Effectiveness of teleneuropsychological rehabilitation: Systematic review of randomized controlled trials.

OBJECTIVE: The effectiveness of neuropsychological rehabilitation is supported by the evidence found in previous reviews, but there is a lack of research regarding the effectiveness of remotely conducted neuropsychological rehabilitation. This review aimed to identify and evaluate the results of studies investigating the effectiveness of teleneuropsychological rehabilitation. METHODS: Relevant articles were extracted from electronic databases and filtered to include studies published in 2016 or later to focus on recent practices. Data were synthesized narratively. RESULTS: A total of 14 randomized controlled studies were included in the synthesis (9 for children/adolescents, 5 for adults). The most common type of intervention was computerized cognitive training with regular remote contact with the therapist (seven studies). Regarding children and adolescents, the evidence for the effectiveness was found only for these types of interventions with improvements in cognitive outcomes. The results regarding the family-centered interventions were mixed with improvements only found in psychosocial outcomes. No support was found for the effectiveness of interventions combining cognitive and motor training. Regarding adults, all included studies offered support for the effectiveness, at least to some extent. There were improvements particularly in trained cognitive functions. Long-term effects of the interventions with generalization to global functioning remained somewhat unclear. CONCLUSION: Remote interventions focused on computerized cognitive training are promising methods within teleneuropsychological rehabilitation. However, their impact on long-term meaningful, everyday functioning remained unclear. More research is needed to reliably assess the effectiveness of teleneuropsychological interventions, especially with more comprehensive approaches.

Neuropsychological intervention of dyslexia has a positive effect on aspects of psychological well-being in young adults - a randomized controlled study.

Effectiveness of individual- and group-based neuropsychological intervention on aspects of psychological well-being of dyslexic adults was evaluated. Dyslexic young adults (n = 120) were randomly assigned into individual intervention, group intervention or wait-list control group. Both interventions focussed on cognitive strategy learning, supporting self-esteem, and using psychoeducation. In group format peer support was also utilized. Cognitive and behavioural strategies, mood states, quality of life and self-esteem were assessed via self-report questionnaires at baseline, after the intervention/wait-list control time at 5 months and 10 months. Results indicated that the neuropsychological interventions had a positive effect on self-evaluated cognitive and behavioural strategies, especially in increasing success expectations and to a lesser degree in diminishing task-avoidance and in group intervention in diminishing social pessimism. The interventions also improved cognition-related quality of life and, to a lesser degree, self-esteem. These results indicate that structured neuropsychological interventions can positively affect self-evaluated psychological well-being, especially on cognitive and behavioural strategies. Considering the secondary consequences of dyslexia, support among young adults is often needed beyond the cognitive and reading-based challenges dyslexia poses.

Executive Dysfunction Related to Binge Drinking in Ischemic Stroke.

BACKGROUND: Recent evidence has shown that cognitive dysfunction is associated with a history of binge drinking in adolescents who do not have an alcohol use disorder. Most previous studies with adults, however, have failed to show a link between cognitive dysfunction and subdiagnostic binge drinking, nor have any studies investigated the additive cognitive effect of binge drinking to ischemic stroke. OBJECTIVE: To examine whether a pattern of cognitive dysfunction, especially executive and memory dysfunction, in patients with a first-ever ischemic stroke is associated with a history of subdiagnostic binge drinking. METHODS: We studied 206 first-ever ischemic stroke patients (18-65 years) and 50 healthy, demographically comparable adults-both groups with no alcohol use disorder. After exclusion by matching, 189 patients and 39 healthy participants were included in our study (228 participants). The binge-drinking group included 76 participants; the non-binge-drinking group included 152. A multivariate analysis of covariance was used to compare nine cognitive functions between the two groups, with age, education, and stroke severity used as covariates. RESULTS: Binge drinking had a significant negative effect on executive functions (P<0.001). The non-binge-drinking group outperformed the binge-drinking group on the Stroop Test (P=0.001), Trail Making Test (P=0.002), and a phonemic fluency test (P=0.005). The Binge×Stroke Severity interaction (P=0.037) indicated that a history of binge drinking increased the negative effect of stroke on executive functions. CONCLUSIONS: Subdiagnostic binge drinking may exacerbate the adverse effects of ischemic stroke on executive dysfunction.

