- Minisymposium voor professionals in de revalidatiezorg -

Datum: woensdag 30 augustus 2023 van 17.30 - 20.30 uur
Locatie: Merem Medische Revalidatie in Hilversum

In het ziekenhuis ligt de focus meestal op overleven en ontslag naar huis. Er zijn echter veel ziekten met cognitieve gevolgen. De meeste mensen zullen herstellen in de periode na ontslag, maar sommigen niet. Tijdige herkenning en uitleg van cognitieve problemen voorkomen dat patiënten en hun families vastlopen in het herstelproces. Bij patiënten die een hartstilstand hebben gehad, ervaart ongeveer 25% cognitieve beperkingen na overleving.

Dit symposium belicht de incidentie en de dagelijkse gevolgen van cognitieve beperkingen bij enkele veelvoorkomende klinische aandoeningen. Het richt zich ook op de invloed van cognitieve beperkingen op de behandelplannen van deze patiënten.

Paulien Goossens MD PhD

In hospital, focus is mostly on survival and discharge home. However, there are numerous diseases with cognitive sequelae. Most of them will recover in the period after discharge, but some will not. Timely recognition of, and explanation about cognitive problems prevents patients and their families from getting stuck in their recovery. In cardiac arrest patients, approximately 25% of survivors suffer from cognitive deficits. The cardiac performance categories (CPC) have long been the gold standard to discover cognitive disorders after cardia arrest. However, this scale is very rough and only detects patients with severe deficits. Therefore use of the MOCA or MMSE are now recommended in guidelines. In The Netherlands, a survey among cardiologists and rehabilitation physicians showed that only in a minority of hospitals these tests are standardly performed. Believe in the possibility to detect cognitive deficits in the anamnestic process, use of the CPC, time and not enough knowledge of cognitive screenings were given as explanation. For other patient groups, these data are not available, but clinical practice indicates that cognitive screenings are mostly used on the neurological ward, but not in other parts of the hospital. Data however are available on cognitive deficits after for example ICU admission, cardiac attack, but also in patients with severe lung disease, myocardial infarction and diabetes. This lecture illuminates the incidence and sequelae in daily life of cognitive deficits in some rather common clinical entities. Besides attention is given to the consequences of the cognitive deficits for the treatment plans of these patients.

Anders Wieghorst MSc
An increasing number of people survive a cardiac arrest every year. In Denmark in 2018, 813 people survived a cardiac arrest. The vast majority are discharged from the hospital without knowing if their cognitive abilities have deteriorated. This despite the fact that approximately 50% of them will have cognitive difficulties due to brain damage from lack of oxygen during the cardiac arrest. Discharge without knowledge of the cognitive difficulties results in impaired quality of life and increased risk of returning to a life one can no longer cope with. This increases the risk of developing anxiety and depression and loss of ability to work. Unfortunately, existing screening tools are not suitable for this group of patients and a complete cognitive examination by a neuropsychologist is very resource-intensive and time consuming. There are screening tools that have been developed for dementia, which have been used on cardiac arrest survivors. Unfortunately, they do not give reliable results, partly because they test several cognitive domains that are not relevant to cardiac arrest survivors. Hence, it is possible for the survivors to obtain enough points from non-affected domains to clear the sum-score and still have critical memory, attention or executive deficits. In parallel with the development described above, it has become more and more common, in research, to use digital tests to test cognitive functions. In the clinical reality in Denmark, there is very little use of digital tools. The main reason for this is that the digital tools are not sufficiently compared (validated) with the best traditional tests. However, the digital tools offer several benefits such as increased precision, uniformity and reduction of errors. The aim of my research project is to develop and validate a screening tool for cardiac arrest survivors, but also to contribute and inspire to use digital test on other patient groups who are at risk of having overlooked discrete cognitive difficulties. In this lecture I will share the (preliminary) data of my research project and discuss the outcomes with the audience.

Eileen Bousché MSc, one of the members of the group of Tanja Nijboer

Cognitive impairment and cognitive complaints are frequent consequences of acquired brain injury (ABI) and significantly impact daily life activities and participation in society. Adequate neuropsychological assessment (NPA) is thus of utmost importance for treatment and psychoeducation. NPA measures cognitive functions objectively using paper-and-pencil tests. Yet, the nature of the tests allows for a final score, overlooking subtle alterations in cognitive performance over time. Additionally, the low stimulus setting for administering the tests does not resemble the dynamics of daily life. The aforementioned can result in a clean NPA outcome, while the patient still experiences problems in daily life activities and participation. The aim of this project is to improve NPA, focusing on more fine-grained measures with a potential to estimate cognitive functions and skills during daily life situations. Solutions may be offered by innovative technology, such as Serious Games in Virtual and Augmented Reality environments. Here I will discuss the possibilities of innovative technology in neuropsychological assessment and the training of cognitive functions. Finally, I will discuss the opinions and user experience of end-users for implementing VR and AR Serious Games in the clinic.

We wensen u veel plezier bij dit symposium! Mocht u wegens omstandigheden niet fysiek aanwezig kunnen zijn, dan kunt u via deze link deelnemen via Teams.