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Ando S, Tsukamoto H, Stacey BS, Washio T, Owens TS, Calverley TA, Fall L, Marley CJ, Iannetelli A, Hashimoto T, Ogoh S, Bailey DM. Acute hypoxia impairs posterior cerebral bioenergetics and memory in man. Exp Physiol 2023; 108:1516-1530. [PMID: 37898979 PMCID: PMC10988469 DOI: 10.1113/ep091245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/03/2023] [Indexed: 10/31/2023]
Abstract
Hypoxia has the potential to impair cognitive function; however, it is still uncertain which cognitive domains are adversely affected. We examined the effects of acute hypoxia (∼7 h) on central executive (Go/No-Go) and non-executive (memory) tasks and the extent to which impairment was potentially related to regional cerebral blood flow and oxygen delivery (CDO2 ). Twelve male participants performed cognitive tasks following 0, 2, 4 and 6 h of passive exposure to both normoxia and hypoxia (12% O2 ), in a randomized block cross-over single-blinded design. Middle cerebral artery (MCA) and posterior cerebral artery (PCA) blood velocities and corresponding CDO2 were determined using bilateral transcranial Doppler ultrasound. In hypoxia, MCA DO2 was reduced during the Go/No-Go task (P = 0.010 vs. normoxia, main effect), and PCA DO2 was attenuated during memorization (P = 0.005 vs. normoxia) and recall components (P = 0.002 vs. normoxia) in the memory task. The accuracy of the memory task was also impaired in hypoxia (P = 0.049 vs. normoxia). In contrast, hypoxia failed to alter reaction time (P = 0.19 vs. normoxia) or accuracy (P = 0.20 vs. normoxia) during the Go/No-Go task, indicating that selective attention and response inhibition were preserved. Hypoxia did not affect cerebral blood flow or corresponding CDO2 responses to cognitive activity (P > 0.05 vs. normoxia). Collectively, these findings highlight the differential sensitivity of cognitive domains, with memory being selectively vulnerable in hypoxia. NEW FINDINGS: What is the central question of this study? We sought to examine the effects of acute hypoxia on central executive (selective attention and response inhibition) and non-executive (memory) performance and the extent to which impairments are potentially related to reductions in regional cerebral blood flow and oxygen delivery. What is the main finding and its importance? Memory was impaired in acute hypoxia, and this was accompanied by a selective reduction in posterior cerebral artery oxygen delivery. In contrast, selective attention and response inhibition remained well preserved. These findings suggest that memory is selectively vulnerable to hypoxia.
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Affiliation(s)
- Soichi Ando
- Graduate School of Informatics and EngineeringThe University of Electro‐CommunicationsTokyoJapan
| | - Hayato Tsukamoto
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
- Faculty of Sports ScienceWaseda UniversitySaitamaJapan
| | - Benjamin S. Stacey
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
| | - Takuro Washio
- Department of Biomedical EngineeringToyo UniversityKawagoeSaitamaJapan
| | - Thomas S. Owens
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
| | - Thomas A. Calverley
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
| | - Lewis Fall
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
| | - Christopher J. Marley
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
| | - Angelo Iannetelli
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
| | | | - Shigehiko Ogoh
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
- Department of Biomedical EngineeringToyo UniversityKawagoeSaitamaJapan
| | - Damian M. Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
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Ramirez-Hernandez D, Wong D, Ownsworth T, Stolwyk RJ. Which training methods are effective for learning new smartphone memory apps after acquired brain injury? A pilot randomized controlled trial comparing trial and error, systematic instruction and error-based learning. Neuropsychol Rehabil 2023; 33:139-172. [PMID: 34724874 DOI: 10.1080/09602011.2021.1993273] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study aimed to compare the efficacy of three skills training methods (Trial and error TEL; systematic instruction SI; and error-based learning EBL) for training the use of a smartphone reminder app in individuals with an acquired brain injury. Participants (N = 38, Mage = 61.21 years, 71.1% stroke) were randomly allocated to one of three training conditions and trained over one two-hour session. Proficiency of performance with the trained app (primary outcome) was assessed immediately post-training, one- and six-weeks post-intervention. Secondary outcomes included generalization of skills, error commission, smartphone use frequency and confidence, and subjective memory complaints. Proficiency with the trained app after TEL was higher than SI immediately after the training (d = 0.87) and EBL at the one-week follow-up (d = 0.98). No differences were found six-weeks post-training. Smartphone use confidence increased at the six-week follow-up after TEL (d = 1.12) and EBL training (d = 0.91) but not after SI (d = 0.26). Self-reported memory complaints decreased across time for all groups (ηp2 = 0.30). There was no clearly superior training method for optimizing proficiency with the reminder app. The expected benefits of SI and EBL may not have emerged due to the single-session format of the training. However, smartphone training via TEL or EBL has the potential to address confidence-related barriers to smartphone use.
