Elsevier

Resuscitation

Volume 116, July 2017, Pages 98-104
Resuscitation

Clinical paper
Comparison of three cognitive exams in cardiac arrest survivors,☆☆

https://doi.org/10.1016/j.resuscitation.2017.04.011Get rights and content

Abstract

Background

Cognitive deficits may detract from quality of life after cardiac arrest. Their pattern and prevalence are not well documented. We used the Computer Assessment of Mild Cognitive Impairment (CAMCI), the Montreal Cognitive Assessment (MOCA) and the 41 Cent Test (41CT) to assess cognitive impairment in cardiac arrest survivors and examine the exams’ diagnostic accuracy. We hypothesized that the scores of these exams would indicate the presence of cognitive impairment in arrest survivors, that the overall scores on the three study assessments would correlate with one another, and that the 41CT, MOCA, and executive function element of the CAMCI would vary independently from other non-executive CAMCI components, reflecting executive function impairment after cardiac arrest.

Methods

Four researchers administered the CAMCI, MOCA, and/or the 41CT to cardiac arrest survivors after discharge from the intensive care unit between 2010 and 2015. Physicians screened patients with the Mini-Mental State Exam to determine when this cognitive testing was feasible, generally when the patient was able to score 20–25 points on the MMSE. We performed pairwise correlations between the different subscales' and tests’ scores.

Results

One hundred and fourteen participants completed the CAMCI, of which 38 (33.3%) participants additionally completed the MOCA and 41CT. The median (IQR) percentile score for CAMCI for all 114 participants was 33.5 (18.3, 49.8), which corresponds to moderately low risk of impairment. The median (IQR) for the MOCA was 22.0 (19, 24.8) out of a possible 30, which is considered indicative of abnormal cognitive function, and for the 41CT was 6 (5, 7) out of a possible 7 points when all 38 participants were included. MOCA correlated strongly with the overall CAMCI score (r = 0.71); the CAMCI correlated moderately strongly with the 41CT (r = 0.62) and the MOCA and 41CT were moderately strongly correlated with each other (r = 0.56). When all 114 CAMCI scores were considered, the Executive Accuracy subscale was strongly correlated with the overall CAMCI score (r = 0.81).

Conclusion

The CAMCI detects cognitive impairment after cardiac arrest. The MOCA correlates strongly with the overall CAMCI and the executive function subscale of the CAMCI. The 41CT as appears less effective than the MOCA in detecting cognitive deficits.

Section snippets

Background

Cardiac arrest affects approximately 350,000 people yearly in the United States, and survival is an estimated 8% [1]. Survivors exhibit cognitive decline or impairment [2], [3] that ranges from mild to severe, including memory loss [2], [3], [4], [5], [6] decreases in psychomotor function [5], [7], executive function [5], and visuospatial function [5]. These impairments affect up to 88% of long-term arrest survivors and can detract from health-related quality of life for many years [8].

Methods

The University of Pittsburgh Institutional Review Board approved the study. All subjects were treated by the PCAS at UPMC Presbyterian and Montefiore hospitals and received standardized post-cardiac arrest care including that has been reported previously [21]. Four researchers administered the CAMCI, MOCA, and/or the 41CT to cardiac arrest survivors no sooner than 24 h after discharge from the intensive care unit (ICU) between April 2010 and January 2015. These researchers were employed as

Results

Between 2010–2015, 1081 patients were treated by the PCAS; 650 (60.1%) did not survive to undergo testing. Of the 431 survivors, 95 (22.0%) could not follow commands, leaving 336 (88.0%) who could be assessed for study eligibility. Of these 336 patients, 207 (61.6%) were excluded due to patient availability or MMSE scores, leaving 129 patients who were offered testing; 3 refused. The CAMCI was completed by 114 patients. Thirty-eight (33.3%) of those participants also completed the MOCA and

Discussion

We demonstrate a cohort of patients with indicators of impairment or risk of impairment despite the their ability to pass a modified MMSE. The mean CAMCI score indicated “Moderate-Low Risk” of impairment, with significant variation in exam scores, ranging from 0 to the 78th percentile. The average MOCA and 41CT scores were in the “Abnormal” range. Scores on the 41CT, MOCA and CAMCI were positively associated with each other. CAMCI and MOCA scores were strongly correlated with the Executive

Conclusion

CAMCI, MOCA, and 41CT testing detected mild cognitive impairment in post-arrest patients who scored satisfactorily on the low-bar MMSE. The three exam scores were associated with each other, ranging from moderately strong to very strong correlations. The Executive Accuracy score was correlated with the overall CAMCI, MOCA, and 41CT scores, indicating impairment in executive function following cardiac arrest. The 41CT and MOCA may be useful screening tools prior to the administration of longer

Conflicts of interest

The authors report no conflicts of interest related to this work.

Funding

This work was supported by a significant research grant from the National Heart, Lung, and Blood Institute (5U01 HL077863) awarded to Dr. Callaway.

Acknowledgements

The authors would like to thank all of our study participants and Dr. David D. Salcido for his assistance with this project.

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    A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2017.04.011.

    ☆☆

    Presented as a poster at the American Heart Association’s Resuscitation Science Symposium in November 2014 in Chicago, Illinois, and as an oral presentation at the 2nd International Symposium on Postresuscitation Care in June 2015 in Lund, Sweden.

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