Domain-Specific Cognitive Recovery after First-Ever Stroke: A 2-Year Follow-Up.

OBJECTIVES: The aim of this work was to study the change in different cognitive domains after stroke during a 2-year follow-up. METHOD: We evaluated both neuropsychologically and neurologically a consecutive cohort of working-age patients with a first-ever stroke at baseline (within the first weeks), 6 months, and 2 years after stroke-onset. A total of 153 patients participated in all examinations and were compared to 50 healthy controls. RESULTS: Forty-nine percent of the patients were cognitively impaired at baseline, 41% at 6 months, and 39% at 2-year follow-up. We analyzed seven cognitive domains (impairment rates at baseline and 2-year follow-up): psychomotor speed (34%; 23%), executive functions (27%; 17%), visual memory (21%; 4%), visuospatial function (20%; 14%), verbal memory (18%; 12%), basic language processing (baseline 11%; 6 months 5%), and reasoning (2 years 14%). The patients who were cognitively impaired at baseline improved more within 6 months, than either the controls or cognitively intact patients in all cognitive domains (all p<.05). Later on, between 6 months and 2 years, the domain-specific change scores did not differ between patients who were cognitively intact and impaired at 6 months. Also, the cognitive status (intact or impaired) remained the same in 90% of patients between 6-month and 2-year follow-ups. At 2 years, half of the patients, who were categorized cognitively impaired, were rated as well-recovered according to neurological evaluation. CONCLUSIONS: Most of the cognitive improvement took place within 6 months. Long-lasting cognitive impairment was common even after good neurological recovery. An early neuropsychological examination is essential in evaluating cognitive dysfunction and need for rehabilitation. (JINS, 2018, 24, 117-127).

Executive Impairment Is Associated with Impaired Memory Performance in Working-Aged Stroke Patients.

OBJECTIVES: Executive dysfunction is associated with impaired memory performance, but controversies remain about which aspects of memory are involved and how general intelligence influences these connections. We aimed to clarify these connections in stroke patients by comparing various memory measures in patients with and without executive impairment. METHODS: Our consecutive cohort included patients with a first-ever ischemic stroke. Neuropsychological assessments were completed 6 months and 2 years after stroke. We classified patients as executively impaired, when at least two of five executive measures were defective at 6 months. At both 6 months and 2 years, we compared list learning of unrelated words, story recall, and recall of geometric figures in patients with and without executive impairment, while controlling for general intelligence. RESULTS: Patients with executive impairment (n=66; 37%) performed worse in list learning (p=.001; partial η2=.058) and immediate recall of a logical passage (p=.010; partial η2=.037) 6 months after stroke compared to executively intact patients (n=113). At the end of the 2-year follow-up period, the patients who were executively impaired at 6 months (n=53; 37%) still performed worse than executively intact patients (n=92) in list learning (p<.001; partial η2=.096), and additionally in delayed recall of the list (p=.006; partial η2=.052) and immediate recall of geometric figures (p=.007; partial η2=.050). CONCLUSIONS: In our working-aged stroke patients, executive impairment was common. Executive impairment was associated with memory tasks that provided less inherent structure and required the use of active memory strategies. Clinicians should remember this role of executive dysfunction when interpreting memory performance.

Use of Stroke-Related Income Supplements and Predictors of Use in a Working-Aged Finnish Ischemic Stroke Cohort.

