Association Between Critical Care Admissions and Cognitive Trajectories in Older Adults*

Abstract

Objectives: Patients requiring admission to an ICU may subsequently experience cognitive decline. Our objective was to investigate longitudinal cognitive trajectories in older adults hospitalized in ICUs. We hypothesized that individuals hospitalized for critical illness develop greater cognitive decline compared with those who do not require ICU admission. Design: A retrospective cohort study using prospectively collected cognitive scores of participants enrolled in the Mayo Clinic Study of Aging and ICU admissions retrospectively ascertained from electronic medical records. A covariate-adjusted linear mixed effects model with random intercepts and slopes assessed the relationship between ICU admissions and the slope of global cognitive z scores and domains scores (memory, attention/executive, visuospatial, and language). Setting: ICU admissions and cognitive scores in the Mayo Clinic Study of Aging from October 1, 2004, to September 11, 2017. Patients: Nondemented participants age 50 through 91 at enrollment in the Mayo Clinic Study of Aging with an initial cognitive assessment and at least one follow-up visit. Interventions: None. Measurements and Main Results: Of 3,673 participants, 372 had at least one ICU admission with median (25–75th percentile) follow-up after first ICU admission of 2.5 years (1.2–4.4 yr). For global cognitive z score, admission to an ICU was associated with greater decline in scores over time compared with participants not requiring ICU admission (difference in annual slope = –0.028; 95% CI, –0.044 to –0.012; p < 0.001). ICU admission was associated with greater declines in memory (–0.029; 95% CI, –0.047 to –0.011; p = 0.002), attention/executive (–0.020; 95% CI, –0.037 to –0.004; p = 0.016), and visuospatial (–0.013; 95% CI, –0.026 to –0.001; p = 0.041) domains. ICU admissions with delirium were associated with greater declines in memory (interaction p = 0.006) and language (interaction p = 0.002) domains than ICU admissions without delirium. Conclusions: In older adults, ICU admission was associated with greater long-term cognitive decline compared with patients without ICU admission. These findings were more pronounced in those who develop delirium while in the ICU.

Cut-Off Values of the Post-Intensive Care Syndrome Questionnaire for the Screening of Unplanned Hospital Readmission within One Year

“…In addition, it is consistent with previous studies that reported that cognitive impairment experienced by critical care survivors had a higher incidence and longer duration than other areas of PICS [27][28][29]. The major risk factor for cognitive impairment is known as delirium [30], so ICU medical staff apply various interventions to prevent delirium. Recently, the use of ABCDEF Bundle has been recommended [31].…”

Cognitive phenotypes 1 month after ICU discharge in mechanically ventilated patients: a prospective observational cohort study

“…11 Health Services Research Network in Chronic Diseases (REDISSEC), Barcelona, Spain. 12 Mental Health Department, Parc Taulí Hospital Universitari, I3PT, UAB, Sabadel, Spain. 13 Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain.…”

“…Cognitive impairment in critically ill survivors who have undergone invasive mechanical ventilation (MV) during the Intensive Care Unit (ICU) stay is a well-established health problem [1][2][3][4][5][6][7][8][9][10][11]. ICU admission is associated with a greater cognitive decline than general ward hospitalization [12], and the rate of dementia diagnosis after 3 years of follow-up has been reported to be higher in elderly ICU survivors than in the general population [13]. This cognitive decline affects the functional and socioeconomic status of ICU survivors and their families, and reduces their quality of life after ICU discharge [5,[14][15][16].…”

“…Most of the studies evaluating cognitive impairment in ICU survivors after MV have focused on global cognitive impairment, and little is known about the characterization of different phenotypes of alteration [ 12 ]. The early detection of distinct groups of patients regarding cognitive deficits might reveal the involvement of diverse pathophysiological mechanisms.…”

Association of Hospitalization with Long‐Term Cognitive Trajectories in Older Adults

“…Hospitalizations for both critical and noncritical illness are associated with long‐term cognitive decline in older adults 1‐8 . The public health implications of cognitive impairment in older adults after hospitalization are considerable.…”