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Affiliation(s)
- Diana Ramirez-Hernandez
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Dana Wong
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia.,School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Tamara Ownsworth
- School of Applied Psychology, Griffith University, Mt Gravatt, Australia
| | - Renerus J Stolwyk
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
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3
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Yu AT, Absar NM. Long-term Neuropsychiatric Complications and 18F-FDG-PET Hypometabolism in the Brain From Prolonged Infection of COVID-19. Alzheimer Dis Assoc Disord 2022; 36:173-175. [PMID: 34966022 PMCID: PMC9132237 DOI: 10.1097/wad.0000000000000485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/07/2021] [Indexed: 11/21/2022]
Abstract
It is becoming increasingly clear that the worldwide outbreak of severe acute respiratory syndrome coronavirus 2 will have long-term negative consequences. Some patients report functional complaints long after recovery from coronavirus disease-2019 (COVID-19), which include fatigue, breathlessness, heart palpitations, loss or alteration of taste and smell, and problems with attention, memory, and cognition. However, the long-term complications for those patients who had severe symptoms and prolonged hypoxia during their course of their hospital stay is still unknown. We report 2 patients with confirmed diagnoses of COVID-19 who experienced prolonged infection and developed rapid progressive dementia following COVID-19 pneumonia after a follow-up period of 5 to 10 months. As these cases may become more prevalent over time, we should learn to recognize the early signs of long-term COVID-19 complications in those who are especially vulnerable to neurocognitive decline.
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Affiliation(s)
| | - Nicole M. Absar
- Department of Psychiatry and Behavioral Health
- Stony Brook Center of Excellence for Alzheimer’s Disease, Stony Brook University, Stony Brook, NY
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4
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Lequerica AH, Houston M, Chen MH, Arango-Lasprilla JC. Preliminary construct validity of a memory concerns scale derived from a PROMIS® item bank in a spanish-speaking sample. Neuropsychol Rehabil 2022:1-13. [PMID: 35362366 DOI: 10.1080/09602011.2022.2058965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study examined preliminary evidence of construct validity in a stand-alone memory concerns scale constructed from the Patient-Reported Outcomes Measurement Information System (PROMIS®) Cognitive Function item bank. A sample of 396 individuals, ages 18-75 (M = 33.7, SD = 12.7), from Spain and Latin America completed an online survey regarding lifetime exposure to factors associated with neurological compromise. The sample was 69.4% female. Respondents completed 8 items from the PROMIS® Cognitive Function item bank v1.0 dealing with memory concerns (MCS-8) along with the PROMIS® 8-item short form reflecting general cognitive concerns (CCS-8). The MCS-8 had high internal consistency reliability (Cronbach's alpha = 0.90), and represented a factor distinct from general cognitive concerns items on the CCS-8 in confirmatory factor analysis. Analysis of covariance controlling for sex, age, and education, showed that individuals endorsing history of exposure to sources of neurological compromise scored significantly lower T-scores on the MCS-8 than those who did not report any such history, F(1,390) = 6.4, p = 0.012. Older age was significantly associated with greater memory concerns, a relationship with age not observed with the CCS-8. As a stand-alone self-report measure, the MCS-8 appears to measure a construct distinct from general cognitive concerns that may be of interest for further research in clinical populations.