BACKGROUND: Compared with the direct costs, the indirect costs of stroke may be larger contributors to the socioeconomic burden of stroke, and the need to better understand the indirect costs of stroke is well established. We investigated the indirect costs of stroke according to a novel outcome, the use of stroke-related income supplements, in a Finnish cohort of working-aged patients. METHODS: Consecutive patients (n = 230) who experienced a first-ever ischemic stroke were recruited. Demographic, clinical, and cognitive function data (which were measured using clinical neuropsychological assessments) were collected at baseline and at 6-month and 2-year follow-ups. Data on the use of income supplements within the first 3 years of the stroke were retrieved from national insurance registry files and used to construct survival models. RESULTS: Stroke patients used a mean of 11 months of stroke-related income supplements; this use was associated with atrial fibrillation, cognitive impairment, prestroke income supplement use, higher National Institutes of Health Stroke Scale scores, lower Barthel Index scores, and increased lesion sizes. In multivariate survival models, atrial fibrillation and cognitive impairment were the factors most strongly associated with the use of stroke-related income supplements. CONCLUSIONS: Using stroke-related income supplement data to quantify poststroke productivity losses allowed a working-aged cohort to be investigated without inclusion restrictions based on occupational status or other factors; the use of these data as an outcome emphasized the well-known detrimental effects of atrial fibrillation and cognitive impairment on stroke outcome. The results support stroke-related income supplement use as a complementary outcome for understanding stroke-related productivity losses.

The cognitive burden of stroke emerges even with an intact NIH Stroke Scale Score: a cohort study.

BACKGROUND: We aim to facilitate recognition of the cognitive burden of stroke by describing the parallels between cognitive deficits and the National Institutes of Health Stroke Scale (NIHSS), a widely used measure of stroke severity. METHODS: A consecutive cohort of 223 working-age patients with an acute first-ever ischaemic stroke was assessed neuropsychologically within the first weeks after stroke and at a 6-months follow-up visit and compared with 50 healthy demographic controls. The NIHSS was administered at the time of hospital admittance and upon discharge from the acute care unit. The associations between total NIHSS scores and domain-specific cognitive deficits were analysed correlatively and with a binary logistic regression. RESULTS: Of the NIHSS measurements (admittance median=3, range 0-24; discharge median=1, range 0-13), the total score at the time of discharge had systematically stronger correlations with cognitive impairment. Adjusted for demographics, the NIHSS discharge score stably predicted every cognitive deficit with ORs ranging from 1.4 (95% CI 1.2 to 1.6) for episodic memory to 1.9 (95% CI 1.5 to 2.3) for motor skills. The specificities of the models ranged from 89.5-97.7%, but the sensitivities were as low as 11.6-47.9%. Cognitive deficits were found in 41% of patients with intact NIHSS scores and in all patients with NIHSS scores ≥4, a finding that could not be accounted for by confounding factors. CONCLUSIONS: Cognitive deficits were common even in patients with the lowest NIHSS scores. Thus, low NIHSS scores are not effective indicators of good cognitive outcomes after stroke.

Executive and memory dysfunction related to binge drinking in stroke survivors during a 9-year follow-up.

Background: Ischemic stroke and heavy alcohol consumption are both known risk factors for cognitive impairment. The issue gains importance because the prevalence of stroke and binge drinking have both increased among working-aged adults. Alarmingly, a recent cross-sectional study suggests the additive negative effects of binge drinking and comorbid brain disease on cognition. However, the long-term cognitive prognosis of the additive effects of stroke and binge drinking on adults remains unknown. Methods: In this prospective, two-center cohort study, we recruited consecutive 18-65-year-old patients with first-ever ischemic stroke along with demographically matched stroke-free controls. Patients participated in neuropsychological assessment at 6 months, 2 years, and 9 years after stroke, and in neurological assessment at acute care and at 9-year follow-up. Controls participated in a similar follow-up procedure. We examined the association between binge drinking, follow-up time, and long-term cognitive outcomes using repeated-measures analysis of variance. Results: We included 85 patients who had had their first-ever and only ischemic stroke (mean age 53 years at the incident stroke). Patients were divided into binge-drinking (n = 22) and non-binge-drinking groups (n = 63) based on the shortened version of the Alcohol Use Disorders Identification Test. Follow-up data in healthy controls (n = 31) was used to normalize the patients' test scores for effects of age, sex, and education. We compared cognitive changes between binge-drinking and non-binge-drinking patients over a 9-year follow-up. Non-binge-drinking patients outperformed binge-drinking patients across all follow-up points on most of the executive function tests and in one memory test: binge drinking had a significant main effect both on executive function (the phonemic fluency task, p = 0.002; the Trail Making Test, p = 0.013) and memory (the list learning task, p = 0.002). Conclusion: Binge drinking was associated with executive and memory dysfunction at three time points over a decade after a first-ever ischemic stroke. Subdiagnostic binge drinking might increase the adverse effects of a first-ever ischemic stroke on executive function and memory, evident over a decade poststroke.

