Early Cognitive Outcomes Research Articles

Presurgical predictors of early cognitive outcome after brain tumor resection in glioma patients

Gliomas are commonly characterized by neurocognitive deficits that strongly impact patients’ and caregivers’ quality of life. Surgical resection is the mainstay of therapy, and it can also cause cognitive impairment. An important clinical problem is whether patients who undergo surgery will show post-surgical cognitive impairment above and beyond that present before surgery. The relevant rognostic factors are largely unknown.This study aims to quantify the cognitive impairment in glioma patients 1-week after surgery and to compare different pre-surgical information (i.e., cognitive performance, tumor volume, grading, and lesion topography) towards predicting early post-surgical cognitive outcome.We retrospectively recruited a sample of N = 47 patients affected by high-grade and low-grade glioma undergoing brain surgery for tumor resection. Cognitive performance was assessed before and immediately after (∼1 week) surgery with an extensive neurocognitive battery. Multivariate linear regression models highlighted the combination of predictors that best explained post-surgical cognitive impairment.The impact of surgery on cognitive functioning was relatively small (i.e., 85% of test scores across the whole sample indicated no decline), and pre-operative cognitive performance was the main predictor of early post-surgical cognitive outcome above and beyond information from tumor topography and volume. In fact, structural lesion information did not significantly improve the accuracy of prediction made from cognitive data before surgery.Our findings suggest that post-surgery neurocognitive deficits are only partially explained by preoperative brain damage. The present results suggest the possibility to make reliable, individualized, and clinically relevant predictions from relatively easy-to-obtain information.

Cognitive outcome in patients one month after mild to moderate aneurysmal subarachnoid hemorrhage: Focus on the location of the aneurysm

ObjectivePatients with good recovery after aneurysmal subarachnoid hemorrhage (SAH) are commonly discharged about one month after the event. However, these patients often still show cognitive symptoms, such as fatigue, difficulty concentrating, and irritability. Understanding the early cognitive outcome of patients with SAH with good recovery is thought to be crucial for neurosurgical nursing staff. We analyzed patient data to clarify whether cognitive outcome depends on the location of the ruptured aneurysm 1 month after SAH. MethodsFor 186 patients (72 men and 114 women; median age, 57 years; age range, 21–83 years) who had experienced SAH (Hunt & Kosnik grade I to III), we retrospectively analyzed data on the location of the ruptured aneurysm, Fisher grade at admission, treatment modality (coil embolization, clipping, or no surgical treatment), neuropsychological assessments 1 month after SAH, and modified Rankin Scale 6 months after SAH. ResultsCrystallized intelligence (i.e., IQ, assessed using the Mini-Mental State Examination and Kohs Block Design Test) improved to almost normal levels in all patients, irrespective of the location of the ruptured aneurysm. In contrast, fluid intelligence (e.g., executive function and attention, assessed using the Frontal Assessment Battery; Trail Making Test, Part A; and the Japanese Kana-hiroi test) did not improve as much, specifically in patients with a ruptured aneurysm in the basilar artery. ConclusionsThese results may help nursing staff to identify mild- to moderate-grade patients at greater risk of problems and to arrange appropriate support strategies for patients after discharge.

Silent brain infarcts and early cognitive outcomes after transcatheter aortic valve implantation: a systematic review and meta-analysis.