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Affiliation(s)
- Anthony H Lequerica
- Kessler Foundation, East Hanover, NJ, USA.,Rutgers - New Jersey Medical School, Newark, NJ, USA
| | | | - Michelle H Chen
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, NJ, USA.,Robert Wood Johnson Medical School, Rutgers University, NJ, USA
| | - Juan Carlos Arango-Lasprilla
- BioCruces Bizkaia Health Research Institute. Barakaldo, Bizkaia, Spain.,IKERBASQUE. Basque Foundation for Science, Bilbao, Spain
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5
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Moretta P, Ambrosino P, Lanzillo A, Marcuccio L, Fuschillo S, Papa A, Santangelo G, Trojano L, Maniscalco M. Cognitive Impairment in Convalescent COVID-19 Patients Undergoing Multidisciplinary Rehabilitation: The Association with the Clinical and Functional Status. Healthcare (Basel) 2022; 10:480. [PMID: 35326958 PMCID: PMC8950669 DOI: 10.3390/healthcare10030480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/01/2022] [Accepted: 03/01/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cognitive impairment has been reported in the aftermath of severe acute respiratory syndrome due to coronavirus 2 (SARS-CoV-2) infection. We investigated the possible association between cognitive impairment and the main clinical and functional status variables in a cohort of convalescent COVID-19 patients without premorbid diseases potentially affecting cognition. METHODS We consecutively screened for inclusion of convalescent COVID-19 patients referring to a post-acute care facility for pulmonary rehabilitation. All the enrolled patients were assessed for cognitive functions. We also investigated features of psychological distress (anxiety, depression, symptoms of posttraumatic stress disorder and quality of life) and cardiac and pulmonary functional status. RESULTS The 63 enrolled patients (mean age 59.82 ± 10.78, male gender = 47) showed a high frequency of depressive symptoms (76.2%) and anxiety (55.5%), and a high prevalence of symptoms of posttraumatic stress disorder (PTSD, 44.4%). About half of the total sample showed reduced cognitive efficiency (RCE, 44.4%) in the domains of spatial and verbal long-term memory and executive functions. Patients with RCE more frequently showed alteration of blood pressure (BP) circadian rhythm (p = 0.01), higher levels of D-Dimer (p = 0.03), had experienced a severe illness (p = 0.02), had longer disease duration (p = 0.04), more clinically relevant symptoms of PTSD (p = 0.02), more frequent cognitive complaints (p = 0.002), higher anxiety scores (p = 0.01) and lower quality of life (p = 0.02) than patients with normal cognitive efficiency. CONCLUSIONS Our findings indicated a possible association between the RCE after COVID-19 and some cardiological variables, including some indirect measures of a residual autonomic disorder, such as the presence of an altered BP circadian rhythm. Future research studies with large samples are needed to provide valid conclusions.
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Affiliation(s)
- Pasquale Moretta
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (A.L.); (L.M.)
| | - Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy;
| | - Anna Lanzillo
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (A.L.); (L.M.)
| | - Laura Marcuccio
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (A.L.); (L.M.)
| | - Salvatore Fuschillo
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (S.F.); (M.M.)
| | - Antimo Papa
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy;
| | - Gabriella Santangelo
- Department of Psychology, Università della Campania Luigi Vanvitelli, 81100 Caserta, Italy; (G.S.); (L.T.)
| | - Luigi Trojano
- Department of Psychology, Università della Campania Luigi Vanvitelli, 81100 Caserta, Italy; (G.S.); (L.T.)
| | - Mauro Maniscalco
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (S.F.); (M.M.)
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6
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Jaywant A, Vanderlind WM, Alexopoulos GS, Fridman CB, Perlis RH, Gunning FM. Frequency and profile of objective cognitive deficits in hospitalized patients recovering from COVID-19. Neuropsychopharmacology 2021; 46:2235-2240. [PMID: 33589778 PMCID: PMC7884062 DOI: 10.1038/s41386-021-00978-8] [Citation(s) in RCA: 134] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/16/2021] [Accepted: 01/20/2021] [Indexed: 02/06/2023]
Abstract
Early reports and case series suggest cognitive deficits occurs in some patients with COVID-19. We evaluated the frequency, severity, and profile of cognitive dysfunction in patients recovering from prolonged COVID-19 hospitalization who required acute inpatient rehabilitation prior to discharge. We analyzed cross-sectional scores from the Brief Memory and Executive Test (BMET) in a cohort of N = 57 COVID-19 patients undergoing inpatient rehabilitation, calculating the frequency of impairment based on neuropsychologist diagnosis and by age-normed BMET subtests. In total, 43 patients (75%) were male, 35 (61%) were non-white, and mean age was 64.5 (SD = 13.9) years. In total, 48 (84%) were previously living at home independently. Two patients had documented preexisting cognitive dysfunction; none had known dementia. Patients were evaluated at a mean of 43.2 (SD = 19.2) days after initial admission. In total, 50 patients (88%) had documented hypoxemic respiratory failure and 44 (77%) required intubation. Forty-six patients (81%) had cognitive impairment, ranging from mild to severe. Deficits were common in working memory (26/47 [55%] of patients), set-shifting (21/44 [47%]), divided attention (18/39 [46%]), and processing speed (14/35 [40%]). Executive dysfunction was not significantly associated with intubation length or the time from extubation to assessment, psychiatric diagnosis, or preexisting cardiovascular/metabolic disease. Attention and executive functions are frequently impaired in COVID-19 patients who require acute rehabilitation prior to discharge. Though interpretation is limited by lack of a comparator group, these results provide an early benchmark for identifying and characterizing cognitive difficulties after COVID-19. Given the frequency and pattern of impairment, easy-to-disseminate interventions that target attention and executive dysfunctions may be beneficial to this population.
