Early prediction of long-term cognitive impairment after cardiac arrest

AbstractThis prospective study evaluated the prognostic value of early neurobiochemical markers, neuron-specific enolase and astroglial protein S-100B, for long-term cognitive outcome after cardiac arrest. Six months after admission of a cohort of 80 consecutive patients, 26 survivors were able to undergo a neuropsychological test battery. Survivors showed low test performances in attention, learning/memory, and executive functioning. Neuropsychological bedside screening during the first month significantly differentiated between patients with and without long-term cognitive impairment. The neurobiochemical marker S-100B at day 3 after admission was found to predict significant proportions of variance in specific cognitive domains (learning/memory and executive functioning). The results indicate that early neuropsychological assessment might help identify patients who run at risk of long-term neuropsychological dysfunction. This study also suggests that especially the protein S-100B provides valuable information on long-term cognitive outcomes. To understand the exact relationship, results have to be replicated in larger trials. (JINS, 2009,15, 344–353.)

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Cognitive Outcome in Childhood-Onset Epilepsy: A Five-Decade Prospective Cohort Study

Journal of the International Neuropsychological Society ◽

10.1017/s1355617716001077 ◽

2017 ◽

Vol 23 (4) ◽

pp. 332-340 ◽

Cited By ~ 7

Author(s):

Mira Karrasch ◽

Petri Tiitta ◽

Bruce Hermann ◽

Juho Joutsa ◽

Shlomo Shinnar ◽

...

Keyword(s):

Cohort Study ◽

Cognitive Impairment ◽

Population Based ◽

Cognitive Outcomes ◽

Cognitive Outcome ◽

Healthy Controls ◽

Childhood Onset ◽

Semantic Function ◽

Active Epilepsy

AbstractObjectives: Little is known about the very long-term cognitive outcome in patients with childhood-onset epilepsy. The aim of this unique prospective population-based cohort study was to examine cognitive outcomes in aging participants with childhood-onset epilepsy (mean onset age=5.3 years) five decades later (mean age at follow-up=56.5 years).Methods: The sample consisted of 48 participants with childhood-onset epilepsy and 48 age-matched healthy controls aged 48–63 years. Thirty-six epilepsy participants were in remission and 12 continued to have seizures. Cognitive function was examined with 11 neuropsychological tests measuring language and semantic function, episodic memory, and learning, visuomotor function, executive function, and working memory. Results: The risk of cognitive impairment was very high in participants with continuing seizures; odds ratio (OR)=11.7 (95% confidence interval [CI] (2.8, 49.6), p=.0008). They exhibited worse performances across measures of language and semantic function, and visuomotor function compared to participants with remitted epilepsy and healthy controls. In the participants with remitted epilepsy, the risk of cognitive impairment was somewhat elevated, but not statistically significant; OR=2.6 (95% CI [0.9, 7.5], p=.08).Conclusions: Our results showed that the distinction of continued versus discontinued seizures was critical for determining long-term cognitive outcome in childhood-onset epilepsy. Few participants in remission exhibited marked cognitive impairment compared to age-matched peers. However, a subgroup of participants with decades long active epilepsy, continuous seizure activity and anti-epileptic drug (AED) medication, showed clinically significant cognitive impairment and are thus in a more precarious position when entering older age. (JINS, 2017, 23, 332–340)

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Elevated Cerebrospinal Fluid Tau Protein Concentrations on Admission Are Associated With Long-term Neurologic and Cognitive Impairment in Ugandan Children With Cerebral Malaria

Clinical Infectious Diseases ◽

10.1093/cid/ciz325 ◽

2019 ◽

Vol 70 (6) ◽

pp. 1161-1168 ◽

Cited By ~ 5

Author(s):

Dibyadyuti Datta ◽

Andrea L Conroy ◽

Peter F Castelluccio ◽

John M Ssenkusu ◽

Gregory S Park ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Cognitive Impairment ◽