Silent brain infarcts (SBIs) are frequently identified after transcatheter aortic valve implantation (TAVI), when patients are screened with diffusion-weighted magnetic resonance imaging (DW-MRI). Outside the cardiac literature, SBIs have been correlated with progressive cognitive dysfunction; however, their prognostic utility after TAVI remains uncertain. This study's main goals were to explore (i) the incidence of and potential risk factors for SBI after TAVI; and (ii) the effect of SBI on early post-procedural cognitive dysfunction (PCD). A systematic literature review was performed to identify all publications reporting SBI incidence, as detected by DW-MRI after TAVI. Silent brain infarct incidence, baseline characteristics, and the incidence of early PCD were evaluated via meta-analysis and meta-regression models. We identified 39 relevant studies encapsulating 2408 patients. Out of 2171 patients who underwent post-procedural DW-MRI, 1601 were found to have at least one new SBI (pooled effect size 0.76, 95% CI: 0.72-0.81). The incidence of reported stroke with focal neurological deficits was 3%. Meta-regression noted that diabetes, chronic renal disease, 3-Tesla MRI, and pre-dilation were associated with increased SBI risk. The prevalence of early PCD increased during follow-up, from 16% at 10.0 ± 6.3 days to 26% at 6.1 ± 1.7 months and meta-regression suggested an association between the mean number of new SBI and incidence of PCD. The use of cerebral embolic protection devices (CEPDs) appeared to decrease the volume of SBI, but not their overall incidence. Silent brain infarcts are common after TAVI; and diabetes, kidney disease, and pre-dilation increase overall SBI risk. While higher numbers of new SBIs appear to adversely affect early neurocognitive outcomes, long-term follow-up studies remain necessary as TAVI expands to low-risk patient populations. The use of CEPD did not result in a significant decrease in the occurrence of SBI.

Eight-year-old very and extremely preterm children showed more difficulties in performance intelligence than verbal intelligence.

AimThis study determined possible discrepancies between verbal IQ and performance IQ in 8‐year‐old very preterm (VPT) and extremely preterm (EPT) children, and examined associations between verbal IQ and performance IQ, and sociodemographic factors, perinatal factors, early cognitive outcomes and also with school achievement scores.MethodsThis prospective cohort study included 120 eight‐year‐old VPT/EPT children. Cognitive development was assessed at the ages of 2, 5 and 8 years. Eight years’ school achievement results in arithmetic, reading and spelling were collected. Multiple regression analyses were performed to determine predictors of verbal IQ and performance IQ at the age of 8 years and to determine associations with school achievement scores.ResultsMean performance IQ (89.8) was significantly lower than mean verbal IQ (99.4; Cohen's d = 0.59) at the age of 8 years. Gestational age (GA), small for GA status, and cognitive scores at the ages of 2 and 5 years significantly predicted verbal IQ and performance IQ at the age of 8 years. Performance IQ at age 8 years was an important predictor for arithmetic scores (β = 0.42).ConclusionPerformance IQ was more strongly affected than verbal IQ in 8‐year‐old VPT/EPT children and was strongly related to mathematical difficulties.

Childcare Use and Its Role in Indigenous Child Development: Evidence from the Longitudinal Study of Indigenous Children in Australia

We investigate patterns of childcare use and its influence on the cognitive development of Indigenous children. The influence of childcare on Indigenous children's cognitive outcomes is less well understood than for non‐Indigenous children due to a lack of appropriate data. We focus on a cohort of Indigenous children in Australia who have been followed from infancy and for whom rich information on childcare use and cognitive outcomes is observed. Compared to Indigenous children who never participated in childcare, Indigenous children who participated in childcare performed better on several early cognitive outcomes. Using regression and propensity score matching, we show that this difference is driven by selection into childcare, with children from more advantaged families being more likely to attend formal childcare. However, matching analysis results suggest that relatively disadvantaged children might benefit more from attending childcare, as indicated by the positive estimated effects found for those who never attended childcare.