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Affiliation(s)
- Abhishek Jaywant
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, US
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, US
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, US
| | - W Michael Vanderlind
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, US
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, US
| | - George S Alexopoulos
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, US
- Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY, US
| | - Chaya B Fridman
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, US
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, US
| | - Roy H Perlis
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, US
| | - Faith M Gunning
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, US.
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, US.
- Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY, US.
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7
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Ahn JH, Lee TK, Tae HJ, Kim B, Sim H, Lee JC, Kim DW, Kim YS, Shin MC, Park Y, Cho JH, Park JH, Lee CH, Choi SY, Won MH. Neuronal Death in the CNS Autonomic Control Center Comes Very Early after Cardiac Arrest and Is Not Significantly Attenuated by Prompt Hypothermic Treatment in Rats. Cells 2021; 10:E60. [PMID: 33401719 PMCID: PMC7824613 DOI: 10.3390/cells10010060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 12/19/2022] Open
Abstract
Autonomic dysfunction in the central nervous system (CNS) can cause death after recovery from a cardiac arrest (CA). However, few studies on histopathological changes in animal models of CA have been reported. In this study, we investigated the prevalence of neuronal death and damage in various brain regions and the spinal cord at early times after asphyxial CA and we studied the relationship between the mortality rate and neuronal damage following hypothermic treatment after CA. Rats were subjected to 7-8 min of asphyxial CA, followed by resuscitation and prompt hypothermic treatment. Eight regions related to autonomic control (the cingulate cortex, hippocampus, thalamus, hypothalamus, myelencephalon, and spinal cord) were examined using cresyl violet (a marker for Nissl substance) and Fluoro-Jade B (a marker for neuronal death). The survival rate was 44.5% 1 day post-CA, 18.2% 2 days post-CA and 0% 5 days post-CA. Neuronal death started 12 h post-CA in the gigantocellular reticular nucleus and caudoventrolateral reticular nucleus in the myelencephalon and lamina VII in the cervical, thoracic, lumbar, and sacral spinal cord, of which neurons are related to autonomic lower motor neurons. In these regions, Iba-1 immunoreactivity indicating microglial activation (microgliosis) was gradually increased with time after CA. Prompt hypothermic treatment increased the survival rate at 5 days after CA with an attenuation of neuronal damages and death in the damaged regions. However, the survival rate was 0% at 12 days after CA. Taken together, our study suggests that the early damage and death of neurons related to autonomic lower motor neurons was significantly related to the high mortality rate after CA and that prompt hypothermic therapy could increase the survival rate temporarily after CA, but could not ultimately save the animal.
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Affiliation(s)
- Ji Hyeon Ahn
- Department of Physical Therapy, College of Health Science, Youngsan University, Yangsan 50510, Korea;
- Department of Neurobiology, School of Medicine, Kangwon National University, Chuncheon 24341, Korea; (B.K.); (H.S.); (J.-C.L.)
| | - Tae-Kyeong Lee
- Department of Biomedical Science and Research Institute for Bioscience and Biotechnology, Hallym University, Chuncheon 24252, Korea;
| | - Hyun-Jin Tae
- Bio-Safety Research Institute, College of Veterinary Medicine, Chonbuk National University, Iksan 54596, Korea;
| | - Bora Kim
- Department of Neurobiology, School of Medicine, Kangwon National University, Chuncheon 24341, Korea; (B.K.); (H.S.); (J.-C.L.)
| | - Hyejin Sim
- Department of Neurobiology, School of Medicine, Kangwon National University, Chuncheon 24341, Korea; (B.K.); (H.S.); (J.-C.L.)
| | - Jae-Chul Lee
- Department of Neurobiology, School of Medicine, Kangwon National University, Chuncheon 24341, Korea; (B.K.); (H.S.); (J.-C.L.)
| | - Dae Won Kim
- Department of Biochemistry and Molecular Biology, and Research Institute of Oral Sciences, College of Dentistry, Gangnung-Wonju National University, Gangneung 25457, Korea;
| | - Yoon Sung Kim
- Department of Emergency Medicine, Samcheok Medical Center, Samcheok 25920, Korea;
| | - Myoung Cheol Shin
- Department of Emergency Medicine, School of Medicine, Kangwon National University, Chuncheon 24341, Korea; (M.C.S.); (Y.P.); (J.H.C.)