The severity of cognitive deficits predicts return to work after a first-ever ischaemic stroke.

BACKGROUND: The inability of stroke patients to return to work contributes disproportionately to the socioeconomic impact of stroke and is best predicted by the severity of stroke. However, the role of cognitive deficits in stroke severity has not been scrutinised. We studied whether the initial cognitive severity of stroke, compared with other influential factors, predicts the inability to return to work after stroke. METHODS: Consecutive patients aged 18--65 with a first-ever ischaemic stroke, working full time previously, were assessed neuropsychologically within the first weeks after stroke and at the 6-month follow-up. Similarly, 50 healthy demographic controls were assessed twice. The cognitive severity of stroke was operationalised as the number of initial cognitive deficits. Cognitive severity as a predictor of the inability to return to work was compared with demographic, occupational, neurological, radiological and functional data, vascular risk factors and mood state. RESULTS: The mean age of the 140 patients assessed both initially and at follow-up was 52 years. They had a mean of 13 years of education and 59% were men. At 6 months, only 41% of the patients had returned to work despite the relatively minor neurological and functional impairments of the cohort. In our model, the number of early cognitive deficits (OR=2.252, CI 1.294 to 3.918) was the only significant predictor of the inability to return to work. CONCLUSIONS: The initial cognitive severity of stroke predicts the later inability to return to work. The benefits of neuropsychological assessments within the first weeks after stroke are emphasised.

Returning to Work after Stroke: Associations with Cognitive Performance, Motivation, Perceived Working Ability and Barriers.

OBJECTIVE: To investigate post-stroke return-to-work and its associations with cognitive performance, motivation, perceived working ability, and self-perceived barriers to returning to work. DESIGN: Prospective cohort study of a clinical sample. SUBJECTS AND METHODS: Participants were 77 stroke patients younger than age 69 years. Assessment included a cognitive screening method for stroke patients (CoMet), a questionnaire regarding work-related matters, and a question regarding motivation to return to work. A predictive model of return-to-work was built, and how participants managed in their working life was examined. RESULTS: Cognitive performance was significantly connected with returning to work. Three of the 5 individuals who dropped out of working life had cognitive dysfunction. Cognitive performance predicted 80% of those who had not returned and 37% of those who had returned by 6 months after the initial assessment. Self-perceived working ability and barriers predicted 64% of those who had not returned and 78% of those who had returned at the 12-month follow-up. CONCLUSION: Cognitive performance seems to be a crucial predictor of return-to-work post-stroke, but individuals' own evaluations of their working capabilities are also important.

Status of Clinical Neuropsychology Training in Finland.

This paper provides information on different training models within clinical neuropsychology in Finland. Systematic specialization training program began in Finland in 1983. It was first organized mainly by the Finnish Neuropsychological Society and since 1997 by the Finnish universities. At present, close to 400 clinical neuropsychologists have completed the training. The number of professionals still does not cover the needs of the country (population 5.5 million, area 338,440 km2), and geographical disparities are a constant concern. The training models in Finland have changed over the years and will continue to evolve. Specialization training can be organized by national societies or by universities. It can lead to an academic degree or a diploma. It can be linked to doctoral studies or form a parallel track. Financial model can involve student fees or be governed by ministries (such as the Ministry of Education or Ministry of Health). This paper describes and compares different strategies in education that have impact on the output of professionals. One model does not fit all, or even one country at all times. The strategies of the stakeholder ministries can change over time. The experiences from Finland can be useful for other countries that are developing their models. The estimated need of practitioners and the educational resources including the available financial models for training differ between countries. The guiding principles in specialist training should focus on the advanced competencies expected from the neuropsychologist when entering the profession.

Memory decline in young stroke survivors during a 9-year follow-up: A cohort study.