The very question of future development of extremely preterm infants

The survival rates for extremely preterm infants, born at <28 weeks of gestation, have markedly improved over the past two decades and this has raised concern over a possible increase in morbidity. Due to advances in perinatal, neonatal and paediatric care, our greatest fears have not materialised. Instead, most infants born preterm these days function in the same way as their term-born counterparts 1. The clinical challenge is to recognise those preterm infants who face a higher risk of a wide range of disabilities, and the most common issues at the moment are cognitive and behavioural problems. A systematic review that was published online in January 2018 looked at 30 studies covering a total of 10 293 preterm infants born before 32 weeks of gestation and/or with very low birthweights of <1500 g after 2006. It estimated that 20.6% had motor delays at approximately two years of corrected age, with a 95% confidence interval of 13.9–29.4, and that the figures for cognitive delays were 16.9% (10.4–26.3) on the basis of developmental scales 2. Despite extensive meta-analyses and outcome research after very preterm births, the clinician at the bedside of an extremely preterm infant in an individual neonatal intensive care unit is still uncertain about the extent to which they will face these delays. One of the major challenges of interpreting the results of any outcome studies or systematic reviews on preterm infants is the heterogeneity of research designs 2. There are wide differences in reporting active treatment policies at birth 3, background mortality rates 3, inclusion and exclusion criteria such as genetic disorders, sociodemographic characteristics, parental education, length of follow-up and the exact measures used and definitions of outcome. All of this might result in flaws with regard to the clinical impact of the study. Brain imaging protocols, magnetic resonance imaging (MRI) settings and expertise levels differ between centres, resulting in a wide variation in sensitivity and specificity of brain MRI findings, for example as predictors of cerebral palsy 4. It is also evident that the landscape of classical phenotypes of preterm morbidity and outcomes is changing. In this issue of Acta Paediatrica, Brumbaugh et al. 5 use the National Institute of Health consensus definition of bronchopulmonary dysplasia (BPD) to define modern BPD. Using this classification by severity, they report that modern BPD may not, in itself, translate to poor early cognitive outcomes that are similar to classic BPD. This is a concrete message that tells clinicians like me that we need to prepare to change our thinking about the causal connections between neonatal morbidities and outcome. The decreasing trend of cerebral palsy, even among extremely preterm infants 2, has already changed our perceptions of the outcomes of prematurity. At the same time, the severity of cerebral palsy in preterm infants has decreased 6. As a clinical observation, it has also been commented that the main type of cerebral palsy in preterm survivors has changed from bilateral spastic type to unilateral spastic cerebral palsy. There is strong demand for harmonising outcome studies to enhance the accumulation of accurate prognostic information. The 2016 paper by Rysavy et al. 7 provided recommendations for reporting outcomes of extremely preterm births to improve the dialogue about the topic and enable us to compare outcomes between different studies. This distinctive paper serves as a valuable resource for everyone carrying out outcome studies of preterm infants. When the parents of an extremely preterm infant who has a severe BPD and unilateral periventricular haemorrhagic infarction ask me about their child's future development, which is the most important factor after their survival, what valid evidence do I use as the basis for my answer? Despite the research that has been carried out to date, the question still remains under debate. We still need to know so much more.

Cognitive development in children up to age 11 years born after ART-a longitudinal cohort study.

