Long‐Term Self‐Reported Cognitive Problems After Delirium in the Intensive Care Unit and the Effect of Systemic Inflammation

Abstract

OBJECTIVES:To describe the association between intensive care unit (ICU) delirium and self-reported cognitive problems in 1-year ICU survivors, and investigate whether this association was altered by exposure to systemic inflammation during ICU stay. DESIGN: Prospective cohort study. SETTING: Dutch medical-surgical ICU. PARTICIPANTS: One-year ICU survivors, admitted to the ICU ≥48 hours. MEASUREMENTS: Self-reported cognitive problems were measured with the Cognitive Failures Questionnaire (CFQ). Cumulative exposure to systemic inflammation was based on all daily C-reactive protein (CRP) measurements during ICU stay, expressed as the area under the curve (AUC). Multivariable linear regression was conducted to evaluate the association between delirium and the CFQ. The effect of inflammation on the association between delirium and CFQ was assessed, comparing the effect estimate (B) of delirium and CFQ between models with and without inclusion of the AUC of CRP. RESULTS: Among 567 1-year ICU survivors, the CFQ was completed by 363 subjects. Subjects with multiple days of delirium during ICU stay reported more selfreported cognitive problems (Badj = 5.10, 95% CI 1.01-9.20), whereas a single day delirium was not associated with higher CFQ scores (Badj = À0.72, 95% CI À5.75 to 4.31). Including the AUC of CRP did not change the association between delirium and the CFQ (ratio for a single and multiple days were respectively: 1.00, 95%CI 0.59-1.44 and 0.86, 95% CI 0.47-1.16). CONCLUSION: Multiple days of delirium was associated with long-term self-reported cognitive problems. The cumulative exposure to systemic inflammation did not alter this association, suggesting that delirium in the context of little inflammation is also detrimental. J Am Geriatr Soc 65:786-791, 2017.

Resting-state fMRI reveals network disintegration during delirium

“…Nevertheless, we did find a difference in connectivity strength between the post delirium group and the control group, and between the post delirium and the delirium group. Delirium is associated with long-term cognitive decline ( Pandharipande et al, 2013 ; Inouye et al, 2016 ; Wolters et al, 2017 ), while decreased functional connectivity was related to cognitive impairment in previous work ( van Dellen et al, 2015 ; Yu et al, 2016 ). We speculate that an irreversible decrease of connectivity strength due to delirium may be an underlying pathophysiological mechanism of this association between delirium and cognitive decline.…”

“…This may be due to the smaller size of the group, but could also indicate heterogeneity. Considering that delirium is associated with long-term cognitive impairment ( Pandharipande et al, 2013 ; Inouye et al, 2016 ; Wolters et al, 2017 ), it could be that the sub-group of delirious patients who will develop this long-term problems shows remaining alterations in global brain organization, while the patients without lasting problems will recover from global brain organization disturbances. In line with this hypothesis, we observed that network integration was negatively associated with delirium duration.…”

Delirium management: Let's get physical? A systematic review and meta‐analysis

“…Symptoms of delirium include a change in level of arousal, abrupt deterioration in cognitive function, disorganised speech and new perceptual disturbances such as delusions and hallucinations . Long‐term complications associated with delirium are common and debilitating; one episode of delirium can set off a cascade of events that may contribute to permanent cognitive deficits, functional decline and other hospital complications including falls, fractures and even death . Implementing strategies to mitigate delirium risk is essential given that approximately 40% of delirium cases may be preventable .…”

Patients’ Cognitive Status and Its Related Factors Before Coronary Artery Bypasses Grafting

“…CFQ has been used in many studies, but the psychometric study was not done for it in Iran [29][30][31][32]. Thus in the first step, it was translated forward and backward by two English language experts.…”