| | - Yoonsoo Park
- Department of Emergency Medicine, School of Medicine, Kangwon National University, Chuncheon 24341, Korea; (M.C.S.); (Y.P.); (J.H.C.)
| | - Jun Hwi Cho
- Department of Emergency Medicine, School of Medicine, Kangwon National University, Chuncheon 24341, Korea; (M.C.S.); (Y.P.); (J.H.C.)
| | - Joon Ha Park
- Department of Anatomy, College of Korean Medicine, Dongguk University, Gyeongju 38066, Korea;
| | - Choong-Hyun Lee
- Department of Pharmacy, College of Pharmacy, Dankook University, Cheonan 31116, Korea;
| | - Soo Young Choi
- Department of Biomedical Science and Research Institute for Bioscience and Biotechnology, Hallym University, Chuncheon 24252, Korea;
| | - Moo-Ho Won
- Department of Neurobiology, School of Medicine, Kangwon National University, Chuncheon 24341, Korea; (B.K.); (H.S.); (J.-C.L.)
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8
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Gunn S, Burgess GH. Factors predicting rehabilitation outcomes after severe acquired brain injury in trauma, stroke and anoxia populations: A cohort study. Neuropsychol Rehabil 2020; 32:179-210. [PMID: 32880210 DOI: 10.1080/09602011.2020.1810077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Severe acquired brain injury has long-term physical and cognitive effects. Identifying patient variables predictive of recovery in different brain injury populations would generate improved prognostic information and help rehabilitation teams set appropriate therapeutic goals. This cohort study of 447 NHS neurorehabilitation inpatients aimed to identify functional and cognitive predictors of recovery following severe acquired brain injury caused by trauma, stroke and anoxia. Motor and cognitive impairment ratings were collected at admission and discharge using the Functional Independence Measure and Functional Assessment Measure (FIM+FAM), and injury-related and demographic data were collated from medical records. Predictors of physical, cognitive and overall recovery were identified via hierarchical regression analyses. Several key findings emerged. Firstly, on-admission motor skills predicted functional and overall outcomes across groups. Secondly, on-admission social interaction skills predicted cognitive discharge outcomes in stroke and trauma, and overall outcomes for stroke, but did not predict anoxia outcomes. Thirdly, age predicted all forms of recovery for stroke only. Further group-specific factors were also identified as predicting motor and cognitive recovery, indicating that factors key to the rehabilitation trajectory may differ between populations. These variables should be considered in rehabilitation goal planning, although further research is required to explore their contributions to recovery.
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Affiliation(s)
- Sarah Gunn
- Neuroscience, Psychology and Behaviour, Collesge of Life Sciences, University of Leicester, Leicester, UK
| | - Gerald H Burgess
- Neuroscience, Psychology and Behaviour, Collesge of Life Sciences, University of Leicester, Leicester, UK
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9
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Jang Y, Lee E, Kim Y, Park JH. Number Processing Error as a Clinical Manifestation of Hemispatial Neglect Following Hypoxic Brain Injury: a Case Report. BRAIN & NEUROREHABILITATION 2020; 13:e20. [PMID: 36741793 PMCID: PMC9879366 DOI: 10.12786/bn.2020.13.e20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 06/26/2020] [Accepted: 07/06/2020] [Indexed: 11/08/2022] Open
Abstract
Hemispatial neglect is a symptom where patients do not show response to stimuli on the contralesional side of their brain lesion. Although it is most common in the context of hemispheric stroke, several pathological processes including neurodegenerative disease, neoplasia, and trauma may cause this. Prevalence of hemispatial neglect is unknown and rarely reported among patients with hypoxic brain injury. Also, hemispatial neglect accompanying neglect dyslexia is rather hard to be recognized and symptoms involving numbers are exceptionally rare. We report a patient with hypoxic brain injury following cardiac arrest who showed signs of neglect dyslexia for numbers that provided a primary clue for the diagnosis of left hemispatial neglect. Early detection of different forms of cognitive dysfunction of hypoxic brain injury is highly essential in providing early neurorehabilitation for better prognosis.
