnT-6 (A; green) and MC-1 (B; red), a marker of early neurofibrillary tangle formation. Figure C is a merged image. Note considerable overlap between ZnT-6 and MC-1 immunostaining. Scale bar = 50 µm.

Visit the Alzheimer's Disease Research Center .

Journal Articles

• M.A. Bradley-Whitman and M.A. Lovell* , Mass spectrometry and studies of nucleic        acid oxidation in neurodegenerative diseases”, ( Invited Review) , J. Anal. Bioanal. Chem ,    In press, (2013).
• M. A. Bradley-Whitman, M. D. Timmons, T. L. Beckett, M. P. Murphy, B. C. Lynn, and M.A. Lovell* “Nucleic acid oxidation: an early feature of Alzheimer’s disease” J. Neurochem ., In press, (2013).
• M.D. Timmons, M.A. Bradley, M.A. Lovell and B.C. Lynn, “Changes in the mitochondrial lipidome in the progression of Alzheimer’s disease”, J. Lipid Res . In press,   (2013).
• M.A. Bradley and M.A. Lovell* “Epigenetic changes in the brain in the progression of Alzheimer’s disease”, Invited article , Mech. Ageing Dev . In press, (2013).  
• M.A. Lovell*, M.A. Bradley and S.X. Fister, “4-Hydroxyhexenal (HHE) impairs glutamate transport in astrocyte cultures”, J. Alzheimer’s Dis . Epub ahead of print (2012).
• F.A. Schmitt, P.T. Nelson, E. Abner, S. Shceff, G.A. Jicha, C. Smith, G. Cooper, M. Mendiondo, D. D. Danner, L.J. Van Eldik, A. Caban-Holt, M.A. Lovell , and R.J. Kryscio, “University of Kentucky Sanders-Brown Healthy Brain Aging Volunteers:  Donor charachteristics, procedures and neuropathology”, Curr. Alzheimer’s Res . 9:724-733, (2012). 
• G. Lyubartseva and M.A. Lovell* , “A potential role for zinc alterations in the pathogenesis of Alzheimer’s disease” Invited Review, Biofactors , 38:98-106, (2012).
• A.M. Weidner, M.A. Bradley, T.L. Beckett, D.M. Niedowicz, A.L. Dowling, S.V. Matveev, H. Levine III, M.A. Lovell * and M.P. Murphy*, “RNA oxidation adducts 8-OHG change with Aß42 levels in late-stage Alzheimer’s disease”, PLoS One , 6:e24930, (2011). 
• M.D. Timmons, M.A. Bradley, M.A. Lovell and B.C. Lynn, “Procedure for the isolation of mitochondria, cytosolic and nuclear material from a single piece of neurological tissue for high-throughput mass spectral analysis”, J. Neurosci. Methods 197:279-282, (2011).  
•   M.A. Lovell,* S. Soman and M.A. Bradley, “Increased DNA and RNA oxidation in Preclinical Alzheimer’s disease (PCAD) brain”, Mech. Aging and Dev ., Invited article , Mech. Ageing Dev . 132:443-448, (2011).
• M.A. Bradley, S. Xiong, W. R. Markesbery and M.A. Lovell* , “Elevated 4-hydroxyhexenal in Alzheimer’s Disease (AD) Progression”, Neurobiol. Aging , [Epub ahead of print], (2010). 
• M.A. Bradley, S. Xiong, W.R. Markesbery and M.A. Lovell* , “Increased levels of 4-hydroxynonenal and acrolein in the brain in preclinical Alzheimer’s disease (PCAD)”, Free Radic. Biol. Med ., 48:1570-1576, (2010). 
• B.C. Lynn, J. Wang, W.R. Markesbery and M.A. Lovell , “Quantitative Changes in the Mitochondrial Proteome from Subjects with Mild Cognitive Impairment, Early Stage, and Late-Stage Alzheimer’s Disease”, J. Alzheimer’s Dis.  19:325-339, (2010).
• G. Lyubartseva, J.L. Smith, W.R. Markesbery and M.A. Lovell* , “Alterations of Zinc Transporter Proteins ZnT-1, ZnT-4 and ZnT-6 in Preclinical Alzheimer’s Disease Brain”,  Brain Pathol ., 20:343-350, (2010).  
• M.A. Lovell* , S. Xiong, G. Lyubartseva and W.R. Markesbery, “Organoselenium (Sel-Plex Diet) Decreases Amyloid Burden and RNA and DNA Oxidative Damage in APP/PS1 Mice”, Free Radic. Biol. Med. , 46: 1527-1533, (2009).
• Y.J. Fu, M.A. Lovell and B.C. Lynn, “Quantitative Proteomic Analysis of Mitochondria in Aging PS-1 Transgenic Mice”, Cell. Mol. Neurobiol. , 29 :649-664, (2009).
• M.A. Lovell*, “A Potential Role for Alterations of Zinc and Zinc Transport Proteins in the Progression of Alzheimer’s Disease”, ( Invited Review ) J. Alzheimer’s Disease, 16 :471-483, (2009).     
• C.D. Smith, H. Chebrolu, A.H. Andersen, D.A. Powell, M.A. Lovell , S. Xiong, and B.T. Gold, “White Matter Diffusion Alterations in Normal Women at Risk of Alzheimer’s Disease”, Neurobiol. Aging , 31:122-131 (2010)  [Epub ahead of print; doi:10.1016/jneurobiolaging.2008.08.006], (2008). 
• C. X. Shao, J. Wang, W. R. Markesbery and M. A. Lovell*, “Decreased Ogg1 Based Excision Repair in Amnestic Mild Cognitive Impairment”, Free Radic. Biol. Med. 45:813-819, (2008).
• J.A. Sonnen, J.C. Breitner, M.A. Lovell, W.R. Markesbery, J.F. Quinn and T.J. Montine, “Free Radical-Mediated Damage to Brain in Alzheimer’s Disease and its Transgenic Mouse Models”, ( Invited Review ) Free Radic. Biol. Med. 45 :219-230, (2008).
• M. A. Lovell*, B. C. Lynn, S. Xiong, J. F. Quinn, J. Kaye and W. R. Markesbery, “An Aberrant Protein Complex as a Biomarker of Alzheimer’s Disease”, Neurology , 70 :2212-2218, (2008).
• M. A. Lovell * and W. R. Markesbery, “Oxidative Modification of RNA in Mild Cognitive Impairment”, Neurobiol. Dis ., 29 :169-175, (2008).
• M. A. Lovell * and W. R. Markesbery, “Oxidative DNA damage in mild cognitive impairment and late-stage Alzheimer’s disease”, (Invited Review) Nucleic Acids Res ., 35 :7497-9504, (2007).

