Autonomy In Daily Life Research Articles

Addressing Long COVID Sequelae and Neurocovid: Neuropsychological Scenarios and Neuroimaging Findings.

In the face of increasing reports of CNS involvement in COVID-19 cases, it is likely that the current epidemic may be accompanied by a significant increase in the prevalence of neurological sequelae, cognitive dysfunction, and long-term behavioural alterations affecting quality of life and autonomy in daily life. This is consequential to the neuroinvasion and multi-organ dysfunction, but also to the psychological distress and socioeconomic changes that occur. Long COVID and neurocovid are now an established concept worldwide. However, the clinical features of these two entities are still debated. The chapter provides information about the nosographic framing, associated pathophysiological mechanisms, alterations in the central and peripheral nervous systems, and the associated neurocognitive profile, indications about predictor and clinical evaluation according to a patient-centred multidimensional immuno-behavioural approach.

THE EFFECT OF DUAL-TASKS ON WALKING SPEED IN HEALTHY OLDER ADULTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Normative age-related changes occur in both walking and cognitive performance; non-normative changes could lead to decreased mobility, loss of autonomy in daily life, and increased fall risk. This systematic review and meta-analysis aimed to assess the effects of completing a dual-task on overground walking speed in healthy older adults. Database searches were carried out in three electronic databases (PubMed, PsycINFO, ProQuest) from inception through October 2022 to find studies that assessed healthy older adults who completed a walking test and a walking task combined with a neurocognitive assessment (dual-task). Methodological quality and risk of bias was assessed via the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Cohen’s d effect size with a 95% confidence intervals, Cochrane’s Q, I2, and Fail-safe N statistics were calculated between the single- and dual-task walking speeds. The initial search yielded 459 articles; six were included in the final review after completing all screening procedures. Included studies had relatively high STROBE scores (19.97±0.82). Eight individual effects across the six articles (total sample size=5627) were calculated. Walking speed significantly decreased in dual-task conditions with cognitive tasks (walking speed Δ=1.03; 95%CI 0.65 to 1.40; p<.001); individual effects were higher during high load cognitive tasks (i.e., serial 7’s subtraction, TMT part B). Dual-tasking with a cognitive component clearly affected walking speed in aging adults. Studying different age groups will help create a model of the aging process to understand when changes begin, as well as the rate of change; this could be useful for earlier fall-prevention interventions.

Pediatric Type 1 Diabetes: Is Age at Onset a Determining Factor in Advanced Hybrid Closed-Loop Insulin Therapy?

The integration of continuous glucose monitoring systems with insulin infusion pumps has shown improved glycemic control, with improvements in hyperglycemia, hypoglycemia, Hb1Ac, and greater autonomy in daily life. These have been most studied in adults and there are currently not many articles published in the pediatric population that establish their correlation with age of debut. Prospective, single-study. A total of 28 patients (mean age 12 ± 2.43 years, 57% male, duration of diabetes 7.84 ± 2.46 years) were included and divided into two groups according to age at T1D onset (≤4 years and >4 years). Follow-up for 3 months, with glucometric variables extracted at different cut-off points after the start of the closed-loop (baseline, 1 month, 3 months). Significant improvement was evidenced at 1 month and 3 months after closed-loop system implantation, with better glycemic control in the older age group at baseline at TIR (74.06% ± 6.37% vs. 80.33% ± 7.49% at 1 month, p < 0.003; 71.87% ± 6.58% vs. 78.75% ± 5.94% at 3 months, p < 0.009), TAR1 (18.25% ± 4.54% vs. 14.33% ± 5.74% at 1 month, p < 0.006; 19.87% ± 5.15% vs. 14.67% ± 4. 36% at 3 months, p < 0.009) and TAR2 (4.75% ± 2.67% vs. 2.75% ± 1.96% at 1 month, p = 0.0307; 5.40% ± 2.85% vs. 3% ± 2.45% at 3 months, p < 0.027). the use of automated systems such as the MiniMedTM780G system brings glucometric results closer to those recommended by consensus, especially in age at T1D onset >4 years. However, the management in pediatrics continues to be a challenge even after the implementation of these systems, especially in terms of hyperglycemia and glycemic variability.

