Cognitive impairments and subjective cognitive complaints after survival of cardiac arrest: A prospective longitudinal cohort study

Steinbusch, C. V. M.; Heugten, Caroline van; Rasquin, S.M.C.; Verbunt, Jeanine; Moulaert, Véronique

doi:10.1016/j.resuscitation.2017.08.007

Cited by 90 publications

(85 citation statements)

References 37 publications

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“…Our results appear consistent with previous studies with larger sample sizes, both on global functional scales and specific functional and cognitive dimensions (6,8,12,13,15,32), suggesting that these may be generalizable. Furthermore, we report a rigorous cognitive evaluation, unveiling the importance of processing speed and language impairment in CA survivors, in addition to the classically demonstrated impairments in memory and executive functions.…”

Section: Discussionsupporting

confidence: 92%

“…Detailed neuropsychological evaluation detected substantial cognitive impairment in 26% of survivors, higher than the 13% at 3 months or 11% at one year reported in (15) (potentially explained by the higher number of tests considered in our study, 13 vs. 6), but lower than the 50% of patients showing mild cognitive impairment reported in (6). In particular, we revealed that impairment in processing speed (21%) and language (21%) were as frequent as the classical impairments in long-term verbal memory (19%) or executive functions (19% for initiation, 17% for inhibition) (6,15).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, how subjective evaluation is related to objective measures is even less clear. Significant complaints have been found in 14% of survivors, but these were not associated with cognition (15). In contrast, complete subjective recovery has been reported in 62-66% of survivors (12) and correlated with anxiety and depression symptoms (13).…”

Section: Introductionmentioning

confidence: 96%

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How Do You Feel? Subjective Perception of Recovery as a Reliable Surrogate of Cognitive and Functional Outcome in Cardiac Arrest Survivors

Juan

Lucia

Beaud

et al. 2018

Critical Care Medicine

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

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How Do You Feel? Subjective Perception of Recovery as a Reliable Surrogate of Cognitive and Functional Outcome in Cardiac Arrest Survivors

Juan

Lucia

Beaud

et al. 2018

Critical Care Medicine

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“…The greatest recovery of cognitive function is usually seen in the first 3 months post-arrest, but evidence from several small studies indicates continued improvement in some functions during at least the first year [17,18]. There is a lack of follow-up with neuropsychological instruments examining several cognitive domains.…”

Section: Introductionmentioning

confidence: 99%

“…There is a lack of follow-up with neuropsychological instruments examining several cognitive domains. Earlier studies on cognition after OHCA have either included a smaller number of participants (less than 50), or investigated more patients (100-300) with elementary cognitive assessments or fewer cognitive domains [10,17,19].…”

Section: Introductionmentioning

confidence: 99%

Neuropsychological outcome after cardiac arrest: a prospective case control sub-study of the Targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest trial (TTM2)

Nordström

Lilja

Vestberg

et al. 2020

BMC Cardiovasc Disord

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Background This study is designed to provide detailed knowledge on cognitive impairment after out-of-hospital cardiac arrest (OHCA) and its relation to associated factors, and to validate the neurocognitive screening of the Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest trial (TTM2-trial), assessing effectiveness of targeted temperature management after OHCA. Methods This longitudinal multi-center clinical study is a sub-study of the TTM2-trial, in which a comprehensive neuropsychological examination is performed in addition to the main TTM2-trial neurocognitive screening. Approximately 7 and 24 months after OHCA, survivors at selected study sites are invited to a standardized assessment, including performance-based tests of cognition and questionnaires of emotional problems, fatigue, executive function and insomnia. At 1:1 ratio, a matched control group from a cohort of acute myocardial infarction (MI) patients is recruited to perform the same assessment. We aim to include 100 patients per group. Potential differences between the OHCA patients and the MI controls at 7 and 24 months will be analyzed with a linear regression, using composite z-scores per cognitive domain (verbal, visual/constructive, working memory, episodic memory, processing speed, executive functions) as primary outcome measures. Results from OHCA survivors on the main TTM2-trial neurocognitive screening battery will be compared with neuropsychological test results at 7 months, using sensitivity and specificity analyses. Discussion In this study we collect detailed information on cognitive impairment after OHCA and compare this to a control group of patients with acute MI. The validation of the TTM2 neurocognitive screening battery could justify its inclusion in routine follow-up. Our results may have a potential to impact on the design of future follow-up strategies and interventions after OHCA. Trial registration ClinicalTrials.gov, NCT03543371. Registered 1 June 2018