Book Chapters

•   M.A. Lovell *, “Zinc transporters in the Progression of Alzheimer’s Disease”, In:  Membrane Transporters in Drug Discovery and Development:  Methods and Protocols , (Methods in Molecular Biology Series), Q. Yan, Ed., 2010.
• J. D. Robertson and M. A. Lovell , "Applications of Radioanalytical Chemistry to Alzheimer's Disease," In: Radioanalytical Methods in Interdisciplinary Research, C. A. Laue and K. L. Nash, Eds., 2004, pp. 298-306.
• M. A. Lovell and W. R. Markesbery, "Analysis of Aldehydic Markers of Lipid Peroxidation in Biological Tissues by High-Pressure Liquid Chromatography with Fluorescence Detection," In: Methods in Biological Oxidative Stress, K. Hensley, Ed., 2003, pp. 17-21.
• W. R. Markesbery, T. J. Montine and M. A. Lovell , "Oxidative Alteration in Neurodegenerative Diseases," In: The Pathogenesis of Neurodegenerative Disorders, M. P. Mattson, Ed., Humana Press, 2001, pp. 21-51.
• M. A. Lovell , W. D. Ehmann, W. R. Markesbery, S. Melethil, C. R. Swyt and P. F. Zatta, "Standardization in Biological Analyses of Aluminum: What are the Needs?" In: Research Issues in Aluminum Toxicity, R. A. Yokel and M. S. Golub, Eds., Taylor and Francis, 1997.

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Mark Lovell, Ph.D.

• Professor , Chemistry
• Chair, Department of Chemistry , Chemistry
• Neuroscience Research Priority Area
• Sanders-Brown Center on Aging (SBCoA)
• Jack and Linda Gill Arts and Sciences Research Excellence Fund Professorships , College of Arts and Sciences
• 14659 Citations

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In 2015, UN member states agreed to 17 global Sustainable Development Goals (SDGs) to end poverty, protect the planet and ensure prosperity for all. This person’s work contributes towards the following SDG(s):

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Doctor of Philosophy, University Of Kentucky

Bachelor of Arts, Berea College

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• Alzheimer's Disease Neuroscience 100%
• Brain Neuroscience 39%
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KSCHIRT: Investigating the Efficacy of BNC-1 in Alleviating Tau Pathology in TBI

Lovell, M. & Bachstetter, A.

KY Spinal Cord and Head Injury Research Trust

2/1/24 → 1/31/27

Project : Research project

• Neurotrauma 100%
• Traumatic Brain Injury 100%
• Hyperphosphorylation 75%
• Neurodegeneration 25%

Mark Lovell Scope: State Matching: Kentucky Network for Innovation & Commercialization (#KYNETIC#) Yr 5

Lovell, M. , Dwoskin, L. & Prisinzano, T.

KY Economic Development Cab

7/1/22 → 6/30/24

• Alzheimer's Disease 100%
• Molecule 100%
• Phosphotransferase 80%

State Matching: Kentucky Network for Innovation & Commercialization (#KYNETIC#) Yr 5

Dwoskin, L. , Arnold, S. , Bondada, S. , Lovell, M. , Prisinzano, T. , Richards, C. , Ueland, F. & Venditto, V.

• Commercialization 100%
• Universities 100%
• Matching 100%
• Innovation 100%

STTR [Phase I]: Commercialization of a Rapid Blood Test for Traumatic Brain Injury

Fawkes Biotechnology LLC

4/1/18 → 1/31/20

Validation of a Point of Care Diagnostic Test for Sports Related Concussion

Lovell, M. , Abner, E. , Hosey, R. , Smoot, M. & West, K.

National Institute of Neurological Disorders & Stroke

12/1/17 → 11/30/21

• Concussion 100%
• Diagnostic Test 100%
• Synapsin I 60%
• Visinin 60%

Research output

• 7 Review article
• 1 Editorial
• 1 Short survey

Research output per year

Preliminary Evaluation of a Novel Point of Care Diagnostic Device for Sports-Related Concussion

Research output : Contribution to journal › Article › peer-review

• Diagnostic Equipment 100%
• Evaluation 100%
• Diagnosis 100%
• Synapsin I 100%

A novel method for the rapid detection of post-translationally modified visinin-like protein 1 in rat models of brain injury

• Rat Model 100%
• Brain Injury 100%
• Visinin 100%

Association of antioxidant supplement use and dementia in the prevention of Alzheimer's disease by Vitamin E and selenium trial (PREADViSE)

• Dementia 100%
• Antioxidant 100%
• Association 100%
• Alpha Tocopherol 100%

Calcineurin/NFAT signaling in activated astrocytes drives network hyperexcitability in Aβ-bearing mice

• Calcineurin 100%
• Astrocyte 100%

Multiregional analysis of global 5-methylcytosine and 5-hydroxymethylcytosine throughout the progression of Alzheimer's disease

• 5-Hydroxymethylcytosine 100%
• 5-Methylcytosine 100%
• 5 Methylcytosine 100%
• 5 Hydroxymethylcytosine 100%

University Research Professor

Lovell, Mark (Recipient), 2013

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Mark Lovell PhD, FACPN, D.Sci Chairman and CEO Software Developer ImPACT Applications, Inc. Management of Sports Concussion and The ImPACT® Program.

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Presentation on theme: "Mark Lovell PhD, FACPN, D.Sci Chairman and CEO Software Developer ImPACT Applications, Inc. Management of Sports Concussion and The ImPACT® Program."— Presentation transcript:

Quantify the head injuries with a highly sensitive measure of brain function. Protect the student athlete Help determine safe return to play. Help prevent.

Sports-related concussion in children and adolescents.

Tim Lee, MHA, MS, ATC Coordinator, VSCC Concussion Baseline Testing.

“Too soon or too late” Pivotal role of neurocognitive testing in safe return-to-play decisions Presented by Dr.Victoria Alexander Ph.D.

SPORTS-RELATED CONCUSSION MANAGEMENT. Recognizing that concussions are a common problem in sports and have the potential for serious complications if.

Concussion Evaluation: On the Sideline Jennifer E Sanders, MD Pediatric Emergency Medicine Fellow Icahn School of Medicine at Mount Sinai Department of.

Concussions: From the Field to the Classroom Robert Jones, M.D. Medical Director UNC Charlotte Student Health Center.

Concussion Cases Kellie Bartlow, DO UMKC Sports Medicine Fellow.

Chris Hummel, MS, ATC Clinical Assistant Professor/Athletic Trainer Ithaca College Department of Exercise and Sport Sciences.

Ghs.org ADHD and the Concussed Athlete S. David Blake, MD Fellow Department of Developmental-Behavioral Pediatrics Children’s Hospital Greenville Hospital.