Introduction: A decade after stroke, young stroke survivors continue to suffer from cognitive impairment. However, it is not known whether this long-term cognitive outcome is caused in part by further cognitive decline or solely by incomplete recovery from the acute effects of ischemic stroke. We studied changes in three cognitive domains over a 9-year follow-up period after first-ever and only ischemic stroke. Patients and methods: In this prospective, two-center cohort study, we recruited consecutive 18-65 year-old patients with acute stroke between 2007 and 2009, along with demographically matched stroke-free controls. We performed comprehensive neuropsychological assessments at 3 months, 2, and 9 years after stroke, and we also performed neurological examinations at the time of inclusion and at the 9-year follow-up. We assessed the associations among stroke, follow-up time and long-term cognitive outcomes using repeated-measures analysis of variance. Results: The subjects comprised 85 patients who had had their first-ever and only ischemic stroke (mean age 53 years at inclusion), along with 31 stroke-free demographic controls. We compared the cognitive changes in patients to those in controls over a 9-year follow-up. After initial recovery between 3 months and 2 years after stroke, patients showed a decline in memory between 2 and 9 years after stroke compared to controls within the same time interval (immediate recall p < 0.001; delayed recall p < 0.001; list learning p < 0.001). Other than memory, we found no difference in cognitive changes between poststroke patients and controls. Discussion: Our main finding was memory decline over a decade in young first-ever stroke patients with no further stroke or neurodegenerative disease. Our study extends the previous results of further memory decline in elderly stroke survivors to young stroke survivors. Conclusion: Young stroke survivors might be at risk of memory decline over the decade following the stroke.

Goal attainment in individual and group-based neuropsychological interventions for young adults with dyslexia in a randomized controlled trial.

In this study, we investigated the outcome of goal attainment in individual and group-based neuropsychological intervention for young adults with dyslexia. Participants (N = 120) were randomly assigned to individual intervention, group intervention, or wait-list control group. Attainment of goals set personally before the intervention was evaluated after the intervention using Goal Attainment Scaling. The participants were asked to report the number of concrete changes made in their study or working habits at five months (after intervention or wait-list control time), at ten months, and 15 months post-interventions. Potential predictive factors for predicting goal attainment were evaluated including background and cognitive variables, self-reported psychological variables (mood, cognitive and behavioral strategies, self-esteem, quality of life), and self-reported behavioral variables (concrete changes made, time used to work on intervention matters). Based on the results, personal goals were, on average, met especially in individual intervention. Nearly 50% of goal attainment was explained by intervention type, behavioral and cognitive strategies, concrete changes made, cognitive capacity, and used time. Concrete changes, e.g., adopting new strategies and methods in study or working habits, were reported in both interventions and more than during the wait-list control period. The changes seemed long-lasting as fifteen months post-intervention, 76.4% reported still using the learned strategies. A structured and relatively short neuropsychological intervention for dyslexia in either individual or group format can lead to attaining pre-set personal goals and positive behavioral changes that can last up to over a year post-intervention.

Both Individual and Group-Based Neuropsychological Interventions of Dyslexia Improve Processing Speed in Young Adults: A Randomized Controlled Study.

Effectiveness of individual and group-based neuropsychological interventions on cognitive aspects of dyslexia in young adults was evaluated. Dyslexic adults were randomly assigned into individual intervention (n = 40), group intervention (n = 40), or wait-list control group (n = 40). The interventions focused on cognitive strategy learning, supporting self-esteem, and using psychoeducation. Cognitive performance and symptoms were assessed via psychometric testing and self-report questionnaires at baseline, after the intervention/wait-list control time at 5 months and at 10 months. And, 15 months post intervention long-term status was checked via mailed inquiry. Wait-list control group also received an intervention after the 5-month control period. No significant effects were found in primary self-report outcome measures. Both interventions had a positive effect on a measure of processing speed and attention and the effect remained after the 5-month follow-up period. In self-reported cognitive symptoms, a positive trend was evident in self-reported reading habits. Furthermore, minor self-evaluated benefits reaching up to 15 months post intervention were found. There were no significant differences between the results of individual and group intervention as both interventions improved cognitive performance. The results indicate that a structured neuropsychological intervention could be effective in ameliorating dyslexia-related cognitive symptoms in young adults.

Clarifying the diversity of first-episode psychosis: Neuropsychological correlates of clinical symptoms.