Cerebral Malaria ◽

Axonal Injury ◽

Kidney Injury ◽

Cognitive Outcomes ◽

Cognitive Outcome ◽

Neurologic Deficits ◽

Lower Glucose

Abstract Background Elevated concentrations of cerebrospinal fluid (CSF) tau, a marker of axonal injury, have been associated with coma in severe malaria (cerebral malaria [CM]). However, it is unknown whether axonal injury is related to long-term neurologic deficits and cognitive impairment in children with CM. Methods Admission CSF tau concentrations were measured in 145 Ugandan children with CM and compared to clinical and laboratory factors and acute and chronic neurologic and cognitive outcomes. Results Elevated CSF tau concentrations were associated with younger age, increased disease severity (lower glucose and hemoglobin concentrations, malaria retinopathy, acute kidney injury, and prolonged coma duration, all P < .05), and an increased CSF:plasma albumin ratio, a marker of blood–brain barrier breakdown (P < .001). Admission CSF tau concentrations were associated with the presence of neurologic deficits at hospital discharge, and at 6, 12, and 24 months postdischarge (all P ≤ .02). After adjustment for potential confounding factors, elevated log10-transformed CSF tau concentrations correlated with worse cognitive outcome z scores over 2-year follow-up for associative memory (β coefficient, –0.31 [95% confidence interval [CI], –.53 to –.10]) in children <5 years of age, and for overall cognition (–0.69 [95% CI, –1.19 to –.21]), attention (–0.78 [95% CI, –1.34 to –.23]), and working memory (–1.0 [95% CI, –1.68 to –.31]) in children ≥5 years of age (all P < .006). Conclusions Acute axonal injury in children with CM is associated with long-term neurologic deficits and cognitive impairment. CSF tau concentrations at the time of the CM episode may identify children at high risk of long-term neurocognitive impairment.

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Abstract 194: Cognitive Outcome in Acute Simvastatin Treatment for Aneurysmal Subarachnoid Hemorrhage

Stroke ◽

10.1161/str.47.suppl_1.194 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

George Wong ◽

Keyword(s):

Cognitive Impairment ◽

Subarachnoid Hemorrhage ◽

Cerebral Infarction ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Primary Outcome Measure ◽

Cognitive Outcomes ◽

Cognitive Outcome ◽

Secondary Outcome ◽

Modified Rankin Scale ◽

Simvastatin Treatment

Objectives: Experimental evidence has indicated the benefit of simvastatin in the treatment of subarachnoid haemorrhage (SAH). Recently, acute simvastatin treatment was not shown to be beneficial in neurological outcome using modified Rankin Scale. Cognitive function is another important dimension of outcome assessment and yet had not been investigated in statin studies for aneurysmal subarachnoid hemorrhage. We therefore explored whether acute simvastatin treatment would improve cognitive outcomes. Methods: The study recruited SAH patients with acute simvastatin treatment enrolled in a randomized controlled double-blinded clinical trial (ClinicalTrials.gov Identifier: NCT01038193). A control cohort of SAH patients without simvastatin treatment was identified with propensity score matching of age and admission grade. Primary outcome measure was Montreal Cognitive Assessment (MoCA). Secondary outcome measures were delayed ischaemic deficit (DID), delayed cerebral infarction, modified Rankin Scale (mRS), and Mini-Mental State Examination( MMSE). Results: Fifty-one SAH patients with acute simvastatin treatment and 51 SAH patients without simvastatin treatment were recruited for analysis. At 3 months, there were no differences in MoCA scores (MoCA: 21+/-6 vs. 21+/-5, p=0.772). MoCA-assessed cognitive impairment (MoCA<26) was not different (75% vs. 80%, OR 0.7, 95%CI 0.3 to 1.8, p=0.477). There were also no differences in DID, delayed cerebral infarction, favorable mRS outcome, and MMSE scores, and MMSE-assessed cognitive impairment between both groups. Conclusions: The current study does not support that acute simvastatin treatment improves cognitive outcome after aneurysmal subarachnoid hemorrhage.