CONCUSSIONS: How do we help the concussed student get back to activities of daily living? Caroll Craig RN, BSN, CSN November 2011.

 A traumatically induced alteration in mental status not necessarily with a loss of consciousness ◦ A change in your brain’s ability to function normally.

Mild Traumatic Brain Injuries Stephanie T. Leive, ATC Certified Athletic Trainer UPMC Sports Medicine Winchester Thurston School.

Sports-Related Concussion George C. Phillips, MD, FAAP, CAQSM Clinical Associate Professor of Pediatrics Sports Medicine Rounds October 16, 2008.

Head Injury Treatment Sports Medicine. BELLWORK  Remember the head injury you started the Unit with.  What was the treatment you received?  Did you.

Concussion Education. Tragedy opens the door for education, increased awareness, and law In North Carolina… –Gfeller-Waller Law passed in June 2011 Three.

Craig Gross A.T.C., L.A.T. North High School’s Athletic Trainer NORTH HIGH SCHOOL SPORTS MEDICINE INFORMATIONAL PRESENTATION.

Concussion Management Protocol Purpose: The purpose of this policy is to establish a protocol for defining concussions, recognizing symptoms of concussions,

Concussions and Concussion Management

Sport Medicine Centre Dr. Victor Lun, MD, CCFP, Dip Sport Med Concussions in Sport.

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Mark Lovell

I am a Delta-ITP postdoctoral fellow at the Universiteit van Amsterdam (UvA), working with Gianfranco Bertone (UvA) and Alexey Boyarsky (Leiden). I completed by PhD in 2013 at the Institute for Computational Cosmology, Durham University, UK, under the supervision of Adrian Jenkins, Carlos Frenk, and Vince Eke.

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Watch CBS News

Never-before-seen photos and details about the man accused of murdering four Idaho college students

By Peter Van Sant

January 7, 2023 / 11:02 PM EST / CBS News

Under a dark Idaho sky, investigators flew Bryan Kohberger to the college town of Moscow. Police delivered him to the Latah County Jail. On Jan. 5, in an orange jumpsuit, his face vacant, the 28-year-old made what will likely be his first of many appearances in this court.  

He stands charged with the murder of four students from the University of Idaho: Kaylee Goncalves, Madison "Maddie" Mogen, Ethan Chapin and Xana Kernodle. Investigators say he stabbed them to death in the home the women shared. 

JUDGE: The maximum penalty for this offense, if you plead guilty or be found guilty is up to  death and imprisonment for life. Do you understand?  

BRYAN KOHBERGER: Yes.  

Kohberger has not yet entered a plea.

In an affidavit , investigators laid out their understanding of the grim details about the night of the killings:  They say the killer left his DNA on a "leather knife sheath" found on a bed next to Maddie Mogen. And, most hauntingly, they say a surviving roommate thought she heard crying and "saw a figure clad in black clothing and a mask."    

The man walked past, as she stood in "frozen shock."  She locked herself in her room.  

The investigation is fast-moving. Authorities have not disclosed a motive or if he had a connection to the students, but we are learning more about just who Bryan Kohberger is.   

WHO IS ACCUSED KILLER BRYAN KOHBERGER?

Just 15 days before his arrest, Bryan Kohberger and his father were driving home from Washington State University for winter break to the family's home in Pennsylvania.

OFFICER (body cam video): Hello MICHAEL KOHBERGER: How you doing? OFFICER: How ya'll doin today?

The journey interrupted by two traffic stops, almost 10 minutes apart, in Indiana for tailgating.

MICHAEL KOHBERGER (to officer): We're gonna be going to Pennsylvania, a couple more miles. OFFICER: Oh, OK. MICHAEL KOHBERGER: …to the Pocono Mountains. We're a little, we're slightly punchy. We've been driving for hours. 

Police body cam video shows Kohberger and his father talking calmly with an officer about the trip.

OFFICER: Hours? And days? BRYAN KOHBERGER: Hours. MICHAEL KOHBERGER: Hours. Well, we've been driving for almost a day. OFFICER: Do me a favor and don't follow too close, OK?  

Then they are released with a warning.

Kohberger had been at the university since August, studying to get his Ph.D. in criminology. He was also a teaching assistant in the Department of Criminal Justice. He lived in an apartment complex on campus and had an office there.

According to the newly released affidavit, Kohberger had applied for an internship with the Pullman Police Department in the fall. He wrote in his application essay that "he had interest in assisting rural law enforcement agencies with how to better collect and analyze technological data."

Benjamin Roberts took four classes with Kohberger.

Benjamin Roberts : He seemed very comfortable around other people. He was very quick to offer his opinion and thoughts. And he was always participating fairly eagerly in classroom discussions.

He says Kohberger appeared highly intelligent.

Peter Van Sant : Does anything else come to mind that Bryan said to you in the past that today you think might be of interest?

Benjamin Roberts : There was a comment that he made, and it was kind of a flippant guy talk thing. At one point, he just idly mentioned, you know, "I can go down to a bar or a club and pretty much have any lady I want."

Kohberger arrived at the university after earning his bachelor's in psychology and master's degree in criminal justice at DeSales University in Center Valley, Pennsylvania.  

While at DeSales, authorities say Bryan Kohberger posted this survey, approved by the university, on the website Reddit asking ex-cons about the crimes they committed. One question he asked: "Before making your move, how did you approach the victim or target?

James Gagliano : This could be a piece of circumstantial evidence.

James Gagliano is a retired FBI Supervisory Special Agent and CBS News consultant.

James Gagliano: The fact that the suspect was interested in pursuing a Ph.D. in criminal justice and was especially interested in … the mental state that people who had committed murders in the past … yes, it could be interesting to note. But I know a lot of researchers that study those things, too, that would never commit a quadruple homicide.

And if Kohberger was involved in these murders, genetic genealogist CeCe Moore questions why he would be so careless as to allegedly leave his DNA at the crime scene. 

CeCe Moore : People are talking about how smart he supposedly is. And I just can't see how that could be true, because any student of forensic science or criminology would have to know that it's virtually impossible not to leave your DNA behind at a very violent, intimate crime scene like this.

CeCe Moore : You know, Ted Bundy thought he was smart. But he wasn't that smart, as it turns out.

After the murders, Roberts says Kohberger appeared disheveled, tired and chattier than usual.

But nothing could prepare Roberts for what he learned o f Kohberger's arrest.

Benjamin Roberts : Looking back over the last four months, I feel like there should have been signs that I should have seen. And I didn't ... I was blindsided.

Jason LaBar : This is out of character for Bryan, these allegations.

Monroe County public defender Jason LaBar represented Kohberger before he was extradited to Idaho.

Jason LaBar : The family would want the general public to know that Bryan is a caring son and brother —that's he's responsible, that he is devoted to them.

