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VOLUME 24 , ISSUE 10 ( October, 2020 ) > List of Articles

Original Article

Neurocognitive and Quality-of-Life Outcomes Following Intensive Care Admission: A Prospective 6-Month Follow-Up Study

Viswesvaran Balasubramanian, J. C. Suri, Debasis Behera, Pankaj Gupta, Shibdas Chakrabarti

Keywords : Neurocognitive impairment, Post intensive care, Quality of life

Citation Information : Balasubramanian V, Suri JC, Behera D, Gupta P, Chakrabarti S. Neurocognitive and Quality-of-Life Outcomes Following Intensive Care Admission: A Prospective 6-Month Follow-Up Study. Indian J Crit Care Med 2020; 24 (10):932-937.

DOI: 10.5005/jp-journals-10071-23576

License: CC BY-NC 4.0

Published Online: 25-01-2021

Copyright Statement:  Copyright © 2020; The Author(s).


Abstract

Background: Post-intensive care survivors have decreased quality of life scores and prolonged cognitive dysfunction due to baseline factors and events related to intensive care unit admission, which remain largely unrecognized. Materials and methods: A prospective observational cohort study to assess the quality of life and occurrence of cognitive dysfunction, 3 and 6 months following discharge from the intensive care unit, was carried out. We enrolled 136 adults presenting to the intensive care unit with no prior cognitive dysfunction or depression and followed up and assessed them with repeatable battery for the assessment of neuropsychological status (RBANS) and quality of life with short Form-36 (SF-36) health survey. Results: The incidence and prevalence of cognitive dysfunction was 100% at 3 and 6 months, respectively, as assessed by RBANS with a global cognition scores at 3 and 6 months of 71 (IQR 68.5–73) and 74 (IQR 72–86), respectively. Higher Charlson's comorbidity score, increased severity of illness, longer duration of mechanical ventilation, pain, delirium, coma, and hospital stay were associated with statistically significant lower scores at 3 months. The median SF-36 mental component score (MCS) and physical component score (PCS) at 3 months were 38.4 and 32.5 and at 6 months were 38.2 and 32.6, respectively. Poor score was associated significantly with advancing age, poor functional parameters at baseline as evidenced by clinical frailty, poor baseline Katz ADL scores, increased severity of illness, longer duration of mechanical ventilation, occurrence and duration of delirium, coma, pain, and usage of sedatives with or without analgesics. Conclusion and clinical significance: Patients discharged from the intensive care unit are at high risk for persistent cognitive impairment and poor quality of life score. Poor baseline patient characteristics and events occurring in ICU are associated with worse cognition and quality of life scores. There is an urgent need to prevent, diagnose, and manage these patients by optimizing intensive care practices.