Quality of life from the patient perspective at the end of the first rehabilitation after the onset of spinal cord injury/disorder – A qualitative interview-based study

Context At present, there is a lack of information concerning patients’ perspectives on their quality of life (QoL) after a recently acquired spinal cord injury/disorder (SCI/D). Objective To explore patients’ perspectives on their QoL during their first inpatient rehabilitation after the onset of SCI/D. Methods Qualitative study. Semi-structured face-to-face interviews were conducted with 20 participants aged 18 years or older at least three months after the onset of SCI/D and two weeks before they were discharged from their first rehabilitation. Audio-recorded interviews were transcribed and analyzed according to the thematic content analysis. Interviewees rated their QoL with the SCI QoL data set. Results The interviewees judged their satisfaction with life as a whole, their physical and mental health, as relatively high with values between six and eight (with 10 meaning complete satisfaction). They highlighted social aspects, health topics, and the experience of autonomy as relevant to their concept of QoL. The aspects that positively influenced QoL included the level of well-being in the current social and institutional environment, the increased level of energy, strength, and autonomy in daily life, and an improved mental state derived from general positive personal attitudes. In contrast, the social restrictions during the COVID-19 pandemic, physical issues including pain, a lack of progress associated with psychological dissatisfaction, and limitations in personal independence decreased patients’ QoL. Conclusion Since the interviewees described different aspects from the areas of social, health and autonomy as important for their QoL, exploring and addressing these areas should be used to achieve an individualized first rehabilitation.

How older adults with physical impairments maintain their autonomy in nursing homes

Abstract Autonomy is important to persons, including when they are living in nursing homes. Especially the relational dimension of autonomy is crucial for older adults with physical impairments. They generally have the decisional capacity to make choices about how they want to live their lives, but are often unable, or only partially able, to exercise these decisions themselves. To execute decisions, older adults are dependent on those who support them or care for them. However, little is known about how nursing home residents maintain autonomy in daily life and how others are involved in the decisions and execution of the decisions. To examine how older adults with physical impairments living in nursing homes maintain autonomy in daily life, shadowing, a non-participative observational method, was used. Seventeen older adults were shadowed during the course of one day. The observation ended with a brief interview. After the shadowing, the detailed observation notes were typed out, combined with the verbatim transcript resulting in one extensive report per shadowee. All 17 reports were coded and analysed thematically. Six elements for how older adults maintain autonomy in relation with others were identified, i.e. ‘being able to decide and/or execute decisions’, ‘active involvement’, ‘transferring autonomy to others’, ‘using preferred spaces’, ‘choosing how to spend time in daily life’ and ‘deciding about important subjects’. For all six elements established in this study, it was found that older adults with physical impairments living in nursing homes could only maintain autonomy in daily life when others, such as staff, family and friends, were responsive to signals of the needs of older adults.

CAN LOCAL MILLIMETRIC WAVES EXPOSURE BE HELPFUL FOR INFLAMMATORY RHEUMATISM CARE? A 4 CASES REPORT ON RHEUMATOID ARTHRITIS AND ANKYLOSING SPONDYLITIS

Rheumatoid arthritis (RA) and ankylosing spondylitis (SPA) are painful autoimmune, acute or chronic pathologies the joints, muscles and other tissues. Global care implies both medical more or less aggressive therapies, and physical treatments ght against pain and stiffness, vicious positions, and also improve autonomy in daily life. Anti-inammatory properties of millimetric waves (MMW) have been identied since the end of 20th century, and recently tested using miniaturized MMW transmitter bracelet. We report here 4 cases (2SPA and 2RA) who experienced pain relief, functional and autonomy improvement, while limiting their intake of analgesics. Further extensive investigations are required.

Deriving Implications for Care Delivery in Parkinson's Disease by Co-Diagnosing Caregivers as Invisible Patients.

