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Cognitive dysfunction occurs in more than half of stroke survivors and can have far-reaching consequences for functioning in daily life. Assessment of cognitive function can play a major role in determining the appropriate discharge destination after a hospital stay. The present study aimed to determine the feasibility of cognitive screening in the acute phase poststroke and to investigate whether this cognitive screening can accurately predict discharge destination to either a dependent or an independent living situation. A total of 287 patients with a first-ever cerebral stroke consecutively admitted to a stroke unit of a general hospital were eligible for the study. All patients underwent neuropsychological screening, consisting of the Mini-Mental State Examination (MMSE), Cognitive Screening Test (CST), and Clock-Drawing Test, within 7 days poststroke. Screening was feasible in 73.2% of the patients. Logistic regression analysis showed that the Barthel Index (BI) score (ie, ability to perform activities of daily living) could predict the discharge destination with 47% explained variance when age and BI score were taken into account. Adding the 3 cognitive tests to the model with age and BI improved the explained variance substantially (53%), with a significant contribution of BI and CST. Cognitive screening in the acute phase poststroke appeared to be feasible and capable of supporting the decision of whether to discharge a patient to home or to a dependent living situation. Functional status improved the predictive value of the model; the MMSE was not suitable for prediction. A comprehensive set of various predictors, including cognition, is recommended to support discharge planning., (Copyright © 2011 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Previous studies on the association between poststroke cognitive impairment and quality of life (QoL) have shown divergent results. In this study, we investigated the relationships between cognitive functioning and various QoL domains at 1 year poststroke. This was a cross-sectional study, examining 92 patients at 1 year poststroke. Cognitive functioning was measured with a neuropsychological test battery covering language, attention and psychomotor function, memory, visuoperception, and neglect. QoL domains were functional independence (Barthel Index), social participation (Frenchay Activities Index), depressive mood (Center for Epidemiological Studies Depression Scale), and life satisfaction (Life Satisfaction Questionnaire). Bivariate and multivariate relationships between cognitive and QoL variables were analyzed, the latter both with and without controlling for demographic variables and motor impairment. The prevalence of cognitive impairments varied between 19.3% (neglect) and 72% (attention and psychomotor function). Correlations between cognitive functioning and QoL were strongest for social participation (0.41-0.60, P < .01) and functional independence (0.13-0.58, P < .05). The percentages of variance explained by the total cognition score were 19% for functional independence, 40% for participation, 8% for life satisfaction, and 5% for depression. Controlling for demographic factors and motor impairments resulted in negligible percentages of variance additionally explained by cognitive functioning. The percentages of explained variance were somewhat lower in the analyses with the separate cognitive domains and not significant for depression. Poor cognitive functioning was associated with reduced functional independence, social participation, depressive mood, and life satisfaction 1 year post; however, motor impairment was a stronger determinant of long-term QoL than cognitive functioning., (Copyright © 2011 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Objective: To explore the consequences of mental slowness in the daily life of patients with stroke., Design: In a cross-sectional survey semi-structured interviews were completed. Interviews were transcribed and coded by two independent reviewers. Qualitative analysis was done by means of the 'constant comparison method'., Setting: Three rehabilitation centres in the Netherlands., Participants: A convenience sample of 13 patients with stroke, suffering from mental slowness, was derived from December 2003 to May 2004., Main Outcome Measures: Interview descriptions of the everyday consequences of mental slowness., Results: Patients experienced many problems in daily life due to mental slowness. These could be divided into two main groups: (1) problems in cognitive functioning; (2) psychological and somatic complaints. In response to these problems, some patients mentioned the use of compensation strategies in order to reduce the demands on their information processing capacity., Conclusions: Mental slowness in cognitive functioning affects a wide range of activities, causing emotional symptoms in many patients and stimulating the spontaneous use of compensation strategies in some patients.

