Don't lose heart - Neuropsychological outcome and treatment after cardiac arrest
Pauline van Gils is a PhD student in the Department of Clinical Neurophysiology. Promotors are prof.dr. J. Hofmeijer from the Faculty of Science & Technology and prof.dr. C.M. van Heugten from Maastricht University.
The number of people experiencing long-term cognitive and psychosocial consequences after out-of-hospital cardiac arrest is increasing due to an aging population and an increased number of successful cardiorespiratory resuscitations. About half of the survivors suffer from long-term cognitive impairment.
The thesis explores the diagnosis, the long-term outcomes, and treatment of cognitive impairment post-cardiac arrest. The Montreal Cognitive Assessment (MoCA) was validated, showing excellent sensitivity and adequate specificity for detecting cognitive impairment, and is recommended to use for follow-up assessment.
Not all patients with cognitive impairments report cognitive complaints, and vice versa. Our findings did not support a lack of awareness as an explanation for this. Instead, a “response shift”, a change in an individual’s standards and values after life-altering events, is proposed.
Epileptiform patterns on EEG occur in 5-10% of comatose patients and indicate severe brain injury. A study of 14 survivors showed that, despite a “good” outcome according to the Cerebral Performance Categories, almost all participants had cognitive impairment and a worse psychosocial outcome compared to other patient populations.
Three studies investigated potential treatments. First, intravenous acyl-ghrelin improved cognitive and psychosocial outcomes numerically but not significantly compared to the placebo group. Second, cognitive rehabilitation combining metacognitive strategy training and direct computerized cognitive training in a single case experimental design enhanced daily functioning and societal participation for most participants. Third, intermitted theta burst stimulation (iTBS) had no impact on working memory on an individual basis, but may have influenced reaction time at the group level.
This thesis contributes to the field of post cardiac-arrest research by validating a screening tool, improving understanding of long-term outcomes, and identifying potential treatments.
