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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.
A Twin Methodology for the Study of Genetic and Environmental Control of Variation in Human Smoking Behavior
- David W. Crumpacker, Rune Cederlöf, Lars Friberg, William J. Kimberling, Stefan Sörensen, Steven G. Vandenberg, James S. Williams, Gerald E. McClearn, Britt Grevér, Hari Iyer, Margaret J. Krier, Nancy L. Pedersen, Richard A. Price, Ingegärd Roulette
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- Journal:
- Acta geneticae medicae et gemellologiae: twin research / Volume 28 / Issue 3 / July 1979
- Published online by Cambridge University Press:
- 01 August 2014, pp. 173-195
- Print publication:
- July 1979
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A method is presented for partitioning the variance associated with human smoking behavior into additive genetic, nonadditive genetic, prenatal environmental, postnatal familial environmental, and postnatal extrafamilial environmental components. Estimations can also be made of additive genetic and residual correlations between spouses and of the correlation between parental additive genetic effect and progeny nonadditive genetic and environmental effect. The variance estimates are free of the biases that might result from these correlations. The statistical genetic analysis is being applied to a large group of MZ and DZ twins, their spouses, and their adult children who live in southern Sweden. Blood samples from each subject will be used to identify their genetic constitution for a number of biochemical polymorphisms, some of which may be considered a priori to have possible relationships to smoking. Associations and genetic linkages between biochemical marker loci and quantitative behavioral traits will be sought. Traits of interest include a wide array of tobacco-use variables, motives for smoking, personality and cognitive variables, and other variables associated with drug use and health. Zygosity determinations based on biochemical polymorphisms have indicated MZ to DZ and DZ to MZ misclassification rates of 0% and 6.15%, respectively, when based solely on external morphology and questionnaire data. The nonpaternity ratio of the fathers with respect to their supposedly biological children is estimated to be 0.28%. Gene frequency estimates for 21 marker loci show that the sample of twins and their relatives is quite representative of the Swedish population at large. All loci were in Hardy-Weinberg-Castle equilibrium, with no evidence of assortative mating for biochemical traits. The MZ twins are significantly more concordant than the DZ twins with respect to whether they have ever had a smoking habit.