Long‐term cognitive impairment is common in cardiac arrest survivors. Screening to identify patients at risk is recommended. Functional magnetic resonance brain imaging (fMRI) holds potential to contribute to prediction of cognitive outcomes. In this study, we investigated the possible value of early changes in resting‐state networks for predicting short and long‐term cognitive functioning of cardiac arrest survivors. We performed a prospective multicenter cohort study in cardiac arrest survivors in three Dutch hospitals. Resting‐state fMRI scans were acquired within a month after cardiac arrest. We primarily focused on functional connectivity within the default‐mode network (DMN) and salience network (SN), and additionally explored functional connectivity in seven other networks. Cognitive outcome was measured using the Montreal Cognitive Assessment (MoCA) during hospital admission and at 3 and 12 months, and by neuropsychological examination (NPE) at 12 months. We tested mixed effects models to evaluate the value of connectivity within the networks for predicting global cognitive outcomes at the three time points, and long‐term cognitive outcomes in the memory, attention, and executive functioning domains. We included 80 patients (age 60 ± 11 years, 72 (90%) male). MoCA scores increased significantly between hospital admission and 3 months (ΔMoCAhospital‐3M = 2.89, p < 0.01), but not between 3 and 12 months (ΔMoCA3M–12M = 0.38, p = 0.52). Connectivity within the DMN, SN, and dorsal attention network (DAN) was positively related to global cognitive functioning during hospital admission (βDMN = 0.85, p = 0.03; βSN = 1.48, p < 0.01; βDAN = 0.96, p = 0.01), but not at 3 and 12 months. Network connectivity was also unrelated to long‐term memory, attention, or executive functioning. Resting‐state functional connectivity in the DMN, SN, and DAN measured in the first month after cardiac arrest is related to short‐term global, but not long‐term global or domain‐specific cognitive performance of survivors. These results do not support the value of functional connectivity within these RSNs for prediction of long‐term cognitive performance after cardiac arrest. [ABSTRACT FROM AUTHOR]

Introduction: There is still much uncertainty about why some people develop persistent cognitive and mental health problems after SARS-CoV-2 infection and require additional care while others do not. In this study, we investigated the cognitive and psychological outcomes of non-hospitalized post-COVID-19 patients referred to an outpatient post-COVID-19 clinic for persistent symptoms more than 3months after infection. Additionally, we aimed to explore the influence of demographic, physical, and personal factors on these outcomes. Methods: This cross-sectional study was conducted at an outpatient post-COVID-19 clinic located at a prominent clinical teaching hospital in the Netherlands. Participants included non-hospitalized patients referred between 2020 and 2022, more than 3 months after SARS-CoV-2 infection, experiencing persistent symptoms. Main outcome measures included levels of anxiety and depression (Hospital Anxiety and Depression Scale), post-traumatic stress symptoms (PTSS) (Post-traumatic Stress Symptoms Checklist 14), and cognitive symptoms (Checklist for Cognitive and Emotional Consequences). Data analysis employed Spearman correlation and hierarchical multiple regression analyses. Results: A total of 265 patients (61% female; mean age of 51.7±13.7years) were included in the study, with an average of 7.6 ±4.5 months following SARS-CoV-2 infection. Among them, 104 patients (40%) reported high levels of anxiety, 111 patients (43%) showed high levels depressive symptoms, and 71 patients (31%) demonstrated high levels of PTSS. Additionally, 200 patients (79%) reported experiencing more than 2 cognitive symptoms. Bivariate analyses indicated associations between psychiatric history and increased cognitive and psychological symptoms. Multivariate analyses revealed positive associations between physical symptoms and cognitive and psychological symptoms, and catastrophizing thoughts were associated with higher anxiety levels (β = 0.217, p< 0.001). Conversely, positive refocusing was associated with lower depressive symptoms (β =-0.325, p <0.001), PTSS (β =-0.290, p <0.001), and cognitive symptoms (β =-0.220, p < 0.001). Discussion: Among non-hospitalized COVID-19 patients seeking care for persistent symptoms, approximately one-third reported high levels of psychological symptoms, and more than three-quarter experienced cognitive symptoms. Physical symptoms, psychiatric history, and a tendency to catastrophize were identified as potential risk factors for persistent psychological and cognitive symptoms. Conversely, positive refocusing demonstrated a protective effect. These findings contribute to the understanding of long-term COVID-19 outcomes and emphasize the importance of integrating a biopsychosocial perspective into treatment approaches. [ABSTRACT FROM AUTHOR]

