Despite advances in cardiopulmonary resuscitation (CPR) procedures, on average, fewer than 30 percent of the victims of sudden cardiac death in whom CPR is attempted live to hospital discharge. A major factor contributing to post-resuscitation morbidity and mortality in this patient group is brain injury secondary to the insult of global ischemia. A wide range of neurological sequelae ranging from mild intellectual impairment to brain death have been reported. In long term aborted sudden death (ASD) survivors, estimates of cognitive impairments range from 29 percent to 80 percent with memory, particularly delayed recall (recall after greater than or equal to 20 minutes), the most severely impaired cognitive area. Despite the impact of these impairments on the long term adjustment of the survivor, as well as their families, it is notable that these patients are rarely directed into cognitive rehabilitation. The purposes of this pilot study are twofold: 1) To determine to what extent two targeted cognitive retraining interventions can realistically be used to improve memory function in patients with chronic anoxic brain damage secondary to sudden cardiac arrest; and 2) to assess whether improvements in memory, if any, are accompanied by survivor and spouse/caregiver reports of improved everyday functional status. A group by trial repeated measures design with three treatment groups (restorative, compensatory and placebo) will be used to assess the efficacy of the cognitive retraining strategies in 15 randomly assigned ASD survivors who have participated in earlier studies on cognitive recovery. Baseline measures will include standardized neuropsychological testing, survivor and spousal interviews, and event related potentials. These measures will be repeated following completion of the training period, and again, two months later. The restorative treatment strategy targets mnemonic exercises to strengthen deficits in encoding; the compensatory strategy uses a memory book to improve functional competence, and the placebo group will be provided with generic tasks and games. Each of these treatment conditions will use computers to implement all or part of the training. After an initial structured training period, the intervention strategies will be carried out in the subjects' homes. Data analyses will consist of specific planned contrasts comparing baseline to 2 months (post completion of intervention), 2 month to 4 months and baseline to 4 months. For quantitative measures, repeated measures ANOVA will be used, and for the ordinal data, the Kruskal-Wallis test will be used to examine the same contrasts.