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Effects of Hypothermia vs Normothermia on Societal Participation and Cognitive Function at 6 Months in Survivors After Out-of-Hospital Cardiac Arrest

Lilja,

Ullén,

Dankiewicz

et al. 2023

JAMA Neurol

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ImportanceThe Targeted Hypothermia vs Targeted Normothermia After Out-of-Hospital Cardiac Arrest (TTM2) trial reported no difference in mortality or poor functional outcome at 6 months after out-of-hospital cardiac arrest (OHCA). This predefined exploratory analysis provides more detailed estimation of brain dysfunction for the comparison of the 2 intervention regimens.ObjectivesTo investigate the effects of targeted hypothermia vs targeted normothermia on functional outcome with focus on societal participation and cognitive function in survivors 6 months after OHCA.Design, Setting, and ParticipantsThis study is a predefined analysis of an international multicenter, randomized clinical trial that took place from November 2017 to January 2020 and included participants at 61 hospitals in 14 countries. A structured follow-up for survivors performed at 6 months was by masked outcome assessors. The last follow-up took place in October 2020. Participants included 1861 adult (older than 18 years) patients with OHCA who were comatose at hospital admission. At 6 months, 939 of 1861 were alive and invited to a follow-up, of which 103 of 939 declined or were missing.InterventionsRandomization 1:1 to temperature control with targeted hypothermia at 33 °C or targeted normothermia and early treatment of fever (37.8 °C or higher).Main outcomes and measuresFunctional outcome focusing on societal participation assessed by the Glasgow Outcome Scale Extended ([GOSE] 1 to 8) and cognitive function assessed by the Montreal Cognitive Assessment ([MoCA] 0 to 30) and the Symbol Digit Modalities Test ([SDMT] z scores). Higher scores represent better outcomes.ResultsAt 6 months, 836 of 939 survivors with a mean age of 60 (SD, 13) (range, 18 to 88) years (700 of 836 male [84%]) participated in the follow-up. There were no differences between the 2 intervention groups in functional outcome focusing on societal participation (GOSE score, odds ratio, 0.91; 95% CI, 0.71-1.17; P = .46) or in cognitive function by MoCA (mean difference, 0.36; 95% CI,−0.33 to 1.05; P = .37) and SDMT (mean difference, 0.06; 95% CI,−0.16 to 0.27; P = .62). Limitations in societal participation (GOSE score less than 7) were common regardless of intervention (hypothermia, 178 of 415 [43%]; normothermia, 168 of 419 [40%]). Cognitive impairment was identified in 353 of 599 survivors (59%).ConclusionsIn this predefined analysis of comatose patients after OHCA, hypothermia did not lead to better functional outcome assessed with a focus on societal participation and cognitive function than management with normothermia. At 6 months, many survivors had not regained their pre-arrest activities and roles, and mild cognitive dysfunction was common.Trial RegistrationClinicalTrials.gov Identifier: NCT02908308

show abstract

Cognitive impairments and subjective cognitive complaints after survival of cardiac arrest: A prospective longitudinal cohort study

Cited by 90 publications

References 37 publications

How Do You Feel? Subjective Perception of Recovery as a Reliable Surrogate of Cognitive and Functional Outcome in Cardiac Arrest Survivors

How Do You Feel? Subjective Perception of Recovery as a Reliable Surrogate of Cognitive and Functional Outcome in Cardiac Arrest Survivors

Neuropsychological outcome after cardiac arrest: a prospective case control sub-study of the Targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest trial (TTM2)

Effects of Hypothermia vs Normothermia on Societal Participation and Cognitive Function at 6 Months in Survivors After Out-of-Hospital Cardiac Arrest

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