Detecting cognitive impairments early after stroke is essential for appropriate referrals. Although recommended in stroke guidelines, early cognitive screening is not always implemented. We assessed whether the Montreal Cognitive Assessment (MoCA) adds diagnostic value compared to clinical observation alone. In addition, discharge destinations for stroke patients with and without cognitive deficits detected with the screening tool or the treatment team were explored. Forty-four stroke patients were screened with the MoCA during stroke unit admission. Their charts were studied for cognitive impairments reported by the stroke care team, who were blinded to screening scores. Proportions of detected cognitive deficits were compared between screening (score <26) and patient charts. Discharge destination distribution (home vs. rehabilitation) was explored. The proportion of cognitively impaired patients indicated by the MoCA (84%) and reported in patients' charts (25%) differed significantly (p < 0.001). The distribution of discharge destination did not suggest an association with the detection of cognitive deficits by the treatment team or the cognitive screening. The MoCA detects more cognitive deficits than clinical impression alone, emphasizing the importance of standard screening for cognitive impairments in acute stroke patients. Ultimately, systematic screening may enhance discharge planning and improve long-term outcomes. [ABSTRACT FROM AUTHOR]

Partners of patients with stroke are at high risk for burden, anxiety and depressive symptoms. Previous studies have reported contradictory results and did not investigate these three courses simultaneously. In this study we comprehensively studied the courses and predictors of burden, anxiety and depressive symptoms in partners of patients with stroke during the first two years after stroke. They were analyzed as outcomes as well as predictors for each other. Six general hospitals recruited 215 patients with stroke and their partners for a longitudinal cohort study. Mixed model analyses were performed for burden (CSI), anxiety (HADS-A) and depressive symptoms (HADS-D) as time-varying outcome variables, measured at four time points during two years after stroke. Burden and depressive symptoms did not significantly change over time, whereas anxiety symptoms initially decreased followed by an increase. Higher burden was predicted by partners' younger age, higher education, more symptoms of anxiety and depression, and by patients' greater stroke severity, lower cognitive functioning and more symptoms of anxiety and depression. More anxiety symptoms were predicted by higher burden, more depressive symptoms, and lower self-efficacy of the partner. More depressive symptoms were predicted by older age, higher burden, more symptoms of anxiety, less proactive coping strategies of the partner, and more depressive symptoms of the patients. Burden, anxiety and depressive symptoms are interrelated and become chronic in partners of patients with stroke. It is important to screen partners early after stroke to identify partners who are at risk for negative outcomes. [ABSTRACT FROM AUTHOR]

This exploratory case-controlled study examined whether the same amount of effort leads to similar feelings of fatigue and whether feelings of fatigue decline at the same rate in people with traumatic brain injury (pwTBI) compared to controls. Twenty pwTBI and 20 healthy controls (HC) completed an adaptive n-back task to induce fatigue and reported mental effort upon task completion and state-fatigue pre-task and several times during 30-minutes rest-period post-task. Task difficulty adapted to performance allowing both groups to invest substantial amounts of mental effort. Fatigue and effort levels were higher in pwTBI compared to controls. Multiple linear regression analyses showed that effort was positively related to post-task fatigue and this relationship did not differ between groups. Pre-task fatigue was the only predictor of post-task fatigue. Multilevel models showed no significant difference in decline of fatigue over the rest-period between groups. Excessive feelings of fatigue following TBI could not be explained by a higher vulnerability to the fatigue-inducing effects of mental effort needed to perform a specific task. In pwTBI pre-task fatigue levels might be more related to the complex demands of everyday life. Future studies should investigate recovery of fatigue and applications of this knowledge to rehabilitation interventions. People with TBI experience long-term fatigue as one of the most frequent and disabling symptoms and this long-term fatigue is a risk factor for development of secondary psychiatric symptoms such as depression or anxiety. Since people with TBI did not show a higher vulnerability to the fatigue-inducing effects of mental effort, fatigue following TBI might be better explained by the complex demands of everyday life such as external (environment) and internal (emotions) factors. Rehabilitation programs should be directed to this complex and highly individual interplay of fatigue in relation to other factors. [ABSTRACT FROM AUTHOR]

