Clinical paperComparison of three cognitive exams in cardiac arrest survivors☆,☆☆
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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The Montreal Cognitive Assessment is a valid cognitive screening tool for cardiac arrest survivors
2022, ResuscitationCitation Excerpt :By routinely implementing a time-efficient cognitive screening tool like the MoCA, cognitive impairments in OHCA patients can be identified at an early stage and proper care can be provided.4 To our knowledge, one previous study has examined the MoCA as a screening tool for cognitive impairment after cardiac arrest.17 These findings were promising.
The second year of a second chance: Long-term psychosocial outcomes of cardiac arrest survivors and their family
2021, ResuscitationCitation Excerpt :This aligns with previous research demonstrating the MMSE’s limited sensitivity in the detection of mild cognitive impairment (MCI), contributing to recent shifts towards the use of tools such as the Montreal Cognitive Assessment (MoCA) in its place.30–34 While substitution of the MoCA for the MMSE in the present study may have improved the accuracy of MCI detection, the MoCA’s poor specificity and weak correlations with multiple neuropsychological test domain scores should not be overlooked.31,35,36 Similarly, normal CFQ scores reflecting subjective perception of cognitive failures could reflect inadequate scale sensitivity and/or poor construct validity.37,38
European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2021: Post-resuscitation care
2021, ResuscitationCitation Excerpt :Formal cognitive screening is recommended because patients are not always aware of their cognitive impairments.443,472,483 We suggest use of the Montreal Cognitive Assessment (MoCA) tool, which takes approximately 10 min to administer, is easy to use and available in many languages (see www.mocatest.org).480,483–485 If there are signs of cognitive impairment, consider referral to a neuropsychologist for more extensive neuropsychological assessment or another specialist in cognitive rehabilitation, such as an occupational therapist, should be considered.486
Protocol for outcome reporting and follow-up in the Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest trial (TTM2)
2020, ResuscitationCitation Excerpt :GOSE can be converted to a simple GOS,16,17 which corresponds to the much used, but criticized,12 Cerebral Performance Category (CPC)-scale. Montreal Cognitive Assessment (MoCA)18 is a cognitive performance-measure, reported to perform well for cognitive screening after cardiac arrest (CA),19 and recommended in current guidelines.20 The MoCA consists of 11 sub-tests of six cognitive domains; short-term memory, attention, working memory, visuo-spatial ability, executive function and language, all summed into a composite score of global cognitive function (0−30 points, higher is better).
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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.
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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.