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Effects of hypoxia on the brain: Neuroimaging and neuropsychological findings following carbon monoxide poisoning and obstructive sleep apnea

  • SHAWN D. GALE (a1) and RAMONA O. HOPKINS (a2) (a3)
Abstract

Hypoxia damages multiple organ systems especially those with high oxygen utilization such as the central nervous system. The purpose of this study was to compare the neuropathological and neuropsychological effects of hypoxia in patients with either carbon monoxide poisoning or obstructive sleep apnea. Neuroimaging revealed evidence of hippocampal atrophy in both groups although a linear relationship between hippocampal volume and memory performance was found only for selected tests and only in the sleep apnea group. There were significant correlations between hippocampal volume and performance on measures related to nonverbal/information processing. Generalized brain atrophy, as measured by the ventricle-to-brain ratio, was more common in the carbon monoxide poisoning group compared to the obstructive sleep apnea group. Performance on tests of executive function improved following treatment with nasal continuous positive airway pressure treatment in the obstructive sleep apnea group but there was no associated improvement in general intellectual function. We found that hypoxia due to obstructive sleep apnea and CO poisoning resulted in neuropathological changes and neuropsychological impairments. The observed group differences provide insight into the relationship between etiology of injury, neuropathological changes, and clinical presentation. (JINS, 2004, 10, 60–71.)

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Corresponding author
Reprint requests to: Shawn D. Gale, Ph.D., ABPP-Cn, Department of Clinical Neuropsychology, Barrow Neurological Institute, 222 W. Thomas Road, Suite 315, Phoenix, Arizona 85013. E-mail: s2gale@chw.edu
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

Barbe, F., Mayorala, L.R., Duran, J., Masa, J.F., Maimo, A., Montserrat, J.M., Monasterio, C., Bosch, M., Ladaria, A., Rubio, M., Rubio, R., Medinas, M., Hernandez, L., Vidal, S., Douglas, N.J., & Agusti, A.G.N. (2001). Treatment with continuous positive airway pressure is not effective in patients with sleep apnea but no daytime sleepiness. Annals of Internal Medicine, 134, 10151023.

Bédard, M.A., Montplaisir, J., Malo, J., Richer, F., & Rouleau, I. (1993). Persistent neuropsychological deficits and vigilance impairment in sleep apnea syndrome after treatment with nasal continuous positive airway pressure (CPAP). Journal of Clinical and Experimental Neuropsychology, 15, 330341.

Bédard, M., Montplaisir, J., Richer, F., Rouleau, I., & Malo, J. (1991). Obstructive sleep apnea syndrome: Pathogenesis of neuropsychological deficits. Journal of Clinical and Experimental Neuropsychology, 13, 950964.

Beebe, D.W. & Gozal, D. (2002). Obstructive sleep apnea and the prefrontal cortex: Towards a comprehensive model linking nocturnal upper airway obstruction to daytime cognitive and behavioral deficits. Journal of Sleep Research, 11, 116.

Berry, D.T.R., Webb, W.B., Block, A.J., Bauer, R.M., & Switzer, D.A. (1986). Nocturnal hypoxia and neuropsychological variables. Journal of Clinical and Experimental Neuropsychology, 8, 229238.

Bliwise, D.L., King, A.C., & Harris, R.B. (1994). Habitual sleep durations and health in a 50–65 year old population. Journal of Clinical Epidemiology, 47, 3541.

Caine, D. & Watson, J. (2000). Neuropsychological and neuropathological sequelae of cerebral anoxia: A critical review. Journal of the International Neuropsychological Society, 6, 8699.

Cheshire, K., Engleman, H., Deary, I., Shapiro, C., & Douglas, N.J. (1992). Factors impairing daytime performance in patients with sleep apnea/hypopnea syndrome. Archives of Internal Medicine, 152, 538541.

Choi, I.S. (1983). Delayed neurologic sequelae in carbon monoxide intoxication. Archives of Neurology, 40, 433435.

Davis, H.P., Tribuna, J., Pulsinelli, W.A., & Volpe, B.T. (1986). Reference and working memory of rats following hippocampal damage induced by transient forebrain ischemia. Physiology and Behavior, 37, 387392.

Engleman, H.M., Martin, S.E., Deary I.J., &Douglas N.J. (1997). Effect of CPAP therapy on daytime function in patients with mild sleep apnoea/hypopnoea syndrome. Thorax, 52, 114119.

Findley, L.J., Barth, J.T., Powers, D.C., Wilhoit, S.C., Boyd, D.G., & Suratt, P.M. (1986). Cognitive impairment in patients with obstructive sleep apnea and associated hypoxemia. Chest, 90, 686690.

Gale, S.D., Hopkins, R.O., Weaver, L.K., Bigler, E.D., Booth, E.D., & Blatter, D.D. (1999). MRI, quantitative MRI, SPECT, and neuropsychological findings following carbon monoxide poisoning. Brain Injury, 13, 229243.

Gale, S.D., Johnson, S.C., Bigler, E.D., & Blatter, D.D. (1995). Nonspecific white matter degeneration following traumatic brain injury. Journal of the International Neuropsychological Society, 1, 1728.

Geffen, G., Moar, K.J., O'Hanlon, A.P., Clark, C.R., & Geffen, L.B. (1990). Performance measures of 16- to 86-year old males and females on the auditory verbal learning test. Clinical Neuropsychologist, 4, 4563.