In a statement the family said, "we care deeply for the for the four families who have lost their precious children" ... and that they "seek the truth and promote his presumption of innocence rather than judge unknown facts and make erroneous assumptions."

Jason LaBar : He is innocent until proven otherwise.

LaBar says Kohberger came from a close-knit family. He grew up in eastern Pennsylvania in the Pocono Mountains. His father was as a maintenance worker and his mom worked in the school system. Bryan has two older sisters – one who works as a family therapist, and another sister who appeared in a 2011 low budget slasher film, "Two Days Back," about a group of young students viciously murdered by a serial killer. She now works as a school counselor. 

Bree : My heart goes out to Bryan's family.

Kohberger's friend, Bree, says she met Bryan at a party when they attended Pleasant Valley High School. She asked "48 Hours" not to use her last name.

Bree : Bryan was really funny. He wasn't outgoing at all. But he also wasn't shy.

She says they bonded over their love of the outdoors.

Bree : I don't necessarily remember the conversations, but you definitely remember how someone makes you feel. … I just remember feeling OK — I was just with a friend. … Just felt natural.

Bree recalls Kohberger was an average student with only a few close friends. In a yearbook photo, Kohberger's caption said he aspired to be an Army Ranger.

Casey Artnz also knew Kohberger from high school . She posted this Tik Tok following Bryan's arrest.

CASEY ARNTZ TIK TOK: "I used to be friends with Bryan Kohberger" ... "I'm in actual shock right now."

Casey Arntz : He was an overweight kid. … So, he did get bullied a lot.

But Arntz says people saw a change in Kohberger the beginning of senior year.

Casey Arntz : He lost like 100 pounds . … He was a rail. … It was after that weight loss that a lot of people noticed a huge switch in him.

Casey Arntz : My brother has since come out to say that even though they were friends, Bryan bullied him.

Casey Arntz : He had said that he would put him in like a chokeholds and stuff like that.

Bree says Kohberger started using heroin, which ended their friendship.

Bree : You just saw him becoming more self-destructive. … He really stayed secluded.

It's unclear when exactly Kohberger went into recovery, but both Bree and Casey say years after he graduated high school it appeared as if he was getting his life together. He was going to Northampton Community College and working security for Pleasant Valley School District.

Bree : He was telling me that he wanted to get sober, that he was getting sober. … And he wanted to let me know like, "I'm gonna do better. I'm gonna be better."

Bree : I'm sorry ... (emotional)

 Casey Arntz : The last time I saw Bryan was in 2017 at one of my friend's wedding. … And I gave him a hug and I said, "You look so good. Like I'm so proud of you."

And both Bree and Casey say it appeared that Kohberger had a new focus — his studies in criminology.

Bree : He wanted to do something that impacted people in a good way.

Bree: People were not his strong suit. And think through his criminology studies, he was really trying to understand humans and to try and understand himself.

Now Bree, like many who knew him, struggles to connect the person they once knew to this unspeakable crime.

Bree : I think a lot of people who were close to him are feeling this massive amount of guilt … "Why didn't I see it? Did I miss something? … Where did it go wrong?

THE YOUNG LIVES LOST

Before it was a crime scene, it was a home to five close friends. Maybe none closer than Maddie Mogen and Kaylee Goncalves.

On TikTok, the 21-year-old seniors looked like they were enjoying their final school year.

In the early morning of November 13, the two friends headed to a food truck. But their seemingly carefree existence would come to an abrupt end just hours later. Kaylee and Maddie were stabbed to death in the upstairs part of the house. A hundred miles away in northern Idaho, Kaylee's father Steve got the news.

Peter Van Sant : Steve, give us a sense of the shock of that moment.

Steve Goncalves : You just feel like you're getting crushed by a thousand pounds of weight.

Peter Van Sant : What do you want the world to know about your daughter, Kaylee?

Steve Goncalves : I want the world to know, they — they got robbed. Somebody stole from you.

Steve Goncalves says his daughter Kaylee would have made the world a better place. A general studies major, she was the middle child of five siblings. Goncalves says Kaylee was always up for a challenge.

Steve Goncalves : She grew up around two boys that were, you know, older than her. And uh, she didn't see any reason why she couldn't be as quick and fast and as good as those two boys were.

Peter Van Sant : What did she want to do with her life?

Steve Goncalves : Like most young people, it changed. She was gonna be a teacher. … But once she found out how long it was gonna take to pay back her student loans, she — she said, "Dad, you know, this thing that you do with computers seems to work pretty well."

She reportedly had a job lined up in Austin but made it clear that one day she hoped to settle down somewhere near her dearest friend Maddie Mogen.  Maddie was a marketing major, and she and Kaylee had been inseparable since the sixth grade.

Steve Goncalves : I just felt like it was more of a sistership than it was a friendship ... And she was just one of our kids.

So, it perhaps did not come as a surprise when Steve revealed at a November memorial that Kaylee and Maddie died side-by-side.

STEVE GONCALVES (memorial service): They went to high school together. … They came here together. … And in the end, they died together. In the same room, in the same bed. It comforts us. It lets us know that they were with their best friends in the whole world.

It was a belief Maddie's stepfather, Scott Laramie, repeated to another packed memorial just days later.

SCOTT LARAMIE (memorial service): The two of 'em were a force to be reckoned with. They stuck together through everything.

Maddie had a boyfriend, Jake Schriger.

JAKE SCHRIGER (memorial service): She was the first person I talked to every morning and the last person I talked to before bed.

They had been together for more than a year. Schriger says Maddie had a talent for making people laugh.

JAKE SCHRIGER (memorial service): She was really funny. Her jokes really would come outta nowhere … And just be like, "Is that the — the cute little blonde girl that just said that?"

But Maddie and Kaylee weren't the only victims.  While two other roommates were in their rooms and unharmed during the attacks, on the second floor, the killer made his way to the room of Xana Kernodle.

JAZZMIN KERNODLE (memorial service): She was my baby sister, but she was so much wiser.

Xana's sister, Jazzmin.

JAZZMIN KERNODLE (memorial service): She would always tell me she wouldn't know what to do without me. And now I have to live this life without her.

A 20-year-old junior majoring in marketing, Xana was known for being focused on her studies. So focused, she didn't make much time for dating.

JAZZMIN KERNODLE (memorial service): Xana never had a boyfriend before, and my dad and I wondered if she was ever gonna get one (laughs).

That was until she met Ethan Chapin.

JAZZMIN KERNODLE (memorial service): The way she would talk and smile about him was something I've never seen her do before.

Ethan was a 20-year-old majoring in recreation and tourism management. Jazzmin says Xana and Ethan began dating in the spring of 2022.

