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.

Adaptation and validation of a computerized neurocognitive battery in the Xhosa of South Africa.

“…However, after appropriate adaptations, the battery was successfully administered within a genomic study to over a thousand Xhosa individuals, including individuals with schizophrenia and healthy comparison participants. The results generally confirmed findings from applications of the battery in other continents (Aliyu et al, 2006;Almasy et al, 2008;Bhatia et al, 2017;Hartung et al, 2016;Iannacone et al, 2014;Ibrahim et al, 2015;Moore et al, 2019;Service et al, 2020;Swagerman et al, 2016;Vatss et al, 2012) and, with few exceptions, support the hypotheses that were based on these findings.…”

“…The Penn Computerized Neurocognitive Battery (PennCNB) (Gur et al, 2001(Gur et al, , 2010) is a publicly available platform for administering "neurobehavioral probes" adapted from functional neuroimaging tasks (Gur et al, 1992) and designed to assess both theoretical psychological constructs (e.g., working memory) and their underlying brain networks (Roalf et al, 2014;Satterthwaite et al, 2013). The PennCNB has been utilized in multiple populations (Gur et al, 2012;Hartung et al, 2016;Iannacone et al, 2014), including large-scale genomic studies (Aliyu et al, 2006;Almasy et al, 2008;Gur et al, 2012;Swagerman et al, 2016), longitudinal research (Calkins et al, 2017;Ibrahim et al, 2015;Izgi et al, 2021), treatment studies (Bhatia et al, 2012(Bhatia et al, , 2017Tang et al, 2020;Wolf et al, 2011), international research (Bhatia et al, 2017;Gulsuner et al, 2020;Ibrahim et al, 2015;Service et al, 2020;Swagerman et al, 2016;Vatss et al, 2012), even in space flight (Garrett-Bakelman et al, 2019). Importantly, numerous studies have examined neurocognitive phenotypes in schizophrenia using this battery (Aliyu et al, 2006;Gur et al, 2015;Hill et al, 2002;Irani et al, 2012), and therefore results could be compared to those obtained in other populations.…”

Development of an abbreviated form of the Penn Line Orientation Test using large samples and computerized adaptive test simulation.

“…C. Gur et al, 2001, 2010; Moore, Reise, Gur, Hakonarson, & Gur, 2014) and has been used in large-scale genomic studies to examine associations with psychiatric disorders and brain structure and function (R. C. Gur et al, 2012; Iannacone et al, 2014; Van Essen et al, 2012). …”

“…The final orientations of the lines, as well as the efficiency of the path used to reach that orientation, are recorded. The test exhibits adequate psychometric properties (Gur et al, 2001, 2010; Moore et al, 2014) and has been used in large-scale genomic studies to examine associations with psychiatric disorders and brain structure and function (Gur et al, 2012; Iannacone et al, 2014; Van Essen et al, 2012).…”

Cognitive Assessment in Adult Cardiac Arrest Survivors: What Is Known and How Shall We Move Forward?

“…Unfortunately, no gold standard is available as a cognitive screening for CA survivors, which is not routinely assessed in the first place possibly due to the extensive and time-consuming nature of a neuropsychological test. A commonly used cognitive screening tool is the MMSE which is fast and easy to complete but has a ceiling effect and insensitivity when used in patients without dementia Koller et al, 2017), Iannacone et al (2014) developed a computerized neurocognitive battery (CNB) that was tested for feasibility in patients with CPC score of 1 and was shown to be specific enough to detect cognitive deficits. (Steinbusch et al, 2017).…”