Cognitive complaints after out of hospital cardiac arrest: first results of a compact screening

Abstract

Purpose: Severe cognitive problems after out-of-hospital cardiac arrest (OHCA) are acknowledged, but mild cognitive problems are rarely recognized. Because of the high impact in daily life it is important to screen for these mild impairments. A compact cognitive screening is not yet available. The aim of this study was to test a compact screening and describe the cognitive status of patients after OHCA. Methods: Survivors of OHCA admitted to the Rijnlands Rehabilitation Centre (RRC), Leiden, The Netherlands, for outpatient cardiac rehabilitation between April 2011 and December 2012. A month after OHCA, cognitive impairments were assessed. Cognitive functioning was measured with Mini Mental State Examination (MMSE). Cognitive complaints were invested using Cognitive Failure Questionnaire (CFQ) for patients and Informant Questionnaire Cognitive Decline of the Elderly (IQCODE) for informants. Cognitive deficits were defined as MMSE 32 or IQCODE>3.6. CFQ and IQCODE were compared to MMSE. Results: 63 consecutive patients were included, median age 58 years (IQR 44-66 yrs), 81% males. Five patients scored 32 on the CFQ, 2 informants scored >3.6 on the IQCODE. In total, cognitive problems were detected in 12 patients. Where one of the informants scored >3.6 on the IQCODE the patient scored <28 on the MMSE. Conclusions: The 17% cognitive problems is lower than in literature (42%). Results can be confounded by insensitive tests, short period between OHCA and tests (complaints free survival phase) or because of patient selection. Also improved chain of care: high percentage of Dutch inhabitants can resuscitate, increased availability AEDs, short arrival times ambulance and use of therapeutic hypothermia may contribute. Although the cognitive complaints were less than expected, the number of patients treated for cognitive problems after OHCA in the RRC tripled.