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1 Neuropsychological Outcome After Cardiac Arrest: Results from a Sub-study of the Targeted Hypothermia Versus Targeted Normothermia After Out-of-hospital Cardiac Arrest (TTM2) Trial
- Erik Blennow Nordström, Susanna Vestberg, Lars Evald, Marco Mion, Magnus Segerström, Susann Ullen, John Bro-Jeppesen, Hans Friberg, Katarina Heimburg, Anders M. Grejs, Thomas R. Keeble, Hans Kirkegaard, Hanna Ljung, Sofia Rose, Matthew P. Wise, Christian Rylander, Johan Unden, Niklas Nielsen, Tobias Cronberg, Gisela Lilja
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 789-790
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Objective:
To describe cognitive impairment in out-of-hospital cardiac arrest (OHCA) survivors, with the hypothesis that OHCA survivors would perform significantly worse on neuropsychological tests of cognition than controls with acute myocardial infarction (MI). Another aim was to investigate the relationship between cognitive performance and the associated factors of emotional problems, fatigue, insomnia, and cardiovascular risk factors following OHCA.
Participants and Methods:This was a prospective case control sub-study of The Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial. Eight of 61 TTM2-sites in Sweden, Denmark, and the United Kingdom included adults with OHCA of presumed cardiac or unknown cause. A matched non-arrest control group with acute MI was recruited. We administered an extensive neuropsychological assessment at approximately 7 months post-cardiac event, including a neuropsychological test battery and questionnaires on anxiety, depression, fatigue, and insomnia, and collected information on the cardiovascular risk factors hypertension and diabetes. Z-scores of individual tests were converted to neuropsychological composite scores per cognitive domain (verbal, visual/constructive, working memory, episodic memory, processing speed, executive functions). Between-group differences on the neuropsychological composite scores were investigated with linear regression. Associations between anxiety, depression, fatigue, insomnia, hypertension, diabetes, and the neuropsychological composite scores among OHCA survivors were calculated with Spearman’s rho.
Results:Of 184 eligible OHCA survivors, 108 were included (mean age = 62, 88% male), with 92 MI controls enrolled (mean age = 64, 89% male). Amongst OHCA survivors, 29% performed z <-1 indicating at least borderline-mild impairment in >2 cognitive domains, and 14% performed z <-2 exhibiting major impairment in >1 cognitive domain. OHCA survivors performed significantly worse than MI controls in episodic memory (mean difference, MD = -0.37, 95% confidence intervals [-0.61, -0.12]), verbal (MD = -0.34 [-0.62, -0.07]), and visual/constructive functions (MD = -0.26 [-0.47, -0.04]) on linear regressions adjusted for educational attainment and sex. When additionally adjusting for anxiety, depression, fatigue, insomnia, hypertension, and diabetes, processing speed (MD = -0.41 [-0.74, -0.09]) and executive functions (MD = -0.69 [-1.13, -0.24]) were also worse following OHCA. Depressive symptoms were associated with worse executive functions (rs = -0.37, p <0.001) and worse processing speed (rs = -0.27, p = 0.01) post-OHCA. Anxiety symptoms (rs = -0.21, p = 0.01) and general fatigue (rs = -0.24, p = 0.01) were associated with worse executive functions. Diabetes was associated with worse processing speed (rs = -0.20, p = 0.03), visual/constructive (rs = -0.29, p <0.001) and executive functions (rs = -0.25, p = 0.02), while hypertension and insomnia were not significantly associated with neuropsychological test performance.
Conclusions:Cognitive impairment is generally mild following OHCA, but most pronounced in episodic memory, executive functions, and processing speed. OHCA survivors performed worse than MI controls. We suggest that a post-OHCA follow-up service should screen for cognitive impairment, emotional problems, and fatigue.