STUDY QUESTIONHow does the cognitive development of children conceived after ART (IVF and ICSI) – measured as cognitive skills at age 3, 5, 7 and 11 years – differ over time from those born after natural conception (NC)?SUMMARY ANSWERImproved measures of cognitive development up to age 5 years were recorded in children conceived with ART compared to NC, which attenuates by 11 years, with ART children still scoring slightly better than NC children.WHAT IS KNOWN ALREADYResults on the cognitive outcomes of children conceived after ART have been highly contradictory. Some have shown that ART children have an impaired behavioural, socio-emotional and cognitive development and higher risk of mental disorders. Others have reported no increased risk or difference. Cognitive development has not been previously examined using latent growth curve models from ages 3 to 11 years, also including appropriate attention to confounding parental characteristics.STUDY DESIGN, SIZE, DURATIONLongitudinal data for the first five waves (2000–2012) of the UK Millennium Cohort Study were used, which is a two-stage sample of all infants born in 2000–2001 and resident in the UK at 9 months of age, drawn from the Department of Social Security Child Benefit Registers. A final sample of N = 15 218 children (125 IVF and 61 ICSI), from 14 816 families was used. Information was available for all waves for 8298 children. Four additional follow-up surveys were conducted in 2003, 2005, 2007 and 2012.PARTICIPANTS/MATERIALS, SETTING, METHODSOur sample includes children born within a union (married or cohabiting parents) and where information on cognitive scores was available for at least two measurement points. Cognitive development was assessed with the British Ability Scales. At age 3 and 5 years (wave 2 and 3), children completed the naming vocabulary component, which measures expressive verbal ability. At age 7 years (wave 4), verbal cognitive abilities were assessed through the word reading test, and at age 11 years (wave 5) through a verbal similarity test. Two-tailed Student's t-tests examined differences between ART and NC groups. Growth curve models (random-coefficient, latent trajectory models) were used to study the effect of ART, confounding parental characteristics and health outcomes at birth, both at a baseline level of cognitive ability at age 3 years and on its growth rate.MAIN RESULTS AND THE ROLE OF CHANCEAt age 3 and 5 years, children conceived with the aid of ART have higher verbal cognitive abilities than NC children (P < 0.001) but this consistently decreases over time and diminishes by age 11 years. Parental environment and resources are pivotal in children's cognitive development.LIMITATIONS, REASON FOR CAUTIONThe sample size of the ART cohort of children is small across each time period (N = 150–180) in comparison with NC children (N = 10 496–11 955). Owing to a limited sample size, we are also unable to compare IVF versus ICSI treatment.WIDER IMPLICATIONS OF THE FINDINGSWith the increasing use of IVF and ICSI, these results indicate that there are no detrimental effects on children's early cognitive outcomes up to age 11 years, and highlight the importance of parental characteristics.STUDY FUNDING/COMPETING INTEREST(S)Funding for this project was provided by the European Union's Seventh Framework Program (FP7 2007–2013) (No. 320116 Families and Societies), ESRC/NCRM SOCGEN Grant (ES/N0011856/1) and the SOCIOGENOME ERC Consolidator Grant (ERC-2013-CoG-615603) (to M.C.M.). The authors have no competing interests to declare.TRIAL REGISTRATION NUMBERN/A.

The effect of desflurane versus propofol anesthesia on postoperative delirium in elderly obese patients undergoing total knee replacement: A randomized, controlled, double-blinded clinical trial

Study objectiveThe goal of this study was to investigate the incidence of delirium, wake-up times and early post-operative cognitive decline in one hundred obese elderly patients undergoing total knee arthroplasty. DesignProspective randomized trial. SettingsOperating room, postoperative recovery area, hospital wards. Patients100 obese patients (ASA II and III) undergoing primary total knee replacement under general anesthesia with a femoral nerve block catheter. InterventionPatients were prospectively randomized to maintenance anesthesia with either propofol or desflurane. MeasurementsThe primary endpoint assessed by a blinded investigator was delirium as measured by the Confusion Assessment Method. Secondary endpoints were wake-up times and a battery of six different tests of cognitive function. Main resultsFour of the 100 patients that gave informed consent withdrew from the study. Of the remaining 96 patients, 6 patients did not complete full CAM testing. Preoperative pain scores, durations of surgery and anesthesia, and amount of intraoperative fentanyl were not different between groups. One patient in the propofol group developed delirium compared to zero in desflurane. One patient in desflurane group developed a confused state not characterized as delirium. Fifty percent of the patients exhibited a 20% decrease in the results of at least one cognitive test on the first 2days after surgery, with no difference between groups. There were no differences in the time to emergence from anesthesia, incidence of postoperative nausea and vomiting, and length of postanesthesia care unit (PACU) stay between the two groups. ConclusionsIn conclusion we found a low incidence of delirium but significant cognitive decline in the first 48h after surgery. In this relatively small sample size of a hundred patients there was no difference in the incidence of postoperative delirium, early cognitive outcomes, or wake up times between the desflurane or propofol group.

