Agnieszka Maryniak

Long-term cognitive outcome in teenage survivors of arrhythmic cardiac arrest

BACKGROUND Sudden cardiac arrest (SCA) can be the first sign of ventricular arrhythmia in teenagers. Neurocognitive problems are common after successful resuscitation. We studied cognitive function in teenage survivors of SCA, including emotional status and coping ability. METHOD Ten SCA survivors, aged 11-19 years, had neuropsychological tests within a few weeks of resuscitation. Awareness status, orientation, episodic and semantic memory, basic auditory-visual functions, praxis and speech, short-term memory, ability to learn new verbal and visual material were assessed. These tests were repeated at about 6 months. RESULTS Eight patients had an initial assessment; one boy remained in a coma and one was making simple emotional contact, revealing intensified mixed aphasia and dyskinesia. Six patients had severe disturbances of memory, motor functions and praxis. After 6 months, four patients had no neurocognitive disturbance. Four patients had memory impairment making school education difficult. Two patients were totally dependent on caregivers. Because of the absence of symptoms before SCA, and amnesia relating to the SCA episodes, patients had problems accepting their heart problems and limitations resulting from it. CONCLUSION Teenagers surviving SCA have significant neurcognitive and psychological problems. They need psychological care and guidance in understanding their condition.

Cognitive and social function in girls with congenital adrenal hyperplasia — Influence of prenatally administered dexamethasone

Objectives: To assess the cognitive, social, and emotional function in girls prenatally treated with dexamethasone (Dex) due to congenital adrenal hyperplasia (CAH), compared to CAH female patients not treated prenatally. Patients and methods: 33 girls from CAH families were studied: 17 girls treated prenatally with Dex (9 CAH-affected and 8 non-CAH-affected) and 16 CAH-affected females prenatally untre-ated. Standardized tests to assess cognitive function, tests of memory and learning process, and the Child Behavior Checklist (CBCL) were used. Results: There were few statistically significant differences between the results of treated girls (CAH-affected and unaffected) and CAH untreated patients, with a tendency for better results in all tests by Dex treated girls. Among three groups— “CAH-unaffected treated,” “CAH-affected treated,” and “CAH-affected untreated”— the best results were found in “CAH-affected treated” in almost all tests. The Wechsler test performance scale was significantly higher in treated CAH-affected girls. The comparison between treated and untreated CAH-affected girls revealed better results in all tasks involving the cognitive function in Dex-treated patients. Poor performance in visual perception, analysis of spatial material, and visual memory tasks were obtained in CAH-unaffected treated girls. Conclusions: Prenatal treatment with Dex creates for CAH-affected females better conditions for cognitive development. The prenatal Dex in CAH-unaffected girls can cause the risk of unfavorable influences on the development of some cognitive functions. Therefore, it is recommended that prenatal treatment in CAH-unaffected female fetuses should be stopped as soon as possible after the exclusion of the disease.

Ventricular fibrillation risk factors in over one thousand patients with accessory pathways

BACKGROUND Published data concerning risk factors of VF in WPW patients are inconsistent or contradictory. METHODS AND RESULTS We included 1007 patient (pts) (mean age 35 years; 45% female) with an accessory pathway (AP) referred for non pharmacological treatment. Group 1 consisted of 56 pts (42M, aged 34 ± 15 yrs) with an AP and documented VF and Group 2-951 pts (513M, aged 35 ± 15 yrs) with an AP and without VF. Univariate predictors of VF were: overt pre-excitation, male gender, multiple AP, large AP. Multivariate predictors were: overt pre-excitation, male gender and MAP. The mean shortest pre-excited RR interval during AF was significantly shorter in Group 1: 205 ± 27 vs. 243 ± 64, P=0.019. VF as an end point of the first arrhythmia episode (AVRT or AF) was observed in 20 pts (15M, 5F). Primary VF (no documented arrhythmia prior to aborted SCD) occurred in 16 pts (13M, 3F). The mean age of primary VF pts was significantly lower than of pts with history of AVRT or AVRT and/or AF (24.5 vs. 36.5 vs. 38 yrs., P<0.005 and P=0.002, respectively). Age at VF occurrence shows a bi-modal distribution with peak occurrences in the 2-nd/3-rd and 5-th decades. CONCLUSION In patients with an accessory pathway, overt pre-excitation, male gender and multiple AP constitute independent risk factors of VF episodes. Young patients in the 2-nd/3-rd and older patients in the 5-th decade might be at higher risk of VF occurrence.

The Effects of Age on Stroop Interference in Clinical vs. Healthy Groups of Children

The Effects of Age on Stroop Interference in Clinical vs. Healthy Groups of Children The Stroop task is widely used to assess attentional dysfunction due to a frontal or frontoparietal deficit and is also thought to be related to the maturation of the prefrontal cortex. The study aimed to prove the diagnostic usefulness of the Polish Names and Colors Interference Test (TINiK) in a clinical setting and to investigate the pattern of performance on four TINiK subtasks according to the type of brain damage (focal or diffuse) and age of the patients. A total of 107 subjects (62 female, 45 male) aged 11-18 were divided into two groups: children aged 10;4-14;6 and adolescents aged 14;7-17;10 within each diagnostic category: healthy (H - 35), heterogeneous focal brain damage (BD - 36) and cardiac arrhythmia (CA - 36). The number of correct responses in the 60s time limit was collected for each TINiK task. The H group significantly outperformed both clinical groups. The H and CA groups show improvement of performance systematically with age on all TINiK subtasks although at a different level. The BD group displayed merely non-significant developmental improvement especially among the adolescent group. A discriminant analysis using the four basic TINiK scores was able to significantly differentiate the BD from the H group (83.1%) and the BD from the CA group (74.6%), but less well the CA from the H group (63.9%). TINiK has acquired preliminary neuro-psychological validation in Polish children. Developmental improvement in interference control may be hampered by various neuropathological mechanisms which are yet to be identified.