Confusion and Amnesia are Different Signs of Concussion

Distinguishing Confusion and Amnesia After a Concussion

By Gordon S. Johnson, Jr.

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Confusion and amnesia are different things. You can be suffering from amnesia and not be confused. [1] If the observer, the EMT, the Emergency Room doctor does not remember the  important distinction, between confusion and amnesia, there will never be adequate documentation of amnesia.

How do we know confusion and amnesia are not the same? Because we have unarguable case studies of this phenomenon, that not even the most conservative of neuropsychologists and neurologists would deny.   Troy Aikman suffered a concussion during the NFC playoff game between the Cowboys and the 49ers, which the Cowboys won.  The Super Bowl was two weeks later and Aikman, even though he was the winning quarterback, does not remember anything about the game.[2]

A confused person cannot quarterback an NFL team.  There is always someone who will claim that quarterbacking a game can be done on auto pilot.   But think of what an NFL quarterback must do on every single play. These not something someone who is confused can do:

  • Listen to the play call, in his helmet, in what may very well be an extremely noisy environment, where concentration may be difficult;
  • Remember that play;
  • Communicate the play call to his teammates;
  • Direct his teammates lining up for the snap of the ball;
  • In a matter of what is likely less than 10 seconds, scan the field, determine whether the play called is appropriate for the defense.
  • He must visually recognize, compare and categorize against everything he has learned about that defense not only in the previous week’s preparation, but throughout his experience as an NFL quarterback, including finite details about each of his players strengths and weaknesses versus the strengths and weakness of the opposing team, and then,
  • Execute the play in three to five seconds, under extreme processing and physical stress, stress which inevitably includes the danger of very large men, trying extremely hard to prevent him from doing all of the above by means that would include giving him another concussion.

I can think of no more cognitively challenging task. It requires speed of information processing, memory and judgment – under extreme stress.    If a quarterback can do all of those things, he is not confused.  The confused quarterback wouldn’t last a play. Clearly, confusion and amnesia are different.

Yet, the Aikman case is not just a case of amnesia for events of the day of his accident, but for events that happened a week or two later.  According to Bigler’s classifications, this is not a concussion, it is a potentially severe injury.

Next Conan O’Brien’s Concussion


[1] Collins, et. al. On-Field Predictors of Neuropsychological and Symptom Deficit

Following Sports-related Concussion, Clinical Journal of Sport Medicine, 13:222–229© 2003 “PTA is typically represented by the length of time between trauma and the point at which the individual regains normal continuous memory functioning.5,6 Disorientation and PTA are not mutually exclusive and can be difficult to dissociate. To help clarify this issue, PTA represents a loss in memory from the point of injury until the return of a full, ongoing memory process. Disorientation, in and of itself, is not associated with memory loss.”

[2] According to Wikipedia, in 1993, suffered a concussion in the NFC title game between the Cowboys and after 49er DT Dana Stubblefield‘s knee hit Aikman’s head. In Super Bowl XXVIII, Aikman was kept out of the endzone, but a combination of key turnovers by the Bills offense and the running of Emmitt Smith helped lead to a 30-13 victory for the Cowboys.

Following Super Bowl XXVIII, Aikman spoke of still feeling the ill effects of the concussion he suffered against the 49ers in the NFC Title game. Aikman spoke afterwards how he did not remember anything about Super Bowl XXVIII, let alone playing in the game.[2]


Gordon Johnson

Attorney Gordon Johnson is one of the nations leading brain injury advocates. He is Past-Chair of the TBILG, a national group of more than 150 brain injury advocates. He has spoken at numerous brain injury seminars and is the author of some of the most read brain injury web pages on the internet.

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