To examine the presence of social cognition deficits and the relationship between social and general cognition (eg, attention, mental speed, verbal, visual, or memory abilities) in a large sample of chronic stroke patients and to identify stroke-related factors associated with social cognitive performance. Inception cohort study in which social cognition was assessed at 3-4 years post stroke. Stroke units in 6 general hospitals. The data of 148 patients were available. Fifty controls without stroke (consisting of partners of patients and acquaintances of researchers) were recruited (N=198). Not applicable. Patients underwent neuropsychological assessment by means of tests for social cognition (emotion recognition, theory of mind [ToM], empathy, and behavior regulation) and general cognition. Subgroup analysis was performed to compare right hemisphere stroke patients with left hemisphere stroke patients. Correlations between general and social cognition tests were assessed. Multiple regression analyses were performed to identify demographic and stroke-related predictors of social cognitive performance. Patients performed significantly worse on emotion recognition (assessed with the Ekman 60-Faces test on total score as well as on the emotion anger), ToM (assessed with the Cartoon test), and behavior regulation (assessed with the Hayling test). Subgroup analysis revealed no differences between right and left hemisphere patients. Social cognition tests showed significant correlations with each other and with tests for visual perception, language, mental speed, cognitive flexibility, and memory. Older age, low level of education (and for ToM, also female sex) were predictors of worse performance on social cognition tests. Social cognition impairments are present in the long term post stroke, even in a group of mildly affected stroke patients, which may contribute to their long-term problems. Severity of impairments is determined mainly by demographic factors. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate changes in self-awareness impairments in outpatients with acquired brain injury (ABI) and the effects these changes have on rehabilitation. Participants were 78 patients with ABI (8.3 years post-injury) who followed an intensive outpatient neuropsychological rehabilitation programme. This longitudinal study comprised pre (T1) and post (T2) measurements and a one-year follow-up (T3). Thirty-eight patients completed the study. The main outcome domains were self-awareness, depressive symptoms, psychological and physical dysfunction, and health-related quality of life (HRQoL). Patients were divided into three awareness groups: underestimation, accurate estimation, and overestimation of competencies. Most patients who underestimated their competencies at the start of treatment accurately estimated their competencies directly after treatment (9 out of 11 patients). These patients also exhibited the largest treatment effects regarding depressive symptoms, psychological and physical dysfunction, and HRQoL. Most patients with impaired self-awareness (i.e., overestimation of competencies) at the start of treatment continued to overestimate their competencies after treatment (10 out of 14 patients). These patients exhibited a significant decrease in depressive symptoms but no other treatment effects. The results indicate that changes in outcome are related to changes in awareness, which underline the importance of taking into account different awareness groups with respect to treatment effects. [ABSTRACT FROM PUBLISHER]

The Motivation for Traumatic Brain Injury Rehabilitation Questionnaire (MOT-Q) evaluates motivation for rehabilitation in four subscales: Interest in rehabilitation, Lack of anger, Lack of denial, and Reliance on professional help. The objective of this study was to further validate the MOT-Q in 122 inpatients and 92 outpatients with acquired brain injury (ABI). The main measures were motivation for rehabilitation (MOT-Q), self-awareness (Patient Competency Rating Scale), and treatment motivation (Visual Analogue Scale). The MOT-Q showed adequate feasibility in terms of few items with missing responses and few undecided responses. We found no floor or ceiling effects, and significant item-total MOT-Q correlations for 29 of 31 items. Internal consistency was good for the MOT-Q total and acceptable to good for the subscales. The MOT-Q scores were significantly intercorrelated except for the subscales Lack of denial and Reliance on professional help in the inpatient group. The MOT-Q total and subscales were significantly associated with treatment motivation. The Lack of denial subscale showed no significant association with treatment motivation and no to moderate significant associations with self-awareness. In conclusion, the overall MOT-Q is a valid instrument to assess motivation for rehabilitation in patients with ABI. Further research is needed to examine the validity of the subscales. [ABSTRACT FROM PUBLISHER]

