The prevalence in the US population of survivors of out-of-hospital cardiopulmonary arrest (CPA) is substantial and likely to increase due to innovations in treatment and secondary prevention of arrest. Many survivors have significant residual cognitive impairment that adversely affects their quality of life. The precise nature of these deficits has not been characterized. In particular, the incidence and severity of executive impairments have never been explicitly assessed. The natural history of recovery is not known with any certainty. There is no evidence that any rehabilitation technique is effective. This proposal aims to define the range and mix of cognitive deficits at 3 and 12 months after CPA, the course of recovery of those deficits between 3 and 12 months, and the effect of the deficits on quality of life at 12 months after CPA. To demonstrate that the cognitive, affective and quality of life effects are specific to the CPA, patients will be compared to a control group of patients matched for heart disease and cardiovascular nsks without history of CPA. A completed pilot study demonstrated that the specific domains of cognition that are sensitive to CPA are memory, executive function, and motor function. A series of cognitive tests will allow creation of composite measures of memory, executive function, motor function, perception and language. Cluster analysis and correlations will identify the key cognitive profiles at both 3 and 12 months. Improvements between 3 and 12 months will be assessed, and the correlation of improvements in memory with executive changes will inform about the extent to which late improvement in memory is dependent on executive function. Evidence from other disorders consistently identifies executive impairments as the critical factor in quality of life. Correlation of quality of life measures with the composite cognitive measures will allow determination of the role of executive impairment in CPA outcome. With a clear picture of the patterns of residual deficits, their specificity to CPA, their probability of recovery within 1 year, and their direct impact on quality of life, it may be possible to create an evidence-based project for rehabilitation. ? ?
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