JAZZMIN KERNODLE (memorial service): They had something so special and everyone around them knew.

Especially anyone who followed the pair on Instagram. For Ethan's birthday, Xana posted photos of them with the caption: "Life is so much better with you in it, love you!" It would be her last Instagram post. Just two weeks later, the young couple was found stabbed to death in Xana's bedroom.

At the University of Idaho, the pain of this tragedy is felt at the root and extends hundreds of miles away to a tulip farm in Skagit Valley, Washington. It's where Ethan worked before heading to college. His boss, Andrew Miller.

Andrew Miller : So, Ethan started – it was in the spring of — of '21. … It was the best Tulip Festival.

Miller says the annual tulip festival attracts close to half-a-million visitors, and Ethan stood out in the crowd.

Andrew Miller : Well, he's a big guy wearin' a big smile, right? I think that's the part that I – that kinda struck me right away.

Ethan – a triplet – worked there with his siblings, Maizie and Hunter, and lived in a rented house on the farm with their parents. The Chapin triplets were incredibly close says Reese Gardner.

Reese Gardner :  They were best friends. … If one did something, they all did something. … It was pretty cool to see.

Including attending the University of Idaho together.

Andrew Miller : And that was the funniest thing, it was like, of course it was a package deal. Like, all three of 'em were gonna go there.

Ariah Macagba : He was excited, I think, 'cause his siblings were going with him.

Ariah Macagba says Ethan's parents had decided to live in Idaho, too. Macagba says when she heard Ethan had been murdered, she couldn't believe it.  

Ariah Macagba : I think the first thing I did was message Ethan. I was like, "Hey, you're OK, right? Like, this isn't real." (crying) And — obviously, he didn't respond.

Reese Gardner scoured the internet for information.

Reese Gardner : And I just couldn't stop reading articles and … I just wanted to know what happened, and I wanted to know why.

But in lieu of answers, Gardner turned to tulips. He had an idea: name one after Ethan.

Reese Gardner : I thought, "There's — there's no better way … to remember someone who had such a big part, a big role in those farms."

Andrew Miller : Cause Reese called me … And it was, "Hey, can this be done, and are you interested in doing it?" And I was, "Yes, and hell yes."

But creating a new tulip is a long process, so instead, Miller suggested a mix of tulips that would be a perfect tribute to Ethan: yellow and white.

Andrew Miller : Yellow, of course, because Go Vandals. University of Idaho, right? That's significant. And then white is — is an eternal color, right? And tulips come up in the spring. It is a symbol of — of hope.

With his parents' blessing, they named the mix of tulips, "Ethan's Smile."

Andrew Miller : So, this will be a nice yellow or white tulip here in about four months.

The trio planted thousands of bulbs in the state of Washington and sent a couple thousand more to the University of Idaho.

Andrew Miller : And it really is our hope that we'll be able to continue to plant and that anybody that wants to remember him will be able to have their own Ethan's — Ethan's Smile Garden. …  It's a living legacy.

Now it is up to prosecutors to get justice for these young victims .

IN SEARCH OF ANSWERS

Forty-seven days after the murders of Kaylee Goncalves, Ethan Chapin, Madison Mogen, and Xana Kernodle, authorities apprehended the man they believed was responsible.  We now know investigators had Bryan Kohberger in their sights early on but kept it close to the vest. So, in the early days, after the Nov. 13 murders, frustration swept over Moscow, Idaho.

James Gagliano : I think in this instance people were expecting a pretty quick arrest in this case, and it takes time.

Steve Goncalves, father of 21-year-old Kaylee, was trying as best he could to deal with news no one expects.

Steve Goncalves : Most things I'm prepared for. Most things as a dad, you can— you can handle. But somethin' like that, you just can't prepare for and you can't fix it.

Steve Goncalves : And, you know, just think if you do everything right, by the book, somethin' like this couldn't happen.

Peter Van Sant : Did you have any sense who might have done something like this?

Steve Goncalves : No … I didn't think anybody in her inner circles was — was capable of interacting and — and her doing something that could even deserve something like that.

As news spread of the murders, so did shock in the college community, which had not seen a homicide since 2015.

Matt Loveless : Parents drove hundreds of miles to pick up their kids to head home and stay home for the semester.

Matt Loveless is a journalism professor at nearby Washington State University.

Matt Loveless : At this point, we don't know if they're gonna come back for — the spring semester there on campus. And that same thing happened in both our communities.

James Gagliano: And, so, when parents send their kids off to school, for something to happen like this, I think it's a parent's worst nightmare

James Gagliano : And it's a place, Moscow, Idaho, where violent crime really is not an issue.

As police started their investigation, they traced the victims' final steps. The day before the murders seemed to start ordinarily. Kaylee Goncalves posted photos with her roommates and Ethan Chapin, to her Instagram account with the caption, "One lucky girl to be surrounded by these ppl everyday." That evening, Ethan and Xana attended a party at a fraternity house on campus.  Kaylee and Madison were at a bar between 10 p.m. and 1:30 a.m. They were then seen at a local food vendor, the "Grub Truck."  It is believed they all returned home by about 2 a.m. on Nov. 13.

James Gagliano : So, in examining the timeline , police know that the crime took place sometime in the early morning hours. There were also two other University of Idaho students who were inside the house when the murders took place.

It was later that morning that a call was made to 911 from one of the surviving roommate's phones to report an unconscious person.  Police arrived at the house at 11:58 a.m.

James Gagliano : Police find the victims on the second and third floor of the house in bedrooms — a horrific and a very large-scale crime scene 'cause you're gonna be dealing with a number of different floors that need to be processed, the bedrooms where the crimes actually occurred, and then ingress and egress points. How did the — how did the alleged killer get inside the house? Through a front door? Through a window? Those are all things police will be looking at.

CHIEF JAMES FRY (to reporters): No weapon has been located at this time. There was no sign of forced entry into the residence.

On Nov. 16, three days after the murders, the Moscow Police held their first press conference.

CHIEF JAMES FRY (to reporters): We believe this was an isolated, targeted attack on our victims. We do not have a suspect at this time and that individual is still out there.

Coroner Cathy Mabbutt issued her report on Nov. 17.

Coroner Cathy Mabbutt: They were all murdered through stabbing with some kind of a, probably a larger knife…

She told police some of the four victims had defensive wounds, but none had signs of sexual assault.  Police continued to work the case, aided by the Idaho State Police and the FBI.

James Gagliano : I just believe that the Moscow Police Department probably just didn't have a lot of experience in working a homicide, especially one as heinous as this one.  

After about three weeks with no arrests, and what, to the public, appeared to be no real suspects, Steve Goncalves grew more concerned that authorities weren't doing enough and that the murders would turn into a cold case. So, he says, he started working with his own team to investigate the murders.