For persons with Parkinson’s disease, the loss of autonomy in daily life leads to a high level of dependency on relatives’ support. Such dependency strongly correlates with high levels of perceived stress and psychosocial burden in informal caregivers. Global developments, such as demographic change and the associated thinning infrastructure in rural areas cause a continuously growing need for medical and nursing care. However, this need is not being adequately met. The resulting care gap is being made up by unpaid or underpaid work of informal caregivers. The double burden of care work and gainful employment creates enormous health-related impairments of the informal caregivers, so that they eventually become invisible patients themselves. Expectedly, those invisible patients do not receive the best care, leading to a decrease in quality of life and, in the end, to worse care for PD patients. Suggested solutions to relieve relatives, such as moving the person affected by Parkinson’s to a nursing home, often do not meet the wishes of patients and informal caregivers, nor does it appear as a structural solution in the light of demographic change against an economic background. Rather, it requires the development, implementation and evaluation of new, holistic approaches to care that make invisible patients visible.

Brain-Computer Interface Training With Functional Electrical Stimulation: Facilitating Changes in Interhemispheric Functional Connectivity and Motor Outcomes Post-stroke.

While most survivors of stroke experience some spontaneous recovery and receive treatment in the subacute setting, they are often left with persistent impairments in upper limb sensorimotor function which impact autonomy in daily life. Brain-Computer Interface (BCI) technology has shown promise as a form of rehabilitation that can facilitate motor recovery after stroke, however, we have a limited understanding of the changes in functional connectivity and behavioral outcomes associated with its use. Here, we investigate the effects of EEG-based BCI intervention with functional electrical stimulation (FES) on resting-state functional connectivity (rsFC) and motor outcomes in stroke recovery. 23 patients post-stroke with upper limb motor impairment completed BCI intervention with FES. Resting-state functional magnetic resonance imaging (rs-fMRI) scans and behavioral data were collected prior to intervention, post- and 1-month post-intervention. Changes in rsFC within the motor network and behavioral measures were investigated to identify brain-behavior correlations. At the group-level, there were significant increases in interhemispheric and network rsFC in the motor network after BCI intervention, and patients significantly improved on the Action Research Arm Test (ARAT) and SIS domains. Notably, changes in interhemispheric rsFC from pre- to both post- and 1 month post-intervention correlated with behavioral improvements across several motor-related domains. These findings suggest that BCI intervention with FES can facilitate interhemispheric connectivity changes and upper limb motor recovery in patients after stroke.

Neurological outcome in WDR62 primary microcephaly.

To characterize the cortical structure, developmental, and cognitive profiles of patients with WD repeat domain 62 (WDR62)-related primary microcephaly. In this observational study, we describe the developmental, neurological, cognitive, and brain imaging characteristics of 17 patients (six males, 11 females; mean age 12y 3mo standard deviation [SD] 5y 8mo, range 5y-24y 6mo) and identify 14 new variants of WDR62. We similarly analyse the phenotypes and genotypes of the 59 previously reported families. Brain malformations, including pachygyria, neuronal heterotopia, schizencephaly, and microlissencephaly, were present in 11 out of 15 patients. The mean full-scale IQ of the 11 assessed patients was 51.8 (standard deviation [SD] 12.6, range 40-70). Intellectual disability was severe in four patients, moderate in four, and mild in three. Scores on the Vineland Adaptive Behavior Scales obtained from 10 patients were low for communication and motor skills (mean 38.29, SD 7.74, and 37.71, SD 5.74 respectively). The socialization score was higher (mean 47.14, SD 12.39). We found a significant difference between scores for communication and daily living skills (mean 54.43, SD 11.6; p=0.001, one-way analysis of variance). One patient displayed progressive ataxia. WDR62-related cognitive consequences may be less severe than expected because 3 out of 11 of the assessed patients had only mild intellectual disability and relatively preserved abilities of autonomy in daily life. We identified progressive ataxia in the second decade of life in one patient, which should encourage clinicians to follow up patients in the long term.

Procedural Learning through Action Observation: Preliminary Evidence from Virtual Gardening Activity in Intellectual Disability.