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Affiliation(s)
- Yongjun Jang
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eunji Lee
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youngkook Kim
- Department of Rehabilitation Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joo Hyun Park
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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10
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A comparison of systematic instruction, error-based learning and trial and error to train the use of smartphone memory apps after acquired brain injury: A three-armed phase II randomised controlled trial study protocol. BRAIN IMPAIR 2020. [DOI: 10.1017/brimp.2020.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:The uptake of smartphones as external compensatory memory aids following an acquired brain injury (ABI) in rehabilitation settings is low. Potential reasons for this include professionals not having evidence-based guidelines regarding the best methods to train smartphone use and prospective users not being familiar with technology and/or having memory and learning difficulties. This paper describes the protocol of a study that aims to compare the efficacy of three training methods (Systematic Instruction, Error-based Learning and Trial-and-Error) for training the use of a smartphone reminder app, in people with ABI presenting with memory complaints.Methods/Design:This is a three-armed, assessor-blinded, Phase II randomised controlled trial. The estimated sample size is 51 participants aged >18 years, who are equally randomised to one of the three training groups. They are seen across four sessions: one to conduct baseline measures; one for training the use of an app and two for follow-up assessments (1- and 6-weeks post-training). The main outcome measure is proficiency of performance in tasks with the trained app. Secondary outcomes include generalisation of skills to other apps, number of errors committed while attempting the tasks, frequency of smartphone usage in general and as a memory aid and confidence in smartphone use and memory self-efficacy. Outcome measures are collected by an independent blinded assessor. Proficiency of performance, generalisation of skills and error commission are measured immediately post-training and at the two follow-up sessions. The other secondary measures are taken pre-intervention and at the two follow-up sessions.Discussion:This study will provide initial evidence regarding the efficacy of three different methods to train ABI survivors with memory difficulties in how to use smartphone apps as compensatory memory aids. The results could inform a larger Phase III trial and advance knowledge concerning the advantages or disadvantages of using error-reducing and trial-and-error techniques. Further, the findings could determine the potential of error-based learning as an emerging training method for people with memory impairment within rehabilitation.
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11
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Nordio S, Burgio F, D'Imperio D, De Biagi F, Cosentino E, Meneghello F. Communicative and swallowing disorders in anoxic patients: A retrospective study on clinical outcomes and performance measures. NeuroRehabilitation 2019; 45:453-461. [PMID: 31868687 DOI: 10.3233/nre-192884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Anoxic brain injury (ABI) is a neurological condition associated to a severe deterioration of brain functioning, whose symptomatology and clinical outcomes may be heterogeneous: cognitive deficits, language disorders like dysarthria and swallowing impairments. Nevertheless, there is still a lack of information on the rehabilitation outcomes. OBJECTIVE To confirm the occurrence of communication and swallowing deficits in 37 ABI patients and to examine whether intensive rehabilitation may contribute to any improvements and its relation to ABI severity and functional autonomy. METHODS 37 patients, hospitalized at IRCCS San Camillo Hospital from 2011 to 2018 were analyzed retrospectively. All patients completed a functional evaluation and a language and swallowing assessment, within one week from hospital admission (T0). The assessment was repeated after an intensive rehabilitation treatment (T1). RESULTS Results show that dysphagia is a frequent and severe outcome in anoxic patients, whereas communication disorders (aphasia and dysarthria) are less severe. Moreover, ABI patients seem to be positively sensitive to an intensive rehabilitation program. CONCLUSIONS An early multidisciplinary management of communicative-linguistic and swallowing functions is crucial in order to prevent adverse events and to plan a tailored rehabilitation pathway.
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Marceaux JC, Soble JR, O'Rourke JJF, Swan AA, Wells M, Amuan M, Sagiraju HKR, Eapen BC, Pugh MJ. Validity of early-onset dementia diagnoses in VA electronic medical record administrative data. Clin Neuropsychol 2019; 34:1175-1189. [PMID: 31645200 DOI: 10.1080/13854046.2019.1679889] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine the validity of diagnoses indicative of early-onset dementia (EOD) obtained from an algorithm using administrative data, we examined Veterans Health Administration (VHA) electronic medical records (EMRs). METHOD A previously used method of identifying cases of dementia using administrative data was applied to a random sample of 176 cases of Post-9/11 deployed veterans under 65 years of age. Retrospective, cross-sectional examination of EMRs was conducted, using a combination of administrative data, chart abstraction, and review/consensus by board-certified neuropsychologists. RESULTS Approximately 73% of EOD diagnoses identified using existing algorithms were identified as false positives in the overall sample. This increased to approximately 76% among those with mental health conditions and approximately 85% among those with mild traumatic brain injury (TBI; i.e. concussion). Factors related to improved diagnostic accuracy included more severe TBI, diagnosing clinician type, presence of neuroimaging data, absence of a comorbid mental health condition diagnosis, and older age at time of diagnosis. CONCLUSIONS A previously used algorithm for detecting dementia using VHA administrative data was not supported for use in the younger adult samples and resulted in an unacceptably high number of false positives. Based on these findings, there is concern for possible misclassification in population studies using similar algorithms to identify rates of EOD among veterans. Further, we provide suggestions to develop an enhanced algorithm for more accurate dementia surveillance among younger populations.