Objective: To review systematically studies investigating the convergent, criterion, and predictive validity of multi-domain cognitive screening instruments in the first four weeks after stroke. Data sources: Electronic databases (Pubmed, PsycINFO, CINAHL, Embase) were searched until June 2014. Review methods: Studies concerning screening for cognitive dysfunction in stroke patients using multidomain instruments, within four weeks postinfarct or haemorrhagic stroke, using tests taking no longer than one hour. Convergent, criterion, and predictive validity were examined. Results: A total of 51 studies investigating 16 cognitive screening instruments were identified. None of the instruments covered all of the most affected cognitive domains. Only one study investigated the convergent validity of a multi-domain test during the (sub)acute phase after stroke. A total of 15 studies examined the criterion validity of cognitive measurements during the acute phase after stroke. The Montreal Cognitive Assessment and Higher Cortical Function Deficit Test had good criterion validity. A total of 24 studies examined the predictive ability of multi-domain cognitive instruments applied in the acute phase after stroke. The Cognistat, Montreal Cognitive Assessment, and Functional Independence Measure-cognitive showed good predictive validity. The Mini-Mental State Examination is the most widely used cognitive screening instrument, but shows insufficient criterion validity. Conclusion: None of the existing instruments fulfils all criteria. The Montreal Cognitive Assessment is the best candidate at present, provided items measuring speed of information processing are added, and further studies investigating the optimal cut-offs are conducted [ABSTRACT FROM AUTHOR]

The dynamic Wisconsin Card Sorting Test (dWCST) examines the effects of brief training on test performance where pre- to post-test change reflects learning potential. The objective was to examine the validity of the dWCST as a measure of learning potential in patients with acquired brain injury (ABI). A total of 104 patients with ABI completed the dWCST at rehabilitation admission. Performance of a subgroup (n=63) was compared to patients (n=28) who completed a repeated administration of the conventional WCST (rWCST). Furthermore, dWCST performance was compared between patients with ABI (n=63) and healthy controls (n=30) matched on gender, age, and education. Three learning potential indices were used: post-test score, gain score, and a group classification (decliners, poor learners, strong learners, high achievers). The median dWCST administration time was 30 min. The dWCST showed no floor or ceiling effects and the post-test and gain score were significantly intercorrelated. The pre-test score showed no significant associations with other neuropsychological tests. The learning potential indices were significantly associated with language and/or memory. In contrast to the dWCST group, the rWCST group showed no significant pre- to post-test improvement. There were significantly more poor learners in the rWCST group. Compared to controls, patients obtained similar gains, but significantly lower pre- and post-test scores for the dWCST. The ratio of poor learners between-groups was not significantly different. The results support the validity of the dWCST for assessing learning potential in patients with ABI. Further research is needed to investigate the predictive validity of the dWCST. (JINS, 2014, 20, 1–11) [ABSTRACT FROM AUTHOR]

Objective: To provide recommendations for the successful implementation of Assistive Technology (AT) in cognitive rehabilitation by investigating the attitudes towards AT of professionals, individuals with acquired brain injury (ABI) and their caregivers in two exploratory studies. Method: A total of 147 professionals in cognitive rehabilitation filled out a web-based survey. Fifteen patients with ABI and 14 caregivers were interviewed. Results: Most professionals were willing to use AT in the future, although only 27% used AT currently in a treatment setting. Professionals with AT experience were more positive than those without about the potential of AT and their own ability to use it in their treatment programmes. Most patients and caregivers were positive about using AT in the future, still, only a minority currently used AT. Refusal to reimburse AT devices by health insurance companies appeared an important barrier for a more widespread use. Conclusions: Although enthusiasm about AT was evident in both studies, a lack of progress in the implementation of AT was noted. This could be improved by promoting knowledge and hands-on experience of professionals who work in rehabilitation centres. More evidence on the efficacy of AT is required to improve coverage of AT devices by insurance companies. [ABSTRACT FROM AUTHOR]

OBJECTIVE. We examined the effect of switching from a familiar to an unfamiliar setting on household task performance in healthy adults. We also examined the influence of the cognitive functions abstract reasoning and memory on the ability to adapt to different environments. METHOD. Thirty healthy adults were observed in two different settings while they performed two daily tasks. We evaluated process skill abilities in task performance, time needed to perform each task, memory functioning, and abstract reasoning. RESULTS. Performance of both tasks required significantly more time in the unfamiliar kitchen. Scores on process skill abilities were significantly lower in the unfamiliar kitchen. We found no associations between environmental effects and abstract reasoning or memory. CONCLUSION. We found environmental effects on task performance in healthy adults. These findings have important implications for rehabilitation practice. Addressing facilitation of transfer of training effects to familiar environments is of great importance to rehabilitation programs. [ABSTRACT FROM AUTHOR]