Intellectual disability (ID) compromises intellectual and adaptive functioning. People with an ID show difficulty with procedural skills, with loss of autonomy in daily life. From an embodiment perspective, observation of action promotes motor skill learning. Among promising technologies, virtual reality (VR) offers the possibility of engaging the sensorimotor system, thus, improving cognitive functions and adaptive capacities. Indeed, VR can be used as sensorimotor feedback, which enhances procedural learning. In the present study, fourteen subjects with an ID underwent progressive steps training combined with VR aimed at learning gardening procedures. All participants were trained twice a week for fourteen weeks (total 28 sessions). Participants were first recorded while sowing zucchini, then they were asked to observe a virtual video which showed the correct procedure. Next, they were presented with their previous recordings, and they were asked to pay attention and to comment on the errors made. At the end of the treatment, the results showed that all participants were able to correctly garden in a real environment. Interestingly, action observation facilitated, not only procedural skills, but also specific cognitive abilities. This evidence emphasizes, for the first time, that action observation combined with VR improves procedural learning in ID.

PDB32 Integration of Patient-Reported Outcome Measures in the Evaluation of Digital Health Solutions: Research in Diabetes

Although the field of Digital Health Solutions (DHS) for improving outcomes in diabetes has evolved rapidly over the last 20 years, there are still significant challenges in generating relevant evidence and demonstrating the value such solutions bring to patients and the overall health-care value chain. Research was conducted to review guidelines from national health authorities regarding patient outcomes to consider in the evaluation of DHS and to determine if existing Patient-Reported Outcome Measures (PROMs) are adequate tools for assessing the value of DHS. Guidelines for evaluating DHS from national health authorities in France (HAS), Germany (BfArM), the UK (NICE), and the US (FDA) were reviewed. Recommended patient outcomes were retrieved, as well as the role of PROMs in assessing them. In addition, a list of PROMs used in diabetes care was identified from the ProQolid database, Clinicaltrials.gov and PubMed. Each instrument was evaluated on multiple attributes, including previous use in assessing DHS, and classified by patient value domain. Five guidelines were reviewed identifying 12 domains of patient outcomes. Most guidelines focused on a particular type of DHS and there was no consensus across guidelines on patient outcomes. Nevertheless, all health authorities recognize PROMs as important tools to demonstrate the value of DHS. Overall, 62 PROMs were identified (46 diabetes-specific and 16 non-diabetes-specific) in the literature. There was a clear alignment between some of the outcomes covered in both the guidelines and PROMs, such as satisfaction, empowerment, health literacy, adherence and quality of life. However, some patient outcomes in the guidelines were poorly covered by (existing) PROMs, such as engagement, autonomy in daily life, coping strategies and reduction of efforts. It is urgent to develop frameworks aiming at integrating relevant domains of patient value in the evaluation of DHS to ensure alignment across national jurisdictions in reimbursement processes.

Being adults with cerebral palsy: results of a multicenter Italian study on quality of life and participation.

Cerebral palsy (CP) is still the most common cause of disability developing in infancy. How such a complex disorder affects adult life raises important questions on the critical issues to consider and the most appropriate care pathway right from early childhood. We conducted a multicenter study on a sample of 109 individuals with CP followed up from infancy and recalled for an assessment at ages ranging between 18 and 50 years (mean age 26 years). Semi-structured interviews and specific questionnaires (SF36, LIFE-H and Hollingshead Index) were conducted to assess general psychological state, quality of life, and socio-economic conditions. Our findings showed a globally positive perception of quality of life, albeit with lower scores for physical than for mental health. Our cases generally showed good scores on participation scales, though those with more severe forms scored lower on parameters such as mobility, autonomy, and self-care. These findings were investigated in more depth in interviews, in which our participants painted a picture showing that gradual improvements have been made in several aspects over the years, in the academic attainment and employment, for instance. On the downside, our sample reported persistent limitations on autonomy in daily life. As for the more profound psychological domain, there was evidence of suffering due to isolation and relational difficulties in most cases that had not emerged from the questionnaires. Our data have possible implications for the management of CP during childhood, suggesting the need to avoid an exclusive focus on motor function goals, and to promote strategies to facilitate communication, participation, autonomy, and social relations.