Hopkins, R.O., Gale, S.D., Johnson, S.D., Anderson, C.V., Bigler, E.D., Blatter, D.D., & Weaver, L.K. (1995a). Severe anoxia with and without concomitant brain atrophy and neuropsychological impairments. Journal of the International Neuropsychological Society, 1, 501509.

Hopkins, R.O., Kesner, R.P., & Goldstein, M. (1995b). Item and order recognition memory in subjects with hypoxic brain injury. Brain and Cognition, 27, 180201.

Jarrard, L.E. & Meldrum, B.S. (1993). Selective excitotoxic pathology in the rat hippocampus. Neuropathology and Applied Neurobiology, 19, 381389.

Kelly, D.A., Claypoole, K.H., & Coppel, D.B. (1990). Sleep apnea syndrome: Symptomatology, associated features, and neurocognitive correlates. Neuropsychology Review, 1, 323342.

Kesler, S.R., Hopkins, R.O., Weaver, L.K., Blatter, D.D., Edge-Booth, H., & Bigler, E.D. (2001). Verbal memory deficits associated with fornix atrophy in carbon monoxide poisoning. Journal of the International Neuropsychological Society, 7, 640646.

Kesner, R.P. & Hopkins, R.O. (2001). Short-term memory for duration and distance in humans: Role of the hippocampus. Neuropsychology, 15, 5868.

Manns, J.R., Hopkins, R.O., Reed, J.M., Kitchener, E.G., & Squire, L.R. (2003). Recognition memory and the human hippocampus. Neuron, 37, 171180.

Mittenberg, W., Burton, D.B., Darrow, E., & Thompson, G.B. (1992). Normative data for the Wechsler Memory Scale–Revised: 25- to 34-year-olds. Psychological Assessment, 4, 363368.

Okeda, R., Funata, N., Takano, T., Miyazaki, Y., Higashino, F., Yokoyama, K., & Manabe, M. (1981). The pathogenesis of carbon monoxide encephalopathy in the acute phase-physiological and morphological correlation. Acta Neuropathologica, 54, 110.

Piantadosi, C.A., Zhang, J., Levin, E.D., Folz, R.J., & Schmechel, D.E. (1997a). Apoptosis and delayed neuronal damage after carbon monoxide poisoning in the rat. Experimental Neurology, 147, 103114.

Piantadosi, C.A., Zhang, J., & Demchenko, I.T. (1997b). Production of hydroxyl radical in the hippocampus after CO hypoxia or hypoxic hypoxia in the rat. Free Radical Biology and Medicine, 22, 725732.

Raub, J.A., Mathieu-Nolf, M., Hampson, N.B., & Thom, S.R. (2000). Carbon monoxide poisoning—a public health perspective. Toxicology, 145, 114.

Reynolds, C.R., Hopkins, R.O., & Bigler, E.D. (1999). Continuing decline of memory skills with significant recovery of intellectual function following severe carbon monoxide exposure: Clinical, psychometric, and neuroimaging findings. Archives of Clinical Neuropsychology, 14, 235249.

Scott, J.G., Krull, K.R., Williamson, D.J., Adams, R.L., & Iverson, G.L. (1997). Oklahoma premorbid intelligence estimation (OPIE): Utilization and clinical samples. Clinical Neuropsychologist, 11, 146154.

Thom, S.R., Taber, R.L., Mendiguren, I.I., Clark, J.M., Hardy, K.R., & Fisher, A.B. (1995). Delayed neurologic sequelae following carbon monoxide poisoning: Prevention by treatment with hyperbaric oxygen. Annals of Emergency Medicine, 25, 474480.

Tombaugh, T.N., Kozak, J., & Rees, L. (1999). Normative data stratified by age and education for two measures of verbal fluency: FAS and animal naming. Archives of Clinical Neuropsychology, 14, 167177.

Uemura, K., Harada, K., Sadamitsu, D., Tsuruta, R., Takahashi, M., Aki, T., Yasuhara, M., Maekawa, T., & Yoshida, K. (2001). Apoptotic and necrotic brain lesions in a fatal case of carbon monoxide poisoning. Forensic Science International, 116, 213219.

Valencia-Flores, M., Bliwise, D.L., Guilleminault, C., Cilveti, R., & Clerk, A. (1996). Cognitive function in patients with sleep apnea after acute nocturnal nasal continuous positive airway pressure (CPAP) treatment: Sleepiness and hypoxemia effects. Journal of Clinical and Experimental Neuropsychology, 18, 197210.

Weaver, L.K., Hopkins, R.O., Chan, K.J., Churchill, S., Clemmer, T.P., Elliott, C.G., Orme, J.F., Jr., Thomas, F.O., & Morris, A.H. (2002). Hyperbaric oxygen for acute carbon monoxide poisoning. New England Journal of Medicine, 347, 10571067.

Young, T., Palta, M., Dempsey, J., Skatrud, J., Weber, S., & Badr, S. (1993). The occurrence of sleep-disordered breathing among middle-aged adults. New England Journal of Medicine, 328, 12301235.

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Journal of the International Neuropsychological Society
  • ISSN: 1355-6177
  • EISSN: 1469-7661
  • URL: /core/journals/journal-of-the-international-neuropsychological-society
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