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Affiliation(s)
- Janice C Marceaux
- Psychology Service, South Texas Veterans Health Care System San Antonio, TX, USA.,Department of Neurology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Jason R Soble
- Psychology Service, South Texas Veterans Health Care System San Antonio, TX, USA.,Psychiatry & Neurology, Neuropsychiatric Institute, University of Illinois College of Medicine, Chicago, IL, USA
| | - Justin J F O'Rourke
- Psychology Service, South Texas Veterans Health Care System San Antonio, TX, USA
| | - Alicia A Swan
- Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Margaret Wells
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Megan Amuan
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, UT, USA
| | - Hari Krishna Raju Sagiraju
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Blessen C Eapen
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Rehabilitation Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Mary Jo Pugh
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, UT, USA.,Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
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Hong JS, Moran MT, Eaton LA, Grafton LM. Neurologic, Cognitive, and Behavioral Consequences of Opioid Overdose: a Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2019. [DOI: 10.1007/s40141-019-00247-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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14
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Nucci MP, Lukasova K, Vieira G, Sato JR, Amaro Júnior E. Cognitive performance in transient global hypoxic brain injury due to moderate drowning. J Clin Exp Neuropsychol 2017; 40:462-472. [PMID: 28922960 DOI: 10.1080/13803395.2017.1371674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Drowning is a serious and frequently neglected public health threat. Primary respiratory impairment after submersion often leads to brain dysfunction. Depending on the period of global hypoxia (respiratory failure), clinical aspects of neurological dysfunction are evident on the first evaluation after the water rescue. Nowadays, many neuropsychological assessments after drowning are inconclusive, with some studies reporting only minor neurological or cognitive impairments. The aim of this study is to identify measures in neuropsychological tests that most contribute to classify volunteers as moderate drowning subjects or healthy controls. To the best of our knowledge, this study is the first neuropsychological prospective case-control study of moderate drowning in a country with large coastal cities. METHOD Fifteen moderate drowning patients (DP), who met the inclusion criteria, were compared with 18 healthy controls (HC). All subjects were assessed on memory, learning, visual spatial ability, executive function, attention, and general intellectual functioning and underwent structural magnetic resonance (MR) imaging of the brain at 3.0 T, in order to exclude subjects with anatomic abnormalities. RESULTS Neuropsychological tests assessing learning, execution function, and verbal fluency-Rey Auditory Verbal Learning Test (RAVLT) general learning ability, Digit Span total, Phonological Verbal Fluency (total FAS correct), and Brief Visuospatial Memory Test Revised (BVMT) correct recognition-have the strongest discriminating ability, using predictive models via the partial least squares (PLS) approach for data classification, while the other tests have shown similar predictive values between groups. CONCLUSIONS Learning, execution function, and verbal fluency domains were the most critically affected domains. Serious impairments in the same domains have already been reported in severe drowning cases, and we hypothesize that subtle alterations found in moderate drowning cases, although not sufficient to be detected in daily routine, may possibly have a negative impact on cognitive reserve.
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Affiliation(s)
- Mariana Penteado Nucci
- a LIM-44 (NIF - Neuroimagem Funcional), Department of Radiology, Faculty of Medicine , University of São Paulo (USP) , São Paulo , Brazil
| | - Katerina Lukasova
- a LIM-44 (NIF - Neuroimagem Funcional), Department of Radiology, Faculty of Medicine , University of São Paulo (USP) , São Paulo , Brazil.,b Faculdade de Psicologia , Universidade Cruzeiro do Sul , São Paulo , Brazil
| | - Gilson Vieira
- a LIM-44 (NIF - Neuroimagem Funcional), Department of Radiology, Faculty of Medicine , University of São Paulo (USP) , São Paulo , Brazil
| | - João Ricardo Sato
- c Center of Mathematics, Computation and Cognition , Universidade Federal do ABC , Santo André , Brazil
| | - Edson Amaro Júnior
- a LIM-44 (NIF - Neuroimagem Funcional), Department of Radiology, Faculty of Medicine , University of São Paulo (USP) , São Paulo , Brazil
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Bhattacharyya S, Gholipour T, Colorado RA, Klein JP. Bilateral Hippocampal Restricted Diffusion: Same Picture Many Causes. J Neuroimaging 2017; 27:300-305. [PMID: 28054736 DOI: 10.1111/jon.12420] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 11/24/2016] [Accepted: 11/25/2016] [Indexed: 12/01/2022] Open
Abstract
With some regularity, we have encountered the unusual imaging abnormality of bilateral hippocampal restricted diffusion, either in isolation or in combination with other coincident abnormalities. In this retrospective case series, we examine clinical and imaging data to explore potential etiologies and clinical implications of this imaging finding. Sixteen cases with the imaging abnormality are presented, with etiologies including hypoxemia, hypoxemia-ischemia, and seizures.