BACKGROUND: Psychosis is marked by heterogeneity, which complicates effective treatment. AIMS: Subgroups of first-episode psychosis could be found by identifying neuropsychological correlates of psychiatric symptoms. METHODS: Ninety-two outpatients with first-episode psychosis were evaluated with the Positive and Negative Syndrome Scale (PANSS) and a comprehensive neuropsychological test battery. RESULTS: Factor analysis of PANSS revealed five symptom dimensions. Negative symptoms were correlated with widespread neuropsychological dysfunction. Disorganization symptoms were correlated with more focused deficits in executive function, attention and processing speed implicating dysfunction in frontal-subcortical circuits. Asocial, positive and affective symptoms were not associated with cognition. CONCLUSIONS: In first-episode psychosis, neuropsychological deficits are associated with negative and disorganization symptom dimensions, which appear to be marked by different cognitive profiles. These findings have implications for improving symptom-specific treatment.

Validation of a New Cognitive Screening Method for Stroke Patients.

OBJECTIVE: Two million adults under fifty years of age have a cerebral stroke every year worldwide. Neuropsychological assessment is the best way to identify poststroke cognitive dysfunction, but it is often time-consuming and can be tiring for the patient, and hospitals vary in their availability of neuropsychological expertise. A valid and reliable cognitive screening method could be advantageous in identifying patients who need comprehensive neuropsychological examination. Our purpose in this study was to validate a newly developed cognitive screening method as an identifier of cognitive dysfunction after stroke in working-aged patients. METHODS: We analyzed new cognitive screening method concurrent validity by comparing it in two groups formed on the basis of a comprehensive neuropsychological examination for 77 stroke patients. We identified the best balance of sensitivity and specificity by using receiver operating characteristic curve analysis and investigated the impact of the sociodemographic variables to the screening method total score variation. RESULTS: We found a significant correlation between the method's total score and performance in neuropsychological examination. The cognitive method's internal consistency was strong; Cronbach's alpha for all items was .818. The best balance of sensitivity (88%) and specificity (50%) was found at a total score cut point of 138. Subjects' age and length of education were each responsible for 10% of total score variation. CONCLUSIONS: This study shows promising results for this new cognitive screening tool's ability to identify poststroke cognitive decline and patients' need for further detailed neuropsychological examination.

Moyamoya angiopathy: long-term follow-up study in a Finnish population.

BACKGROUND AND PURPOSE: Moyamoya angiopathy (MMA) is a chronic cerebrovascular disorder predominantly starting in childhood or early adulthood and thus affects the whole lifetime. Little is known on MMAs long-term outcomes in European patients. We report long-term follow-up data on Finnish MMA patients. METHODS: We included patients from our Helsinki University Hospital MMA database and arranged long-term follow-up visits for all the patients. This follow-up included a review of the medical records accumulated in due time, detailed neurological and neuropsychological evaluation, and outcome measures modified Rankin Scale (mRS) and Barthel Index (BI). RESULTS: There were 61 MMA patients with a mean follow-up period of 9.5 years (SD 6.7 years; range 1.3-35.4 years; 581 patient-years). Only two patients had died and two-thirds (n = 40, 65.6%) had no new events during the follow-up period. Eight patients (13.1%) had an ischemic and five patients (8.2%) a hemorrhagic stroke during the follow-up. There were no differences between operated (n = 26) and conservatively (n = 35) treated groups regarding recurrent events or the outcome measured with mRS or BI. Finnish MMA patients reported significantly poorer physical and psychological health aspects of QOL when compared to the general Finnish population. Symptoms of low mood were found in 27 (56%) patients. CONCLUSIONS: Finnish MMA patients have a benign and stable course with a ~3.5 % annual stroke risk. We found no differences in the clinical outcomes between the operated and conservative groups, however, the psychosocial well-being requires more attention in MMA patients.

Cognitive and neurophysiological outcome of cardiac arrest survivors treated with therapeutic hypothermia.