Steve Goncalves : So, we just thought, "This is the time. Let's get it out there, and let's not let it get cold. Let's get as many resources as— as possible."

Peter Van Sant : And did you have any sense whatsoever as to what a motive … might have been for these murders?

Steve Goncalves : Pretty girls and a handsome guy. I thought, you know, that might be somethin' to do with their, you know, stalking them in the sense of that.

Meanwhile, names of possible people of interest were trickling out — including members of the community and acquaintances of the victims. But they all seemed to be part of an unfounded rumor mill, many from online sleuths.  Goncalves even had people come to him to prove they were not involved.

Steve Goncalves : We — had certain suspects take their shirts off in our kitchen to show if they had scratches. And we tried to do everything in — in our powers to make sure that if we thought somebody was ruled out, we truly — we truly felt like, you know, we — we looked at 'em.

Law enforcement would end up receiving thousands of tips, but the investigation, by outward appearances, seemed to be stalled.  Nearly a month after the murders, on Dec. 7, police were seen packing up the victims' belongings to return to the families, who had lost so much. It was the police chief behind the wheel of the U-Haul truck. That same day, a plea was made to the public.

Police were interested in speaking with the occupant(s) of a white 2011-2013 Hyundai Elantra with an unknown license plate, spotted near the crime scene, around the time of the killings.

AMANDA ROLEY | KREM REPORTER: Today's update is the first descriptive tip that we have received in several days. Detectives now want to speak with anyone who was inside a white Hyundai Elantra that was near this home on King Road around Nov. 13th.  

Police released photos of similar makes to the vehicle they were looking for.

CHIEF JAMES FRY (to reporters): We still believe there is more information to be gathered.

James Gagliano : Pushing that out to the media. Pushing that out to people on the internet. Pushing that out so that people can look for either a potential suspect, person of interest, or a potential vehicle. That goes a long way towards running down leads.

INSIDE THE INVESTIGATION

It turns out that about two weeks before the police asked the public to be on the lookout for a white Hyundai Elantra , they had already shared that information with surrounding law enforcement. And on Nov. 29, 2022, a white Elantra was located by Washington State University Police. The car was registered to Bryan Kohberger.

CBS News learned, that in mid-December, the Hyundai Elantra was tracked for several days by the FBI, using E-ZPass monitoring, fixed wing aircraft and ground support, as it was driven by Kohberger, along with his father, from Pullman, Washington, on that cross-country trip to the family's home in Pennsylvania.

On Dec. 15, the car was stopped twice in Indiana for those driving violations, by the Indiana State Police and the Hancock Sheriff's Office.

OFFICER: So, you're coming from Washington State University? MICHAEL KOHBERGER: Yeah. BRYAN KOHBERGER: Yup OFFICER: And you're going where? MICHAEL KOHBERGER: We're gonna be going to Pennsylvania.

Both agencies said at the time of the stops, "there was no information available on a suspect for the crime in Idaho, to include identifying information or any specific information related to the license plate state or number of the white Hyundai Elantra …" 

Police did not ticket Kohberger; they gave a verbal warning and the trip continued home. And then, Kohberger's holiday came to an abrupt halt . 

CBS NEWS REPORT:  A suspect is under arrest for the quadruple murder of four Idaho college students.

On Dec. 30, 2022, police made that announcement that Bryan Kohberger was under arrest for the murders. He was arrested at his family's home in Albrightsville, Pa., at 3 a.m., with approximately 50 law enforcement officers on the scene. 

MAJ. CHRISTOPHER PARIS | PENNSYLVANIA STATE POLICE: There were multiple windows that were broken I believe to gain access, as well as multiple doors.

Authorities believe Bryan Kohberger acted alone.

Jason LaBar : Bryan was very shocked by his arrest. … Bryan did not know why they were there, but he was aware of the case in Idaho.

Monroe County public defender Jason LaBar represented Kohberger in Pennsylvania as he was awaiting extradition to Idaho.

Jason LaBar : Bryan indicated to me that he was eager to be exonerated — that he was willing to go back to Idaho.

On Jan. 3, at a hearing in Pennsylvania, Kohberger signed his waiver of extradition. And on Jan. 4, was flown to Idaho, where he is in jail, charged with the four murders.

On Jan. 5, Kohberger appeared in court in Moscow with his new public defender to hear the charges read against him. He has yet to enter a plea.

JUDGE MEGAN MARSHALL:  The maximum penalty for this offense if you were to plead guilty or be found guilty is death or imprisonment for life. Do you understand?   

BRYAN KOHBERGER: Yes.

That same day, that affidavit was released that laid out startling new details about the murder investigation. According to the affidavit, one of the surviving roommates actually saw the murderer and stood in a "frozen shock phase."  She is referred to as DM in the affidavit, and told police that earlier, she heard a female voice say, 'something to the effect of  "there's someone here." And later, a male voice say, "something to the effect of "it's ok, I'm going to help you." Later she opened her door "… after she heard crying and saw a figure clad in black clothing and a mask..." She described the figure as "5'10'… with bushy eyebrows."

The affidavit states that, according to DM, the male walked toward the back sliding door and DM locked herself in her room. It was later in the morning when that call was made to 911 from one of the surviving roommate's phones, to report an unconscious person. It is unclear what occurred in the hours before police were called. It is believed the murders took place between 4 and 4:25 a.m. Police say they discovered, on the bed in Madison's room, a knife sheath with a Marine insignia.

James Gagliano : I would imagine that a — crime scene as — as grisly and ghastly as this one — that there would have been … DNA left by the perpetrator.

According to the affidavit, the knife sheath was processed and "the Idaho State Lab later located a single source of male DNA on the button snap."  They were able to link it to DNA recovered from the trash at the Pennsylvania Kohberger family home.

It is not clear, what, if any, connection Kohberger had with the victims. However, the affidavit states that by using cellular phone data, police were able to place Kohberger's cell phone near the crime scene "on at least twelve occasions before November 13, 2022. All of those occasions, except for one, occurred in the late evening and early morning hours …"

Even with these new details, many question remain. A newly issued gag order prohibits officials and others involved in the case from speaking about the murders. Also, authorities have sealed a search warrant that was carried out at Kohberger's home in Pullman, Washington.

Jim Gagliano : This is one where you don't want a mistake. You don't want something to happen during this process that's going to give the alleged suspect an opportunity to beat the case.

Now, the case will work its way through the court system as parents, who lost their children, will be looking for answers.

Steve Goncalves : We find the truth, you know. You get the truth, and then that — that'll — that'll be everything.

IN REMEMBRANCE

You can see it in the stunned, silent faces of the kids. Faces that ask "why?" without even speaking. 

