• Blennow NordströmErikELund University, Department of Clinical Sciences Lund, Neurology, Lund, Sweden; Skane University Hospital, Department of Rehabilitation Medicine, Lund, Sweden. Electronic address: erik.blennow_nordstrom@med.lu.se., Lars Evald, Marco Mion, Magnus Segerström, Susanna Vestberg, Susann Ullén, Katarina Heimburg, Gregersen OestergaardLisaLDEFACTUM, Central Denmark Region, Aarhus, Denmark; Aarhus University, Department of Public Health, Aarhus, Denmark., Anders M Grejs, Thomas R Keeble, Hans Kirkegaard, Christian Rylander, Matthew P Wise, and Gisela Lilja.
• Lund University, Department of Clinical Sciences Lund, Neurology, Lund, Sweden; Skane University Hospital, Department of Rehabilitation Medicine, Lund, Sweden. Electronic address: erik.blennow_nordstrom@med.lu.se.
• Resuscitation. 2024 Aug 13; 202: 110361110361.

AimTo assess the merit of clinical assessment tools in a neurocognitive screening following out-of-hospital cardiac arrest (OHCA).MethodsThe neurocognitive screening that was evaluated included the performance-based Montreal Cognitive Assessment (MoCA) and Symbol Digit Modalities Test (SDMT), the patient-reported Two Simple Questions (TSQ) and the observer-reported Informant Questionnaire on Cognitive Decline in the Elderly-Cardiac Arrest (IQCODE-CA). These instruments were administered at 6-months in the Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial. We used a comprehensive neuropsychological test battery from a TTM2 trial sub-study as a gold standard to evaluate the sensitivity and specificity of the neurocognitive screening.ResultsIn our cohort of 108 OHCA survivors (median age = 62, 88% male), the most favourable cut-off scores were: MoCA < 26; SDMT z ≤ -1; IQCODE-CA ≥ 3.04. The MoCA (sensitivity 0.64, specificity 0.85) and SDMT (sensitivity 0.59, specificity 0.83) had a higher classification accuracy than the TSQ (sensitivity 0.28, specificity 0.74) and IQCODE-CA (sensitivity 0.42, specificity 0.60). When using the cut-points for MoCA or SDMT in combination to identify neurocognitive impairment, sensitivity improved (0.81, specificity 0.74), area under the curve = 0.77, 95% CI [0.69, 0.85]. The most common unidentified impairments were within the episodic memory and executive functions domains, with fewer false negative cases on the MoCA or SDMT combined.ConclusionThe MoCA and SDMT have acceptable diagnostic accuracy for screening for neurocognitive impairment in an OHCA population, and when used in combination the sensitivity improves. Patient and observer-reports correspond poorly with neurocognitive performance.Clinicaltrialsgov Identifier: NCT03543371.Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.

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