Using the concept of activity space to understand the social health of older adults living with memory problems and dementia at home

Globally as the population ages, the prevalence of dementia will increase. Simultaneously, there is a trend toward people ageing at home. Therefore, more people will be ageing at home with dementia, as opposed to institutional environments. In this context, there has been a recent shift in research exploring ways that people can live well with the consequences of the disease. As a part of this emerging research, the social and spatial aspects of the lives of people living with memory problems are becoming increasingly of interest. The aim of this article is to use the concept of activity space to examine the social health of older adults with memory problems and dementia who live at home. Activity space data were collected from seven older adults experiencing memory problems and living at home in the Netherlands. Using a mixed-methods approach, insight into their activity spaces were gained through walking interviews, 14 days of global positioning system (GPS) movement data, travel diary entries and in-depth interviews. The GPS data, travel diary data and interview transcripts were analyzed using a grounded visualization approach. Our findings show that participants interact independently in routine activity spaces but depend on others to participate in occasional activity spaces. Interactions within both these spaces contribute to the social health of older adults with memory problems and dementia who live at home. Additionally, participants used coping strategies and decision-making to maintain autonomy in daily life. The findings can inform dementia-friendly initiatives and social health care planning.

Quality of life up to 10 years after traumatic brain injury: a cross-sectional analysis

BackgroundTraumatic brain injury (TBI) is the leading cause of death and disability among children and young adults in industrialized countries, but strikingly little is known how patients cope with the long-term consequences of TBI. Thus, the aim of the current study was to elucidate health-related quality of life (HRQoL) and outcome predictors in chronic TBI adults.MethodsIn this cross-sectional study, 439 former patients were invited to report HRQoL up to 10 years after mild, moderate or severe TBI using the QOLIBRI (Quality of Life after Brain Injury) questionnaire. The QOLIBRI total score has a maximum score of 100. A score below 60 indicates an unfavorable outcome with an increased risk of an affective and/or anxiety disorder. Results were correlated with demographics and basic characteristics received from medical records (TBI severity, etiology, age at TBI, age at survey, time elapsed since TBI, and sex) using regression models. Differences were considered significant at p < 0.05.ResultsFrom the 439 invited patients, 135 out of 150 in principle eligible patients (90%) completed the questionnaire; 76% were male, and most patients experienced severe TBI due to a traffic-related accident (49%) or a fall (44%). The mean QOLIBRI total score was 65.5 (± 22.6), indicating good HRQoL. Factors for higher level of satisfaction (p = 0.03; adjusted R2 = 0.1) were autonomy in daily life (p = 0.03; adjusted R2 = 0.09) and cognition (p = 0.05; adjusted R2 = 0.05). HRQoL was weakly correlated with initial TBI severity (p = 0.04; adjusted R2 = 0.02). 36% of patients reported unfavorable HRQoL with increased risk of one (20%) or two (16%) psychiatric disorders.ConclusionsThe majority of chronic TBI patients reported good HRQoL and the initial TBI severity is a slight contributor but not a strong predictor of HRQoL. Autonomy and cognition are decisive factors for satisfied outcome and should be clearly addressed in neurorehabilitation. One third of patients, however, suffer from unsatisfactory outcome with psychiatric sequelae. Thus, an early neuropsychiatric assessment after TBI is necessary and need to be installed in future TBI guidelines.

Perspectives on decision making amongst older people with end-stage renal disease and caregivers in Singapore: A qualitative study.

BackgroundEnd‐stage renal disease (ESRD) is increasing both globally and in Asia. Singapore has the fifth highest incidence of ESRD worldwide, a trend that is predicted to rise. Older patients with ESRD are faced with a choice of haemodialysis, peritoneal dialysis or conservative management, all of which have their risks and benefits.ObjectiveThis study seeks to explore perspectives on decision making amongst older (≥70) Singaporean ESRD patients and their caregivers to undergo (or not to undergo) dialysis.DesignQualitative study design using semi‐structured interviews.Setting and participantsTwenty‐three participants were recruited from the largest tertiary hospital in Singapore: seven peritoneal dialysis patients, five haemodialysis patients, four patients on conservative management and seven caregivers.ResultsWhile some patients believed that they had made an independent treatment decision, others reported feeling like they had no choice in the matter or that they were strongly persuaded by their doctors and/or family members to undergo dialysis. Patients reported decision‐making factors including loss of autonomy in daily life, financial burden (on themselves or on their families), caregiving burden, alternative medicine, symptoms and disease progression. Caregivers also reported concerns about financial and caregiving burden.Discussion and conclusionThis study has identified several factors that should be considered in the design and implementation of decision aids to help older ESRD patients in Singapore make informed treatment decisions, including patients' and caregivers' decision‐making factors as well as the relational dynamics between patients, caregivers and doctors.