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Affiliation(s)
- Shamik Bhattacharyya
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Taha Gholipour
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Rene A Colorado
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Joshua P Klein
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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Bickler PE, Feiner JR, Lipnick MS, Batchelder P, MacLeod DB, Severinghaus JW. Effects of Acute, Profound Hypoxia on Healthy Humans. Anesth Analg 2017; 124:146-153. [DOI: 10.1213/ane.0000000000001421] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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17
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Brain injury after moderate drowning: subtle alterations detected by functional magnetic resonance imaging. Brain Imaging Behav 2016; 11:1412-1421. [DOI: 10.1007/s11682-016-9619-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Schwark J, Fields W. Reading as a Nursing Intervention for Agitation in Patients With Anoxic Brain Injury. Rehabil Nurs 2016; 42:341-346. [PMID: 27535115 DOI: 10.1002/rnj.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
PURPOSE The purpose of this article is to describe and recommend reading as a nursing intervention for agitated patients with anoxic brain injury. DESIGN The design of this study is a case report of the results from reading to an agitated patient with anoxic brain injury. METHODS Observation of the effects of reading to an agitated patient. FINDINGS Fifteen minutes of reading to an agitated patient during the evening hours had a calming effect. CONCLUSIONS Reading to agitated patients is an additional nursing intervention with little risk and represents efficient, patient-centered care. CLINICAL RELEVANCE Reading is a successful nursing intervention that has a calming effect on agitated patients.
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Affiliation(s)
- James Schwark
- 1 Formerly of Sharp Grossmont Rehabilitation Center, La Mesa, CA, USA2 San Diego State University, San Diego, CA, USA3 Sharp Grossmont Hospital, La Mesa, CA, USA
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Tazopoulou E, Miljkovitch R, Truelle JL, Schnitzler A, Onillon M, Zucco T, Hawthorne G, Montreuil M. Rehabilitation following cerebral anoxia: An assessment of 27 patients. Brain Inj 2016; 30:95-103. [DOI: 10.3109/02699052.2015.1113563] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wilson M, Staniforth A, Till R, das Nair R, Vesey P. The psychosocial outcomes of anoxic brain injury following cardiac arrest. Resuscitation 2014; 85:795-800. [DOI: 10.1016/j.resuscitation.2014.02.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 01/01/2014] [Accepted: 02/09/2014] [Indexed: 12/18/2022]
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Thaler NS, Reger SL, Ringdahl EN, Mayfield JW, Goldstein G, Allen DN. Neuropsychological profiles of six children with anoxic brain injury. Child Neuropsychol 2013; 19:479-94. [DOI: 10.1080/09297049.2012.696602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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FitzGerald A, Aditya H, Prior A, McNeill E, Pentland B. Anoxic brain injury: Clinical patterns and functional outcomes. A study of 93 cases. Brain Inj 2010; 24:1311-23. [DOI: 10.3109/02699052.2010.506864] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Peskine A, Rosso C, Picq C, Caron E, Pradat-Diehl P. Neurological sequelae after cerebral anoxia. Brain Inj 2010; 24:755-61. [DOI: 10.3109/02699051003709581] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kelly G, Brown S, Todd J, Kremer P. Challenging behaviour profiles of people with acquired brain injury living in community settings. Brain Inj 2009; 22:457-70. [DOI: 10.1080/02699050802060647] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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26
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Hofgren C, Lundgren-Nilsson Å, Esbjörnsson E, Sunnerhagen KS. Two years after cardiac arrest; cognitive status, ADL function and living situation. Brain Inj 2009; 22:972-8. [DOI: 10.1080/02699050802491289] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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