Objective To investigate the association between cognition and daily life functioning in dementia subtypes. Methods Cross-sectional data were used from 615 patients with dementia who were referred to the Maastricht Memory Clinic of the Maastricht University Medical Centre. Pearson correlation coefficients were calculated between the Mini-Mental State Examination (MMSE; to measure cognitive status) and the Blessed Dementia Scale (BDS; to measure daily life functioning) for the following types of dementia: Alzheimer's Disease (AD, n = 442); Vascular dementia (VaD, n = 113); frontotemporal dementia (FTD, n = 18); Parkinson's dementia (PD, n = 21); and primary progressive aphasia (PPA, n = 21). One-way ANOVA was used to test differences in age, MMSE scores and BDS scores across dementia subtypes. Results Scores on the MMSE showed strong correlation with BDS scores in cases of FTD (r = -0.80); moderate correlation in cases of AD, VaD, and PD (range r = -0.50–0.60); while no correlation was found in PPA cases. Conclusions The association between cognition and daily life functioning varied among dementia subtypes for AD, VaD, FTD and PD. Furthermore, the overall scores on both domains differ between dementia subtypes, indicating that different types of dementia are characterized by a specific pattern of cognitive status and daily life functioning. These findings underline the need for multidomain assessment in patients with dementia. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Fatigue and sleep problems are common after a traumatic brain injury (TBI) and are experienced as highly distressing symptoms, playing a significant role in the recovery trajectory, and they can drastically impact the quality of life and societal participation of the patient and their family and friends. However, the etiology and development of these symptoms are still uncertain. Objective: The aim of this study is to examine the development of fatigue and sleep problems following moderate to severe TBI and to explore the changes in underlying biological (pain, brain damage), psychological (emotional state), and social (support family, participation) factors across time. Methods: This study is a longitudinal multicenter observational cohort study with 4 measurement points (3, 6, 12, and 18 months postinjury) including subjective questionnaires and cognitive tasks, preceded by 7 nights of actigraphy combined with a sleep diary. Recruitment of 137 moderate to severe TBI patients presenting at emergency and neurology departments or rehabilitation centers across the Netherlands is anticipated. The evolution of fatigue and sleep problems following TBI and their association with possible underlying biological (pain, brain damage), psychological (emotional state), and social (support family, participation) factors will be examined. Results: Recruitment of participants for this longitudinal cohort study started in October 2017, and the enrollment of participants is ongoing. The first results are expected at the end of 2020. Conclusions: To the authors' knowledge, this is the first study that examines the development of both post-TBI fatigue and sleep longitudinally within a biopsychosocial model in moderate to severe TBI using both subjective and objective measures. Identification of modifiable factors such as mood and psychosocial stressors may give direction to the development of interventions for fatigue and sleep problems post-TBI. [ABSTRACT FROM AUTHOR]

Rhythmic and periodic patterns (RPPs) on the electroencephalogram (EEG) in comatose patients after cardiac arrest have been associated with high case fatality rates. A good neurological outcome according to the Cerebral Performance Categories (CPC) has been reported in up to 10% of cases. Data on cognitive, emotional, and quality of life outcomes are lacking. We aimed to provide insight into these outcomes at one-year follow-up. We assessed outcome of surviving comatose patients after cardiac arrest with RPPs included in the 'treatment of electroencephalographic status epilepticus after cardiopulmonary resuscitation' (TELSTAR) trial at one-year follow-up, including the CPC for functional neurological outcome, a cognitive assessment, the hospital anxiety and depression scale (HADS) for emotional outcomes, and the 36-item short-form health survey (SF-36) for quality of life. Cognitive impairment was defined as a score of more than 1.5 SD below the mean on ≥ 2 (sub)tests within a cognitive domain. Fourteen patients were included (median age 58 years, 21% female), of whom 13 had a cognitive impairment. Eleven of 14 were impaired in memory, 9/14 in executive functioning, and 7/14 in attention. The median scores on the HADS and SF-36 were all worse than expected. Based on the CPC alone, 8/14 had a good outcome (CPC 1–2). Nearly all cardiac arrest survivors with RPPs during the comatose state have cognitive impairments at one-year follow-up. The incidence of anxiety and depression symptoms seem relatively high and quality of life relatively poor, despite 'good' outcomes according to the CPC. [ABSTRACT FROM AUTHOR]