Stereotypic behaviours in frontotemporal dementia and progressive supranuclear palsy

IntroductionThe behavioural variant of frontotemporal dementia (bvFTD), and the Richardson variant of progressive supranuclear palsy (PSP-RS) share several clinical signs and symptoms. Since stereotypic behaviours are fairly common in bvFTD, and are also described in other degenerative dementias including Alzheimer's disease, and parkinsonisms with dementia, we aimed to examine the extent to which stereotypies also characterise PSP-RS. MethodsWe compared 53 bvFTD patients with 40 demented PSP-RS patients, seen consecutively as outpatients at four Italian Hospitals. Patients were assessed by the Neuropsychiatric Inventory (NPI); Mini-Mental State Examination (MMSE) and Frontal Assessment Battery (FAB) for cognitive functions; Stereotypy Rating Inventory (SRI) for stereotypies; Unified Parkinson's Disease Rating Scale (UPDRS) for motor function; and Activities of Daily Living (ADL) to assess autonomy in daily life. ResultsThe groups did not differ for age, illness duration, cognitive functions or total NPI score; PSP-RS had significantly more depressive symptoms and greater motor and autonomy compromise than bvFTD. The groups did not differ significantly on total SRI score, but bvFTD had significantly more cooking and eating stereotypies. Twenty-three (57.5%) PSP-RS and 43 (81%) bvFTD patients had at least one stereotypy; 16/23 (69.5%) PSP-RS and 9/43 (20.9%) bvFTD patients appeared aware of their stereotypies. ConclusionStereotypies were common in our demented PSP-RS patients. Further studies on earlier stage non-demented PSP patients are required to ascertain whether stereotypies are characteristic of PSP in general or are confined to PSP-RS, and whether they may be used to suggest a PSP diagnosis early in disease course.

Knee extensor muscular activity estimation during different walking patterns: flat normal and brisk walking, stair climbing.

Preserving mobility, the ability to keep a correct posture and dynamic balance in order to walk properly, is fundamental to maintain autonomy in daily life. Based on the correlation between muscle groups and autonomy, previous research has suggested that maintaining muscular tone in knee extensors is critical. Continuous training of knee extensors during aging is therefore essential to maintain independence. In this work, it is hypothesized that it is possible to estimate knee extensor activity only from IMU data based on a simple lower limbs model. The accuracy of the knee extensor activity estimation algorithm has been tested using sEMG measurements as control data on three different walking patterns: normal walk, fast walk and stair climbing. Estimated knee torque area and measured muscular activity for each step were compared confirming a high estimation accuracy with a correlation efficient R=0.80. Moreover, muscular activity can be divided based on intensity in three groups of statistically significant difference confirmed by the Steel-Dwass method. Future works should test the usability of the algorithm for different walking patterns, and use the collected data and the refined algorithm to implement a smart resistive device to increase knee extensor exertion during each walking pattern to the level necessary for sufficient extensor training.

The Role of Women's Empowerment on Child Nutrition in India

Child malnutrition remains a pervasive problem in India though there are significant improvements in several health indicators with country’s consistent economic growth. Along with other factors, maternal autonomy is considered to be critical in influencing health outcome of a child. This paper attempts to examine the determinants of nutritional measures of children under age five with the focus on the role of mother’s autonomy in India. There are many literature which link characteristics of mother, like education, age, with nutrition of her children. But maternal autonomy is a complex subject as this variable is not tangible. Women’s autonomy in daily life is more likely to result in their better healthcare which in turn influences children’s birth weight and infant nutrition. We used nationally representative India Human Development Survey 2004-05 (IHDS- 1) and 2011-12 (IHDS 2) data for the analysis. Logistic regressions are used to study the effect after controlling for child-specific variables (age, sex), mother-specific variables (age, height, education, age at marriage,), demographic information (caste, religion), household characteristics (wealth, region). We have used the panel data with two waves and used mothers fixed effect model to evaluate the impact of maternal autonomy. A child’s height-for-age (stunting) is an indicator of chronic malnutrition. Our sample is restricted to children below five years. Final sample contains 9,389 children below five for which height and weight both are available to calculate Z-score. The autonomy index is created using four dimensions- women’s decision making, freedom of movement, financial autonomy and attitude towards domestic violence. Logistic regression models were used to test associations between indicators of female autonomy and the risk of having a stunted child.

