title: Feasibility of cognitive functional assessment in cardiac arrest survivors using an abbreviated laptop-based neurocognitive battery.
abstract: Cardiac arrest survivors exhibit varying degrees of neurological recovery even in the setting of targeted temperature management (TTM) use, ranging from severe impairments to making a seemingly full return to neurologic baseline function. We sought to explore the feasibility of utilizing a laptop-based neurocognitive battery to identify more subtle cognitive deficits in this population. In a convenience sample of cardiac arrest survivors discharged with a cerebral performance category (CPC) of 1, we evaluated the use of a computerized neurocognitive battery (CNB) in this group compared to a healthy control normative population. The CNB was designed to test 11 specific neurocognitive domains, including such areas as working memory and spatial processing. Testing was scored for both accuracy and speed. In a feasibility convenience sample of 29 cardiac arrest survivors, the mean age was 52.9±16.7 years; 12 patients received postarrest TTM and 17 did not receive TTM. Patients tolerated the battery well and performed at normative levels for both accuracy and speed on most of the 11 domains, but showed reduced accuracy of working memory and speed of spatial memory with large magnitudes (>1 SD), even among those receiving TTM. Across all domains, including those using speed and accuracy, 7 of the 29 subjects (24%) achieved statistically significant scores lower from the normative population in two or more domains. In this population of CPC 1 cardiac arrest survivors, a sensitive neurocognitive battery was feasible and suggests that specific cognitive deficits can be detected compared to a normative population, despite CPC 1 designation. Such testing might allow improved measurement of outcomes following TTM interventions in future trials.
authors.affiliation: 1 Department of Emergency Medicine, Center for Resuscitation Science, University of Pennsylvania , Philadelphia, Pennsylvania.
authors.forename: Stephen
authors.initials: S
authors.lastname: Iannacone
authors.forename: Marion
authors.initials: M
authors.lastname: Leary
authors.forename: Emily C
authors.initials: EC
authors.lastname: Esposito
authors.forename: Kosha
authors.initials: K
authors.lastname: Ruparel
authors.forename: Adam
authors.initials: A
authors.lastname: Savitt
authors.forename: Allison
authors.initials: A
authors.lastname: Mott
authors.forename: Jan A
authors.initials: JA
authors.lastname: Richard
authors.forename: Ruben C
authors.initials: RC
authors.lastname: Gur
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Abella
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D003936:Diagnosis, Computer-Assisted / Q000295:instrumentation*; D005240:Feasibility Studies; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000523:psychology*; D008297:Male; D008570:Memory, Short-Term; D008838:Microcomputers; D008875:Middle Aged; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D065855:Spatial Processing; D017741:Survivors / Q000523:psychology*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult