Cognitive sequelae of hypoxic-ischemic brain injury: a review

Abstract

Despite improvements in the pre-hospital and critical care management of persons with hypoxic-ischemic brain injury (HI-BI) and the conditions with which it is associated, acute and chronic cognitive impairments remain problems for many survivors of such injuries. Disorders of consciousness, attention, speed of processing, and memory impairments, and executive dysfunction are among the most prominent and common disturbances of cognition after HI-BI. Acute interventions, including therapeutic hypothermia, may improve global outcomes after HI-BI, but their specific effects on post-hypoxic cognitive impairments remain uncertain. Additionally, treatments for cognitive impairments after HI-BI are underdeveloped and are generally arrived at by analogy to the treatment of such problems arising from other neurological conditions, especially traumatic brain injury. In the service of offering a practical approach to the evaluation and care of persons with cognitive impairments after HI-BI, the most common types of post-hypoxic cognitive impairments are reviewed. Cognitive outcomes after HI-BI are discussed and suggestions for the nonpharmacologic and pharmacologic neurorehabilitation of these problems are offered.