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  1. Needham DM, Davidson J, Cohen H, Hopkins RO, Weinert C, Wunsch H, et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference. Crit Care Med 2012;40:502–509.
  2. Ehlenbach WJ. The sobering reality of outcomes when older adults require prolonged mechanical ventilation. J Am Geriatr Soc 2014;62:183–185.
  3. Hopkins RO, Weaver LK, Pope D, Orme JF, Bigler ED, Larson-LOHR V. Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. Am J Respir Crit Care Med 1999;160:50–56.
  4. Jackson JC, Hart RP, Gordon SM, Shintani A, Truman B, May L, et al. Six-month neuropsychological outcome of medical intensive care unit patients. Crit Care Med 2003;31:1226–1234.
  5. Ehlenbach WJ, Hough CL, Crane PK, Haneuse SJ, Carson SS, Curtis JR, et al. Association between acute care and critical illness hospitalization and cognitive function in older adults. JAMA 2010;303: 763–770.
  6. Adhikari NK, Fowler RA, Bhagwanjee S, Rubenfeld GD. Critical care and the global burden of critical illness in adults. Lancet 2010;376: 1339–1346.
  7. Chodosh J, Seeman TE, Keeler E, Sewall A, Hirsch SH, Guralnik JM, et al. Cognitive decline in high-functioning older persons is associated with an increased risk of hospitalization. J Am Geriatr Soc 2004; 52:1456–1462.
  8. Rockwood K, Brown M, Merry H, Sketris I, Fisk J. Vascular Cognitive Impairment Investigators of the Canadian Study of Health and Aging. Societal costs of vascular cognitive impairment in older adults. Stroke 2002;33:1605–1609.
  9. Jorm AF. The Informant Questionnaire on cognitive decline in the elderly (IQCODE): a review. Int Psychogeriatr 2004;16:275–293.
  10. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of Adl: a standardized measure of biological and psychosocial function. Jama 1963;185:914–919.
  11. Pfeffer RI, Kurosaki TT, Harrah CH Jr, Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323–329.
  12. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005;173(5): 489–495.
  13. Ferreira FL, Bota DP, Bross A, Melot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA 2001;286:1754–1758.
  14. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40(5):373–383.
  15. Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O'Neal PV, Keane KA, et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 2002;166:1338–1344
  16. Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 2001;286:2703–2710.
  17. Randolph C, Tierney MC, Mohr E, Chase TN. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS): preliminary clinical validity. J Clin Exp Neuropsychol 1998;20:310–319.
  18. Ware JE. SF-36 Physical and Mental Health Summary Scales: a user's manual. Boston, MA: Health Assessment Lab, New England Medical Center, 1994.
  19. Sharma A, Malhotra S, Grover S, Jindal SK. Incidence, prevalence, risk factor and outcome of delirium in intensive care unit: a study from India. Gen Hosp Psychiatry 2012;34:639–646.
  20. Pandharipande PP, Girard TD, Jackson JC, Morandi A, Thompson JL, Pun BT, et al; BRAIN-ICU Study Investigators. Long-term cognitive impairment after critical illness. N Engl J Med 2013;369:1306–1316.
  21. Jackson JC, Pandharipande PP, Girard TD, et al. Depression, post-traumatic stress disorder, and functional disability in survivors of critical illness in the BRAIN-ICU study: a longitudinal cohort study. Lancet Respir Med 2014;2(5):369-379. doi:10.1016/S2213-2600(14)70051-7
  22. Sakusic A, O'Horo JC, Dziadzko M, Volha D, Ali R, Singh TD, et al. Potentially Modifiable Risk Factors for Long-Term Cognitive Impairment After Critical Illness: A Systematic Review. Mayo Clin Proc 2018;93:68–82.
  23. Hopkins RO, Suchyta MR, Snow GL, Jephson A, Weaver LK, Orme JF. Blood glucose dysregulation and cognitive outcome in ARDS survivors. Brain Inj 2010;24:1478–1484.
  24. Van den Boogaard M, Schoonhoven L, Evers AW, van der Hoeven JG, van Achterberg T, Pickkers P. Delirium in critically ill patients: impact on long-term health-related quality of life and cognitive functioning. Crit Care Med 2012;40:112–118.
  25. Jevtovic-Todorovic V, Absalom AR, Blomgren K, Brambrink A, Crosby G, Culley DJ, et al. Anaesthetic neurotoxicity and neuroplasticity: an expert group report and statement based on the BJA Salzburg Seminar. Br J Anaesth 2013;111:143–151.
  26. Trzepacz PT. Is there a final common neural pathway in delirium? Focus on acetylcholine and dopamine. Semin Clin Neuropsychiatry 2000;5:132–148.
  27. Dilger RN, Johnson RW. Aging, microglial cell priming, and the discordant central inflammatory response to signals from the peripheral immune system. J Leukoc Biol 2008;84:932–939.
  28. Reidel B, Browne K, and Silbert B. Cerebral protection: inflammation, endothelial dysfunction, and post-operative cognitive dysfuncton. Curr Opin Anesthesiol 2014;27:89–97.
  29. Hovens IB, Schoemaker RG, van der Zee EA, Heineman E, Izaks GJ, van Leeuwen BL. Thinking through postoperative cognitive dysfunction: How to bridge the gap between clinical and pre-clinical perspectives. Brain Behav Immun 2012;26:1169–1179.
  30. Gunther ML, Morandi A, Krauskopf E, Pandharipande P, Giard TD, Jackson JC et al. The association between brain volumes, delirium duration, and cognitive outcomes in intensive care unit survivors: the VISIONS cohort magnetic resonance imaging study. Crit Care Med 2012;40:2022–2032.
  31. Agarwal R, D'Silva C. Assessment of quality of life in normal individuals using the SF-36 questionnaire. IJCCR 2017;3:43–47.
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