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306 GCS Does Not Predict Cognitive Outcome 30 Years After Severe Traumatic Brain Injury

Neurosurgery ◽

10.1093/neuros/nyx417.306 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 264-265

Author(s):

Molly E Hubbard ◽

Abdullah Bin Zahid ◽

Gabrielle Meyer ◽

Kathleen Vonderhaar ◽

David Y Balser ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Assessment Tool ◽

Cognitive Status ◽

Cognitive Outcomes ◽

Cognitive Outcome ◽

Symptom Severity Score ◽

History Of ◽

Severe Tbi

Abstract INTRODUCTION Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in the US. The effects of TBI on quality of life may not become apparent for years after the injury. There are conflicting reports in the literature regarding long term outcomes. Physicians are often asked to predict long term functional and cognitive outcomes, with limited data available. METHODS Patients with severe TBI (GCS = 9) who previously participated in a clinical trial during the 1980s were followed up with and compared to healthy controls without history of TBI. A health questionnaire, sports concussion assessment tool version 3 (SCAT3) and the Telephone Interview for Cognitive Status-modified (TICS-m) were completed over the phone and compared with controls using t-test. GCS at admission and 12-month GRS were used to predict to TICS-M at 30 years using linear regression. RESULTS >45 of the initial 168 subjects were confirmed alive, and 37 (13 females; mean age: 52.43 years S.D. 10.7) consented. Controls (n = 58; 23 females; mean age = 54 years, S.D. 11.5) had lower symptom severity score (6.7 S.D. 12.6 versus 20.6 S.D. 25.3; P = 0.005), lower total number of symptoms (3.4 S.D. 4.7 versus 7.12 S.D. 6.5; P = 0.006), higher standardized assessment of concussion score (25.6 S.D. 2.8 versus 21.2 S.D. 6.9; P = 0.001), and lower corrected MPAI-4 (22.3 S.D. 17.0 versus 43.7 S.D. 12.8; P < 0.001). GCS at admission did not predict cognitive status at 30-years assessed using TICS-M (P = 0.345). The Glasgow Outcome Scale score at 12-months was correlated to TICS-M at 30 years (R = 0.548, P < 0.001); each point decrease in GOS decreasing the score at TICS-M by 5.6 points. CONCLUSION Remote history of TBI disrupts the lives of survivors long after injury. Admission GCS does not predict cognitive status 30 years after TBI. The GOS at 12-months predicted the cognitive status assessed using TICS-M score at 30 years.

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Hypothermia after cardiac arrest does not affect serum levels of neuron-specific enolase and protein S-100b

Acta Anaesthesiologica Scandinavica ◽

10.1111/aas.12386 ◽

2014 ◽

Vol 58 (9) ◽

pp. 1093-1100 ◽

Cited By ~ 10

Author(s):

R. PFEIFER ◽

M. FRANZ ◽

H. R. FIGULLA

Keyword(s):

Cardiac Arrest ◽

Neuron Specific Enolase ◽

Protein S ◽

Serum Levels

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Long-term cognitive outcomes following out-of-hospital cardiac arrest: A population-based study

Neurology ◽

10.1212/wnl.0b013e318232ab33 ◽

2011 ◽

Vol 77 (15) ◽

pp. 1438-1445 ◽

Cited By ~ 50

Author(s):

F. J. Mateen ◽

K. A. Josephs ◽

M. R. Trenerry ◽

M. D. Felmlee-Devine ◽

A. L. Weaver ◽

...

Keyword(s):

Cardiac Arrest ◽

Population Based ◽

Cognitive Outcomes ◽

Population Based Study ◽

Hospital Cardiac Arrest

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Long-Term Cognitive Impairment After Critical Illness

50 Studies Every Anesthesiologist Should Know ◽

10.1093/med/9780190237691.003.0017 ◽

2018 ◽

pp. 86-90

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Cognitive Impairment ◽

Critical Illness ◽

Cognitive Outcomes ◽

Adult Patients ◽

Illness Experience ◽

Icu Patients ◽

Global Cognition

This case focuses on long-term cognitive impairment after critical illness by asking the question: What is the prevalence of long-term cognitive impairment after critical illness, and does the duration of delirium and use of sedative or analgesic medications affect cognitive outcomes? This study demonstrated that 74% of adult patients with critical illness experience delirium during their hospital course. Furthermore, patients in the intensive care unit (ICU) setting commonly experience global cognition and executive function deficits at 3 and 12 months following hospitalization. These findings highlight the importance of careful delirium surveillance in ICU patients.

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