Early Cognitive Outcomes Following Proton Radiation in Pediatric Patients With Brain and Central Nervous System Tumors

To report, from a longitudinal study, cognitive outcome in pediatric patients treated with proton radiation therapy (PRT) for central nervous system (CNS) tumors. Sixty patients receiving PRT for medulloblastoma (38.3%), gliomas (18.3%), craniopharyngioma (15.0%), ependymoma (11.7%), and other CNS tumors (16.7%) were administered age-appropriate measures of cognitive abilities at or near PRT initiation (baseline) and afterward (follow-up). Patients were aged ≥ 6 years at baseline to ensure consistency in neurocognitive measures. Mean age was 12.3 years at baseline; mean follow-up interval was 2.5 years. Treatment included prior surgical resection (76.7%) and chemotherapy (61.7%). Proton radiation therapy included craniospinal irradiation (46.7%) and partial brain radiation (53.3%). At baseline, mean Wechsler Full Scale IQ was 104.6; means of all 4 Index scores were also in the average range. At follow-up, no significant change was observed in mean Wechsler Full Scale IQ, Verbal Comprehension, Perceptual Reasoning/Organization, or Working Memory. However, Processing Speed scores declined significantly (mean 5.2 points), with a significantly greater decline for subjects aged <12 years at baseline and those with the highest baseline scores. Cognitive outcome was not significantly related to gender, extent of radiation, radiation dose, tumor location, histology, socioeconomic status, chemotherapy, or history of surgical resection. Early cognitive outcomes after PRT for pediatric CNS tumors are encouraging, compared with published outcomes from photon radiation therapy.

Mild traumatic brain injury in older adults: early cognitive outcome.

Severe traumatic brain injury (TBI) in older age is associated with high rates of mortality. However, little is known about outcome following mild TBI (mTBI) in older age. We report on a prospective cohort study investigating 3 month outcome in older age patients admitted to hospital-based trauma services. First, 50 mTBI older age patients and 58 orthopedic controls were compared to 123 community control participants to evaluate predisposition and general trauma effects on cognition. Specific brain injury effects were subsequently evaluated by comparing the orthopedic control and mTBI groups. Both trauma groups had significantly lower performances than the community group on prospective memory (d=0.82 to 1.18), attention set-shifting (d=-0.61 to -0.69), and physical quality of life measures (d=0.67 to 0.84). However, there was only a small to moderate but non-significant difference in the orthopedic control and mTBI group performances on the most demanding task of prospective memory (d=0.37). These findings indicate that, at 3 months following mTBI, older adults are at risk of poor cognitive performance but this is substantially accounted for by predisposition to injury or general multi-system trauma.

Breastfeeding and Children's Early Cognitive Outcomes

This paper investigates whether breastfeeding affects 5- to 6-year old children's cognitive development using three U.S. longitudinal data sets. The results for the full samples roughly point to a dose-response effect of breastfeeding on children's cognitive outcomes, with breastfeeding six months or more associated with about one-tenth of a standard deviation increase in cognitive test scores. The breastfeeding effects do not appear to be due to differences in maternal employment, cognitive ability, or parenting skills. In contrast, within-sibling results show no statistically significant breastfeeding effect.

Effect of Different Pump Heads for CPB on Early Cognitive Outcome after Coronary Artery Bypass Surgery

Reduction of cognitive function is a possible side effect after coronary artery surgery using cardiopulmonary bypass (CPB). We investigated the effect of roller versus centrifugal pumps for CPB on cognitive performance in patients undergoing coronary artery bypass grafting (CABG). 50 consecutive CABG patients operated with centrifugal pump were compared to 50 roller pump patients matched for age and duration of CPB. Six neuropsychological subtests from the Syndrom Kurz Test and the Alzheimer's Disease Assessment Scale were performed preoperatively and on the third postoperative day in a double blind fashion. To assess the overall cognitive function and the degree of cognitive decline across all tests after surgery we combined the six test-scores by principal component analysis. Patients with a mean age of 63.9±8.4 years received a mean of 3.0±0.9 bypasses within an average of 80.6±20.7 mins on CPB. These parameters as well as the preoperative combined neurocognitive score were not significantly different between the groups. After the operation there was a significant deterioration of the combined neuropsychological score in both groups (centrifugal: preop 0.41±2.49 vs.postop -2.86±2.70, p <0.0005 and roller: preop -0.41±2.35 vs. postop -2.73±3.16, p <0.0005). However, the patients operated with a centrifugal pump had a significantly greater decline of overall cognitive function compared to the roller pump patients(3.3±1.7 vs. 2.3±2.7, p = 0.04). Roller pumps have a less cerebro-damaging effect than centrifugal pumps since they lead to a smaller postoperative decline of neuropsychological abilities in coronary bypass patients.