Young eyes glisten, bathed in the glow of candlelight at a vigil held for the young lives lost.  A ritual all too familiar across America. The flowers, the prayers, the vows to carry on. In Idaho, they hold on tight to each other and to the memories of those loved and lost.

EMILY (memorial service): Life is so unfair and unpredictable (crying).

For Xana Kernodle's friend Emily, the wound remains raw.

EMILY (memorial service): And it tears me apart knowing I can't hug her. (Crying) So hold those you love closer. Hug them a little tighter and tell 'em you love them. We'll find justice for you, Ethan, Maddie, and Kaylee. We love you all so much.

And for Ashlin, Maddie Mogen's memory is still vibrant.

ASHLIN (memorial service): You truly will live on forever -- not only in my heart, but in the heart of so many people that were impacted by your beautiful smile, your grace, your patience, your open heart, and your craziness.

Hunter Johnson remembers a pal he could rely on — Ethan Chapin.

HUNTER JOHNSON (memorial service): Ethan was always someone you could count on to make you smile and — cheer up your mood. … And I — feel so lucky to have shared so many great memories with him (emotional).

But those who are older perhaps sense that pain that runs this deep, never goes away. Kaylee's father, Steve Goncalves.

Steve Goncalves : You don't heal from somethin' like this. … it's never gonna happen. You're never gonna be healed. You're never gonna get through this. And when they die, part of you dies.

Steve Goncalves : We're tired of all these types of crimes. We're tired of all this stuff. And — we can rally around these terrible tragedies, and … We're hopin' that as a society we come back stronger. And we — we decide to not let this be accepted anymore, you know. That's what I hope for.

Bryan Kohberger's next court appearance is scheduled for Jan. 12.

He will have a chance to enter a plea at a later date.

• Bryan Kohberger

"48 Hours" correspondent Peter Van Sant first joined CBS News in 1984.

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Aug 08, 2014

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Management of Sports Concussion and The ImPACT Program. Jon French, PsyD University of Pittsburgh Medical Center Department of Orthopaedic Surgery Clinical Fellow and Neuropsychologist UPMC Sports Concussion Program. Mark Lovell PhD, FACPN, D.Sci Chairman and CEO Software Developer

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Management of Sports Concussion and The ImPACT Program Jon French, PsyD University of Pittsburgh Medical Center Department of OrthopaedicSurgery Clinical Fellow and Neuropsychologist UPMC Sports Concussion Program Mark Lovell PhD, FACPN, D.Sci Chairman and CEO Software Developer ImPACT Applications, Inc. Micky Collins, PhD University of Pittsburgh Medical Center Department of Orthopaedic Surgery Department of Neurological Surgery Program Director UPMC Sports Concussion Program Co-Founder, ImPACT Applications

Workshop Goals To Provide Background Information Regarding Concussion Management To Present Data Pertaining to Outcomes and Risk Factors Associated with Sports Concussion To Discuss Academic Needs for Recovering Student Athlete with Concussion To Review the Utility of Computerized Neurocognitivie Testing and ImPACT as a Tool for Effective Concussion Management To Review Clinical Case Material

Concussion 101: Biomechanics, Pathophysiology, Definition • Micky Collins, PhD • Associate Professor and Director • UPMC Sports Medicine Concussion Program

Neurometabolic Cascade Following Cerebral Concussion/MTBI 500 Calcium 400 K+ 300 Glucose % of normal 200 Glutamate 100 50 2 6 12 20 30 6 24 3 6 10 Cerebral Blood Flow 0 hours days minutes (Giza & Hovda, 2001) UCLA Brain Injury Research Center

Concussion Management: Areas of Focus • Acute Management • Rule out more serious intracranial pathology • CT, MRI, neurologic examination primary diagnostic tests • Post Injury Management • Prevent against Second Impact Syndrome • Prevent against cumulative effects of injury • Less biomechanical force causing extension of injury • Prevent presence of Post-Concussion Syndrome • Determination of asymptomatic status essential for reducing repetitive and chronic morbidity of injury

Most Commonly Reported Symptoms Athletes with Concussion – 1-7 days following concussion Kontos, Elbin, French Collins, Data Under Review; N = 1,438

Post-Concussion Symptom Groups (Pardini, Lovell, Collins, et al. 2004) N=327, High School and University Athletes Within 7 Days of Concussion

The Evolving Definition of Concussion CDC Physicians Toolkit 2007 Regarding Cerebral Concussion…… A concussion (or mild traumatic brain injury) is a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces secondary to direct or indirect forces to the head. Disturbance of brain function is related to neurometabolic dysfunction, rather than structural brain injury, and is typically associated with normal structural imaging findings (CT Scan, MRI). Concussion may or may not involve a loss of consciousness. Concussion results in a constellation of physical, cognitive, emotional, and sleep-related symptoms. Recovery is a sequential process and symptoms may last from several minutes to days, weeks, months, or even longer in some cases.” CDC Physicians Toolkit; Collins, Gioia et al 2006

Management of MTBI: Topics of Concern • Grading systems ineffective/not data based. • CT and MRI insensitive to subtleties of injury. • Self-report predicates management directives. • Variability in clinician recommendations. • Lack of education and awareness of injury. • Inadequate/Improper recommendations from ED/Trauma Departments.

“When it comes to concussion, don’t believe me when I tell you that I’m OK ” NFL Athlete, 2010 23

Return to Play Following mTBI: Can we safely rely on symptoms alone? • In some cases (not all), athletes will minimize difficulties • Athletes are naïve to the subtleties of the injury • Young athletes lack insight into self-assessment of MTBI symptoms • Studies suggest that up to 50% of athletes experience concussion symptoms per year but only 10 % report having an injury • Need for comprehensive understanding of athletes recovery status

Computer-Based Neurocognitive Testing CURRENTLY AVAILABLE PROGRAMS: Cogsport (Axon) Headminders (CRI) ANAM CNS Vital Signs ImPACT Extensive research since 2001

Immediate Post-Concussion Assessmentand Cognitive TestingComputerized Neurocognitive Testing Mark Lovell, PhD, FACPN, Dsci, Software Developer, ImPACT Micky Collins, PhD - UPMC Dept. of Orthopaedic Surgery Joseph Maroon, MD - UPMC Dept. of Neurological Surgery ImPACT

Demographic / Concussion History Questionnaire Concussion Symptom Scale 21 Item Likert Scale (e.g. headache, dizziness, nausea, etc) 8 Neurocognitive Measures Verbal Memory, Visual Memory, Reaction Time, Processing Speed Summary Scores Detailed Clinical Report Outlines Demographic, Symptom, Neurocognitive Data Automatically Computer Scored Internal baseline validity checks built into program Desktop and On-Line Versions Available Extensive normative data available from ages 11-60 Over 100 peer-reviewed research articles/books/chapters, published since 2000 Extensive data published on reliability, validity, sensitivity/specificity of test ImPACT: Post-Concussion Evaluation

Neurocognitive Testing: What it is and Isn’t

Concussion Evaluation Timeline Pre-season 1-3 Days Return to Play Remove From Play Evaluation Supervised at School Or clinic

Measuring Neurocognitive Recovery from Sports mTBI How Long Does it Take?