11039 Indiana CTSI High-School STEM Summer Research Program: Future opportunities from a 2020 virtual program
- Elmer Sanders, Leigh-Ann Cruz, Emily Speidell, Rose Schnabel, Adhitya Balaji, Elise Hogarth, Jade Miller, Sofia Vaides, Matthew R. Allen
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- Journal:
- Journal of Clinical and Translational Science / Volume 5 / Issue s1 / March 2021
- Published online by Cambridge University Press:
- 30 March 2021, p. 63
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ABSTRACT IMPACT: o The Indiana Clinical and Translational Sciences Institute K-12 STEM Outreach Program’s pivoted to a virtual program in summer 2020 which yielded novel approaches that could be retained in future years to extend the reach/impact of our pipeline program. OBJECTIVES/GOALS: o Provide students with a meaningful and safe research experience during the COVID Pandemic. o Develop new modules and approaches that could be delivered virtually. o Engage students from communities that were not possible in previous years when in person meetings were required. METHODS/STUDY POPULATION: o The program has historically supported over 100 high school students per year in a summer research internship for the last 5 years. Students are placed with academic research mentors in various Schools and Departments across the IUPUI campus, and also with industry laboratories. o COVID-related restrictions required development of 100% virtual program. Key aspects of the virtual program included: cohort-based research mentor assignments with 1-4 mentees matched per research mentor, research projects that could be conducted virtually, heavy engagement of high-school teachers to facilitate the research experience with cohorts of mentees, a more rigorous virtual seminar series that included new modules such as COVID-specific programming and thus enhancing public education about COVID. RESULTS/ANTICIPATED RESULTS: o The program served 130 students in summer 2020. o We were able to recruit new faculty and industry mentors involved in data science research. As a result, we have now increased our mentor pool to serve more students in the future. o Because student participation was virtual, we were able to accept students from further distances (up to 120 miles away) across the state. We were also able to accept local economically disadvantaged students that may have not been able to participate because of lack of reliable transportation. o A positive unanticipated outcome was that mentees relationships with the mentors was established virtually thus increasing the potential for students to remain engaged in their research. DISCUSSION/SIGNIFICANCE OF FINDINGS: o Adapting to a virtual platform provided research experience to high school students during a time when traditional approaches were not possible. Given some research experiences do not require in-person activities, this newly established model could be used moving forward to allow more statewide engagement in research experiences.
Contributors
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- By Zachary W. Adams, Margarita Alegría, Atalay Alem, Jordi Alonso, Victor Aparicio, Rifat Atun, Florence Baingana, Emily Baron, Marco Bertelli, Dinesh Bhugra, Sanchita Biswas, José Miguel Caldas de Almeida, Edwin Cameron, Somnath Chatterji, Erminia Colucci, Janice L. Cooper, Carla Kmett Danielson, Diego De Leo, Mary-Jo DelVecchio Good, Marten W. de Vries, Maureen S. Durkin, Xiangming Fang, Julia W. Felton, Sally Field, Andrea Fiorillo, Lance Gable, Teddy Gafna, Sandro Galea, Patrick Gatonga, Sofia Halperin-Goldstein, Yanling He, Grace A. Herbert, Sabrina Hermosilla, Simone Honikman, Takashi Izutsu, Ruwan M. Jayatunge, Janis H. Jenkins, Rachel Jenkins, Lynne Jones, Jayanthi Karunaratne, Ronald C. Kessler, Rob Keukens, Lincoln I. Khasakhala, Hanna Kienzler, Sarah Kippen Wood, M. Thomas Kishore, Robert Kohn, Natasja Koitzsch Jensen, Sheri Lapatin, Anna Lessios, Isabel Louro Bernal, Feijun Luo, Laura MacPherson, Matthew J. Maenner, Anne W. Mbwayo, David McDaid, Ingrid Meintjes, Victoria N. Mutiso, David M. Ndetei, Samuel O. Okpaku, Lijing Ouyang, Ramachandran Padmavati, Clare Pain, Duncan Pedersen, Jordan Pfau, Felipe Picon, Rodney D. Presley, Reima Pryor, Shoba Raja, Thara Rangaswamy, Jorge Rodriguez, Diana Rose, Moosa Salie, Norman Sartorius, Ester Shapiro, Manuela Silva, Daya Somasundaram, Katherine Sorsdahl, Dan J. Stein, Deborah M. Stone, Heather Stuart, Athula Sumathipala, Hema Tharoor, Rita Thom, Lay San Too, Atsuro Tsutsumi, Chris Underhill, Anne Valentine, Claire van der Westhuizen, Thandi van Heyningen, Robert van Voren, Inka Weissbecker, Gail Wyatt
- Edited by Samuel O. Okpaku
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- Book:
- Essentials of Global Mental Health
- Published online:
- 05 March 2014
- Print publication:
- 27 February 2014, pp x-xiv
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