Neurodevelopmental Outcomes in Infants after Surgery for Congenital Heart Disease: A Comparison of Single-Ventricle vs. Two-Ventricle Physiology

The neurodevelopmental outcome of children with repaired congenital heart defect has risen in importance with improved survival. This study compares neurodevelopmental outcomes of children who had CHD with single ventricle physiology with those who had CHD with two-ventricle physiology. Participants included 112 infants discharged from the NICU between February 1999 to August 2006. The 12 infants who had a known genetic defect were excluded. Of the 100 infants 26 had single ventricle physiology and 74 had CHD with two-ventricle physiology. The children were seen in a follow-up clinic and growth parameters and standardized instruments were used to evaluate development. The referral rate to early intervention services was also compared. The number of functional ventricles did not significantly differentiate growth parameters at 6-8 months of age. Early cognitive outcomes were relatively unimpaired in both the groups (single ventricle vs. two ventricle physiology). Early motor outcomes were worse in (p < 0.05) CHD with single ventricle physiology. The rate of referral for early intervention services was high in both groups compared to the average rate of referral in the state, but there was not a significant difference between the CHD groups. Significant differences noted on motor outcomes at the 6-8 month visit were no longer apparent in later visits. Referral to early intervention services is high in both the groups. These findings are important to those caring for infants with CHD because many of these patients may need referral for early intervention.

Early Cognitive Outcome After Neonatal Stroke

The purpose of this study was to assess the cognitive development of 27 children with nonhemorrhagic neonatal stroke (occurring within the first 28 days of life). The cognitive evaluation consisted of the Bayley Scales of Infant Development, administered at 12 and/or 24 months poststroke. Compared with the normative sample, children with neonatal stroke obtained significantly lower scores on the Bayley Psychomotor Development Index at 12 months poststroke and on the Bayley Mental and Psychomotor Development Indices at 24 months poststroke. Outcome did not differ based on stroke type or laterality of infarct. However, there was a trend toward higher scores on the Bayley Psychomotor Development Index at 24 months in the left hemisphere group compared to the right hemisphere group. Overall, children with neonatal stroke evidenced significant impairment within the first 2 years poststroke. Further research is required to confirm whether cognitive impairments in these children resolve, remain in the low-average range, or increase with development as more complex skills are learned.

Computed tomography findings and early cognitive outcome after traumatic brain injury

Primary objective: To examine the relationship between CT abnormalities and early neuropsychological outcome following traumatic brain injury (TBI) using quantitative CT analyses, data reduction methods for neuropsychological results and specific hypotheses based on literature review.Research design: Observational, prospective cohort study using acute (emergency) CT data and neuropsychological test data from 89 participants with TBI who were hospitalized for rehabilitation.Methods and procedures: Principal components analysis with varimax rotation was used to reduce data from a standard battery of eight neuropsychological tests administered after clearance of post-traumatic amnesia (1 month post-TBI on average). Bivariate correlations were used to examine relationships of three factors (verbal memory, cognitive processing speed and verbal working memory) to quantitative volumetric analysis of CT scan abnormalities (size, number and location). Specific hypotheses as to CT predictors of poor performance on each factor were tested using multivariable linear regression that included injury severity and demographic variables.Main results: Eighty-nine per cent of participants had some pathology on initial CT. Age, education and time to follow commands (TFC), an index of overall injury severity, were significantly associated with the neuropsychological factors. However, none of the specific hypotheses about CT scan variables and cognitive outcome were strongly supported by the data. There was a trend for any CT abnormality to predict slower speed of processing and for higher number of brain lesions to predict worse memory performance.Conclusions: Despite the precision added by quantitative CT analysis, CT findings did not improve on demographic factors and TFC in predicting early cognitive outcome of TBI. Imaging methods that are more sensitive to white matter integrity may be needed to develop pathophysiologic predictors of TBI outcome.