Concussion Recovery Rates Vary by Age/Dependent Measure

Three-year prospective study in Western PA. • 17 high school football teams (2,141 total sample) • 134 athletes with diagnosed concussion (6.2%) • All athletes referred for evaluation at UPMC • Recovery determined by “Back to Baseline” on computer • neurocognitive test scores & symptom inventory • Determined by Reliable Change Index Scores-RCI’s) Collins, Lovell, Iverson, Ide, Maroon et al, Neurosurgery, 2006:58;275-283

Individual Recovery From Sports MTBI: How Long Does it Take? WEEK 1 WEEK 2 WEEK 3 WEEK 4 WEEK 5 80% RECOVERED 60% RECOVERED N=134 High School Male Football Athletes 40% RECOVERED Collins et al., 2006, Neurosurgery

Functional MRI and Sports Concussion Lovell, Collins, Eddy, Becker, Pardini, Maroon, Field, Marion, and Boada (2001-2006) RO1 HD 42386-05

Brain Metabolism is Related to Recovery • Over 200 High School Athletes Studied using fMRI • Tested w/in 7 days of concussion and at point of clinical recovery • Hyperactivation predicts CLINICAL recovery time • Resolution of hyperactivation correlates with recovery on ImPACT Lovell et al., Neurosurgery, 2007

Recovery: fMRI Subsample (UPMC Program)(Lovell, Pardini, Collins et al; Neurosurgery 2007) Mean Age: 16.2 yrs Gender: 78% male N = 208

Prognosticating Concussion Outcomes: An Evidence-Based Analysis Micky Collins, Ph.D. University of Pittsburgh Medical Center Associate Professor Department of Orthopaedic Surgery Department of Neurological Surgery Director UPMC Sports Concussion Program

Researching/Determining Prognosis for Sports Concussion: Why is it Important? • Helps to set up clear communication to player, coaches, and medical personnel regarding recovery expectations • May help to alleviate some pressure on RTP issue • May help to immediately provide individualized clinical management recommendations (e.g. need for academic accommodations/physical rest, etc.) • Begins to create a risk profile for sports concussion and may set stage to effectively research treatment and rehabilitation strategies. • Because it is the next stage in our scientific understanding of this injury….

Lau B, Kontos A, Lovell MR, Collins MW, AJSM: 2011 Which On-Field Symptoms Predict Protracted Recovery (i.e. Post-Concussion Syndrome)?

Which On-Field Symptoms Increase Risk of Post Concussion Syndrome in High School Football Players? • 176 Male HS Football Players (Mean Age = 16.2 years) • Athletes had baseline ImPACT testing and were revaluated within 3 days of injury. • All followed until clinical recovery (Mean = 4.1 evaluations) • Within RCI of baseline on ImPACT for neurocognitive/symptom scores • 32% of sample required < 7 days until recovery (N =56) “Rapid Recovery” (Mean = 4.9 days) • 39% of sample required 7-14 days until recovery (N = 68) • 17% of sample required > 21 days until recovery (N = 31) “Protracted Recovery” • (Mean = 33.2 days) • 12% lost to follow up (e.g. did not RTP or no follow-up in clinic) (N = 21) • MANOVA used to determine differences between rapid/> 3 week recovery • ATC’s documented on-field markers (e.g. LOC, Amnesia) and on-field Symptoms (e.g. headache, dizziness, etc) Lau B, Kontos A, Lovell MR, Collins MW, AJSM 2011

Which On-Field Markers/Symptoms Predict 3 or More WeekRecovery from MTBI In High School Football Players **p<.01 The total sample was 107. Due to the normal difficulties with collecting on-field markers, there were varying degrees of missing data. The number of subjects who had each coded ranged from 92-98. The N column represents the number of subjects for whom data were available for each category. Markers of injury are not mutually exclusive. Lau, Kontos, Collins, Lovell , AJSM 2011

On-Field Symptom Summary • Brief LOC (<30 sec) not predictive of subacute or protracted outcomes following sports-concussion • Amnesia important for sub-acute presentation, but may not be as predictive of protracted recovery • On-Field dizziness best predictor of protracted recovery and • “post concussion syndrome” • Etiology of dizziness? • Migraine variant? • Central Vestibular Dysfunction? • Peripheral Vestibular Dysfunction? • Cervico-genic? • Psychiatric?

Lau B, Lovell MR, Collins MW; Pardini J; CJSM 2009 (3):216-21 Which SubacuteSymptoms Predict Protracted Recovery?

108 concussed high school football players • Athletes had baseline ImPACT testing and were revaluated within 3 days of injury (Mean = 2.2 days) • All followed until clinical recovery • - Within Reliable Change Score of baseline for neurocognitive/symptom scores • 43.5% of sample recovered < 10 days = “Quick” • - Mean = 5.9 Days • 56.5% of sample required >10 days until recovery = “Protracted” • - Mean = 29.2 Days • MANOVA conducted on which individual symptoms and neurocognitive domains predicted “quick” versus “protracted” recovery Lau B, Lovell MR, Collins MW; Pardini J; CJSM 2009 (3):216-21

Post-Concussion Symptom Scale

Top 11 Symptom Predictors of Protracted Recovery Expressed as Effect Sizes (Cohen’s D). Only includes symptoms with large (greater than .80) effect sizes. Sample is composed of 108 male HS football athletes. Lau, Lovell, Collins et al. 2009, CJSM

“Fogginess” Athlete Descriptions • “It is like going from a high definition TV world • to standard TV world” • “Feeling one step removed from my surroundings” • “It is like my vision is impaired, but it isn’t” • “Feeling like I am underwater” Iverson, Lovell, Collins. JINS (2004),10, 94-906.

Factor Analysis, Post-Concussion Symptom Scale (Pardini, Lovell, Collins et al. 2004) N=327, High School and University Athletes Within 7 Days of Concussion

Rank Order of Most Predictive Symptoms of Outcome Lau, Lovell, Collins et al. CJSM, 2009 *Symptoms with the largest contributions to differences between “quick” and “protracted” recovery in each symptom factor.

The Role of Sub-Acute Migraine-Symptoms in Determining Outcomes Following Concussion Kontos AP, Elbin RJ, Simensky S, French J, Collins MW; data in preparation for publication

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Business Name : Lovell's Tree Service

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