Long-term cognitive impairment after ICU treatment: a prospective longitudinal cohort study (Cog-I-CU)

Abstract

In this prospective cohort study we aimed to investigate the trajectory of the cognitive performance of patients after discharge from an intensive care unit (ICU). Special consideration was given to patients with suspected premorbid cognitive impairment who might be at risk for the development of dementia. Clinical characteristics were collected until discharge. The premorbid cognitive state was estimated by a structured interview with a close relative. Cognitive outcome was assessed using the Consortium to Establish a Registry of Alzheimer’s Disease (CERAD) Plus battery and the Stroop Color and Word Test at the time of discharge from ICU and 9 months later. The results of the study group were compared to an established healthy control group and to normative data. A total number of 108 patients were finally included. At the time of discharge, patients underperformed the healthy control group. In linear regression models, delirium during the ICU stay and the factor premorbid cognitive impairment were associated with poorer cognitive outcome (p = 0.047 and p = 0.001). After 9 months, in 6% of patients without evidence of premorbid cognitive impairment long-lasting deficits were found. In patients with suspected premorbid cognitive impairment, performance in tests of executive function failed to improve.

Rest-Activity Rhythm Fragmentation and Weaker Circadian Strength Are Associated With Cognitive Impairment in Survivors of Acute Respiratory Failure

“…The first PCA factors for the global circadian rhythms and cognitive measures, respectively, were used in the statistical analyses in the second phase. The second phase involved an exploratory analysis of partial correlations of circadian rhythms with cognitive function adjusting for age, education, and estimated premorbid intellectual ability as covariates influencing cognitive functioning after ARF (Bracco et al, 2007; Müller et al, 2020; Teri et al, 1995). We used IBM SPSS Statistics, version 26 for all statistical analyses.…”

Neurological update: COVID-19

“…Hypoxic-ischaemic encephalopathy resulting from persistent hypoxaemia will undoubtedly leave a legacy of neurological impairment, and yet the literature has yet to delineate the prevalence of this. Delirium is commonplace in critically ill patients [112], and will have been exacerbated during the pandemic with the necessary use of older sedation agents given medication shortages [113]; the occurrence of delirium is well recognised to have detrimental long-term consequences on cognition [114]. Whilst the true incidence of encephalopathy in COVID-19 has not been fully delineated, it appears in the majority of patients requiring ICU admission [67], and EEG studies suggest that is likely to represent one of the most common acute neurological disturbances, with altered mental status being the most frequent indication for an EEG request, and diffuse slowing being the most frequently detected abnormality [115].…”

Effect of sedation with inhaled anaesthetics on cognitive and psychiatric outcomes in critically ill adults: a systematic review protocol

“… 12 14 15 While one systematic review did not find an association between sedative use and long-term cognitive dysfunction in ICU survivors, 16 some prospective cohort studies found that intravenous sedative exposure in the ICU is associated with worse long-term cognitive function. 15 17 However, a recent study found that when comparing intravenous sedation with a non-sedation approach in critically ill adults, there was no difference in cognition at 3 months following ICU discharge. 18 There is also some evidence to suggest that intravenous sedation may contribute to psychiatric morbidity in the form of depression, anxiety and post-traumatic stress disorder (PTSD), which are also common among ICU survivors.…”

“…Furthermore, the presence of delirium while in the ICU may be a predictor of long-term cognitive disability, the incidence of which ranges from 10% to 58% across various studies. 12 14 15While one systematic review did not find an association between sedative use and long-term cognitive dysfunction in ICU survivors,16 some prospective cohort studies found that intravenous sedative exposure in the ICU is associated with worse long-term cognitive function 15 17. However, a recent study found that when comparing intravenous sedation with a non-sedation approach in critically ill adults, there was no difference in cognition at 3 months following ICU discharge 18.…”