BACKGROUND AND PURPOSE: Cognitive deficits are common in survivors of cardiac arrest (CA). The aim of this study was to examine the effect of therapeutic hypothermia after CA on cognitive functioning and neurophysiological outcome. METHODS: A cohort of 70 consecutive adult patients resuscitated from out-of-hospital ventricular fibrillation CA were randomly assigned to therapeutic hypothermia of 33 degrees C for 24 hours accomplished by external cooling or normothermia. Neuropsychological examination was performed to 45 of the 47 conscious survivors of CA (27 in hypothermia and 18 in normothermia group) 3 months after the incident. Quantitative electroencephalography (Q-EEG) and auditory P300 event-related potentials were studied on 42 patients at the same time point. RESULTS: There were no differences between the 2 treatment groups in demographic variables, depression, or delays related to the resuscitation. No differences were found in any of the cognitive functions between the 2 groups. 67% of patients in hypothermia and 44% patients in normothermia group were cognitively intact or had only very mild impairment. Severe cognitive deficits were found in 15% and 28% of patients, respectively. All Q-EEG parameters were better in the hypothermia-treated group, but the differences did not reach statistical significance. The amplitude of P300 potential was significantly higher in hypothermia-treated group. CONCLUSIONS: The use of therapeutic hypothermia was not associated with cognitive decline or neurophysiological deficits after out-of-hospital CA.

Neuropsychology in Finland - over 30 years of systematically trained clinical practice.

OBJECTIVE: The aim of this invited paper for a special issue of international practice in The Clinical Neuropsychologist is to provide information on training models, clinical practice, and professional issues within neuropsychology in Finland. METHOD: Relevant information was gathered via literature searches, a survey by the Neuropsychology Working Group of the Finnish Psychological Association, archives of the Finnish Neuropsychological Society, and personal communication with professionals in Finland. RESULTS: The roots of Finnish neuropsychology are linked to the early German tradition of experimental psychology. Since the 1970s, it has been strongly influenced by both the psychometric approach in the U.S. and the qualitative approach by Luria. Systematic specialization training program began in Finland in 1983. It was first organized by the Finnish Neuropsychological Society and since 1997 by Finnish universities. At present, around 260 neuropsychologists have completed this training. According to the survey by the Finnish Psychological Association in 2014, 67% of Finnish neuropsychologists work in the public sector, 36% in the private sector, and 28% reported that they had private practice. Work includes assessments for 90% of the respondents, rehabilitation for 74%, and many are involved in teaching and research. Of the respondents, 20% worked both with adults and children, 44% with adults only and 36% with children only. Within test development, pediatric neuropsychology is an especially prominent field. CONCLUSIONS: A unique blend of approaches and a solid systematic training tradition has led to a strong position of neuropsychologists as distinguished experts in the Finnish health care system.

Functional outcome, cognition and quality of life after out-of-hospital cardiac arrest and therapeutic hypothermia: data from a randomized controlled trial.

BACKGROUND: To study functional neurologic and cognitive outcome and health-related quality of life (HRQoL) in a cohort of patients included in a randomised controlled trial on glucose control following out-of-hospital cardiac arrest (OHCA) from ventricular fibrillation (VF) treated with therapeutic hypothermia. METHODS: Patients alive at 6 months after being discharged from the hospital underwent clinical neurological and extensive neuropsychological examinations. Functional outcome was evaluated with the Cerebral Performance Category scale, the modified Rankin scale and the Barthel Index. Cognitive outcome was evaluated by neuropsychological test battery including two measures of each cognitive function: cognitive speed, execution, memory, verbal skills and visuospatial performance. We also assessed quality of life with a HRQoL 15D questionnaire. RESULTS: Of 90 OHCA-VF patients included in the original trial, 57 were alive at 6 months. Of these, 52 (91%) were functionally independent and 54 (95%) lived at their previous home. Focal neurological deficits were scarce. Intact cognitive performance was observed in 20 (49%), mild to moderate deficits in 14 (34%) and severe cognitive deficits in 7 (17%) of 41 patients assessed by a neuropsychologist. Cognitive impairments were most frequently detected in executive and memory functions. HRQoL of the CA survivors was comparable to that of age- and gender matched population. CONCLUSIONS: Functional outcome six months after OHCA and therapeutic hypothermia was good in the great majority of the survivors, and half of them were cognitively intact. Of note, the HRQoL of CA survivors did not differ from that of age- and gender matched population.