Correction of hypercapnia improves cognitive efficiency and attention in a brain-injured patient

Correction of obstructive sleep apnea (OSAS) by non-invasive continuous pressure ventilation (CPAP) allows an improvement of attentional and executive functions, especially post-stroke. On the other hand, in chronic obstructive pulmonary disease, correction of hypercapnia by bilevel positive airway pressure ventilation (BiPAP) improves cognitive impairment. We present a case of a brain-injured patient who remains hypercapnic despite an effective CPAP for the correction of an OSAS. We present a 36-year-old patient with visuo-spatial disorders, dysexecutive syndrome, cerebellar syndrome, swallowing disorders after a rupture of a right vertebral artery aneurysm 2 years before. Oral feeding by adapted texture (mixed), tracheotomy, CPAP for OSAS for several months were needed. We performed cognitive assessments (MoCA: Montreal Cognitive Assessment and BAWL: Attentional Battery William Lennox), pre- (T1) and post- (T2) correction of hypercapnia by night BiPAP, 2 months later. After correction of hypercapnia (T1 PaCO 2 = 7.36 kPa or 55 mmHg then T2 PaCO 2 = 5.86 kPa or 44 mmHg), improvement of: Global cognitive efficiency (MoCA score: + 4/30); Attention (MoCA attention items: +2/6); Simple reaction times (BAWL: –32 ms, from percentile 5 at T1 to percentile 15 at T2); Memory encoding (MoCA 5 words test: + 2/5 points and no false memories anymore). In addition, dysphagia improves by mealtime reduction (50 min versus 1h40) and laryngeal penetration decrease, which allows a withdrawal of the tracheotomy. In this case, the improvement of global cognitive capacities, attention and cognitive processing speed seems to result from the decrease of capnia. The persistence of sequelae of the intracranial aneurysm rupture (specially visuo-spatial and cerebellar) suggests that improvements on cognitive functions stem from the correction of hypercapnia. This case suggests the importance of a normalization of capnia in brain-injured patients with ventilatory disorders to improve the cognitive (global and attentional) capacities and autonomy in daily life (feeding and tracheotomy withdrawal). Larger studies are needed to confirm this.

Predictors of long-term functional outcome and health-related quality of life after out-of-hospital cardiac arrest

BackgroundEven if a large majority of out-of-hospital cardiac arrest (OHCA) survivors appear to have a good neurological recovery with no important sequellae, whether health-related quality of life (HRQOL) is altered is less explored. Patients and methodsHRQOL was evaluated by telephone interview using SF-36 questionnaire. Each OHCA case was age and gender-matched with 4 controls from the French general population. Association between current condition of the survivors with the 8 dimensions of the SF-36 questionnaire was investigated using MANCOVA. Cluster analysis was performed to identify patterns of HRQOL among CPC1 survivors. Results255 patients discharged alive from our referral centre between 2000 and 2013 (median age of 55y [45,64], 73.7% males) were interviewed. Global physical and mental components did not differ between CPC 1 survivors and controls (47.0 vs. 47.1, p=0.88 and 46.4 vs. 46.9, p=0.45) but substantially differed between CPC2, CPC3 and the corresponding controls. Younger age, male gender, good neurological recovery and daily-life autonomy at telephone interview were significantly associated with better scores in each SF-36 dimensions. Cluster analysis individualized 4 distinct subgroups of CPC1 patients characterised by progressively increased score of SF-36. Return to work and daily-life autonomy were differently distributed across these 4 groups while pre-hospital Utstein variables were not. ConclusionHRQOL of CPC1 OHCA survivors appeared similar to that of the general population, but patients with CPC2 or 3 had altered HRQOL. Younger age, male gender, good neurological recovery and daily-life autonomy were independently associated with a better HRQOL.