Cognitive Intervention in a Patient with Carbon Monoxide Intoxication

Ji-Hyang Oh; Go-Woon Kim; Seong H. Choi; Jee H. Jeong; Hae R. Na; Jung E. Kim; Duk L. Na; Chang Hee Hong; Eun-Joo Kim

doi:10.12779/dnd.2014.13.4.139

Journal List > Dement Neurocogn Disord > v.13(4) > 1120740

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Oh, Kim, Choi, Jeong, Na, Kim, Na, Hong, and Kim: Cognitive Intervention in a Patient with Carbon Monoxide Intoxication

Original Article

Dementia and Neurocognitive Disorders 2014; 13(4): 139-145.

Published online: 31 December 2014

DOI: https://doi.org/10.12779/dnd.2014.13.4.139

Cognitive Intervention in a Patient with Carbon Monoxide Intoxication

Ji-Hyang Oh, M.A.^*, Go-Woon Kim, M.A.^*, Seong H. Choi, M.D.^†, Jee H. Jeong, M.D.^‡, Hae R. Na, M.D.^§, Jung E. Kim, M.D.^‡, Duk L. Na, M.D.^¶, Chang Hee Hong, Ph.D.^**, Eun-Joo Kim, M.D.^*

^*Department of Neurology, Pusan National University School of Medicine and Medical Research Institute, Busan, Korea.

^†Department of Neurology, Inha University School of Medicine, Incheon, Korea.

^‡Department of Neurology, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea.

^§Department of Neurology, Bobath Memorial Hospital, Seongnam, Korea.

^¶Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.

^**Department of Psychology, Pusan National University, Busan, Korea.

Address for correspondence: Eun-Joo Kim. Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, 179 Gudeok-ro, Seo-gu, Busan 602-739, Korea. Tel: +82-51-240-7317, Fax: +82-51-245-2783, eunjookim@pusan.ac.kr

Received 10 November 2014 Revised 2 December 2014 Accepted 2 December 2014

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Cognitive intervention (CI) is a nonpharmacological approach used to compensate for cognitive impairment. It is categorized into cognitive training, cognitive stimulation and cognitive rehabilitation. Several studies showed that CI could induce cognitive enhancement and reduction of risk for future cognitive decline in patients with brain injury. We investigated effects of CI on cognitive functions and brain glucose metabolism based on serial cognitive assessments and [18F]-Fluorodexoxyglucose positron emission tomography (FDG-PET) in a patient with carbon monoxide (CO) intoxication.

Methods

A 40-year-old man presented with memory impairment and abnormal behaviors such as apathy, indifference, and perseveration 2-month after CO intoxication. Brain magnetic resonance image (MRI) demonstrated high signal changes in the bilateral basal ganglia, hippocampus and the subcortical white matter on T2 weighted images. FDG-PET also showed glucose hypometabolism in the bilateral hippocampus, basal ganglia, and the subcortical white matter. A detailed neuropsychological evaluation revealed multiple cognitive impairments in memory, language and frontal functions. He received twice a week sessions of 60-minute group-based cognitive intervention for 12 weeks. Several neuropsychological examinations and FDG-PETs were conducted at baseline and after CI.

Results

After CI, he showed improvements in memory and frontal functions compared with baseline performances. These cognitive improvements persisted by the 7-month follow-up. The extent of glucose hypometabolism was decreased 1-month after CI, however increased 8-month after CI.

Conclusions

This case study suggested that CI could enhance cognitive functions and improve glucose metabolism in a patient with CO intoxication. Also, the effects of CI on cognitive functions seem to be last at least 7-month after training.

Keywords: Neuroplasticity, Neuropsychology, Cognitive intervention, Carbon monoxide intoxication, FDG-PET

Figures and Tables

Fig. 1

Fluid-attenuated inversion recovery axial images (A) 3 days after CO intoxication show high signal intensities in the bilateral globus pallidus, putamen, hippocampus, cerebellum, and subcortical white matter. [18F]-Fluorodeoxyglucose positron emission tomography (FDG-PET) axial images taken 5 months after onset (baseline) showed glucose hypometabolism in the bilateral hippocampus, basal ganglia, and the subcortical white matter. Hypometabolic regions were examined using statistical parametric mapping PET analysis before (C), and 1 month (D) and 8 months (E) after cognitive intervention (CI) which were compared with those of 3 age-matched healthy controls. The extent of hypometabolic regions was decreased in 1 month after CI, whereas that in 8 months after CI was increased compared to that before CI (uncorrected, p<0.001).

Fig. 2

Changes of performance in each cognitive domain: before and after CI. A percentage of raw score in each cognitive domain is plotted with 7 months follow-up.

Table 1

Neuropsychological evaluations before and after cognitive intervention (CI)

M, month; K-BNT, Korean-Boston naming test; RCFT, Rey complex figure text; SVLT, Seoul verbal learning test; IR, immediate recall; DR, delay recall; REC, recognition; K-MMSE, Korean-mini mental state examination; CDR, clinical dementia rating; MS, memory scale; SB, clinical dementia rating-sum of boxes; GDS, global deterioration scale; G dep S, Global depression Scale; K-IADL, Korean version of Barthel activities of daily living index; S-IADL, Seoul-instrumental activities of daily living; CGA-NPI, caregiver-administered neuropsychiatric inventory; FBI, frontal behavioral inventory; SNSB-D, Seoul neuropsychological screening battery-dementia version.

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