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Research issues in the evaluation of cognitive impairment in intensive care unit survivors

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Abstract

Neuropsychological assessment has been utilized extensively in the research of cognitive outcomes associated with medical illnesses, such as HIV, and post-surgical procedures, such as coronary artery bypass graft. However, few investigations of intensive care unit (ICU) survivors have examined cognitive function as a clinical outcome. Significant clinical questions exist regarding the impact of critical illness on long-term cognitive function. Many of these questions can be systematically evaluated through the use of standardized neuropsychological assessment instruments within the context of well designed, prospective research trials. This review will provide information for clinical researchers interested in the study of neuropsychological outcomes in intensive care unit survivors ( a comparison article in this issue will address clinical issues related to cognitive functioning).

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References

  1. Angus DC, Carlet J (2003) Surviving intensive care: a report from the 2002 Brussels Roundtable. Intensive Care Med 29:368–377

    PubMed  Google Scholar 

  2. Hopkins RO, Weaver LK, Pope D, Orme JF, Bigler ED, Larson-Lohr V (1999) Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. Am J Respir Crit Care Med 160:50–56

    CAS  PubMed  Google Scholar 

  3. Jackson JC, Hart RP, Gordon SM, Shintani A, Truman B, May L, Ely EW (2003) Six-month neuropsychological outcome of medical intensive care unit patients. Crit Care Med 31:1226–1234

    Article  PubMed  Google Scholar 

  4. Rothenhausler HB, Ehrentraut S, Stoll C, Schelling G, Kapfhammer HP (2001) The relationship between cognitive performance and employment and health status in long-term survivors of the acute respiratory distress syndrome: results of an exploratory study. Gen Hosp Psychiatry 23:90–96

    Article  CAS  PubMed  Google Scholar 

  5. Al-Saidi F, McAndrews MP, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Herridge M (2003) Neuropsychological sequelae in ARDS survivors (abstract). Am J Respir Crit Care Med 167:A737

    Google Scholar 

  6. Marquis KA, Curtis JR, Caldwell ES, Davidson TA, Davis JM, Sanchez P, Rosenbaum G, Hudosn LD, Steinberg KP (2000) Neuropsychological sequelae in survivors of ARDS compared with critically ill control patients (abstract). Am J Respir Crit Care Med 161:A383

    Google Scholar 

  7. Hopkins RO, Collingridge D, Weaver LK, Chan K, Orme JF (2003) Neuropsychological sequelae following acute respiratory distress syndrome: two year outcome. J Int Neuropsychol Soc 9:584

    Google Scholar 

  8. Symes E, Maruff P, Ajani A, Currie J (2000) Issues associated with the identification of cognitive change following coronary artery bypass grafting. Aust N Z J Psychiatry 34:770–784

    Article  CAS  PubMed  Google Scholar 

  9. Selnes OA, Royall RM, Borowicz LM, Quaskey S, McKhann GM (2001) Cognitive changes 5 years after coronary bypass artery grafting: is there evidence of late decline? Arch Neurol 58:598–604

    Article  CAS  PubMed  Google Scholar 

  10. Ryan CM, Hendrickson R (1998) Evaluating the effects of treatment for medical disorders: has the value of neuropsychological assessment been fully realized? Appl Neuropsychol 5:209–219

    Google Scholar 

  11. Zamvar V, Williams D, Hall J, Payne N, Cann C, Young K, Karthikeyan S, Dunne J (2002) Assessment of neurocognitive impairment after off-pump and on-pump techniques for coronary artery bypass graft surgery: prospective randomised controlled trial. BMJ 325:1268–1279

    Article  PubMed  Google Scholar 

  12. Diegeler A, Hirsch R, Schneider F, Schilling LO, Falk V, Rauch T et al. (2000) Neuromonitoring and neurocognitive outcome in off-pump versus conventional coronary bypass operation. Ann Thorac Surg 69:1162–1166

    Article  CAS  PubMed  Google Scholar 

  13. Weaver LK, Hopkins RO, Chan KJ, Churchill S, Elliott CG, Clemmer TP, Orme JF, Thomas FO, Morris AH (2002) Hyperbaric oxygen for acute carbon monoxide poisoning. N Engl J Med 347:1057–1067

    Article  CAS  PubMed  Google Scholar 

  14. Kress JP, Gehlbach B, Lacy M, Pliskin N, Pohlman AS, Hall JB (2003) The long-term psychological effects of daily sedative interruption on critically ill patients. Am J Respir Crit Care Med 168:1457–1461

    Article  PubMed  Google Scholar 

  15. Starr JM, Whalley LJ (1994) Drug induced dementia. Drug Saf 11:310–317

    CAS  PubMed  Google Scholar 

  16. Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, Speroff T, Gautam S, Bernard G, Inouye S (2001) Evaluation of delirium in critically ill patients: validation of the confusion assessment method for the intensive care unit (CAM-ICU). Crit Care Med 29:1370–1379

    Article  CAS  PubMed  Google Scholar 

  17. Truman B, Ely EW (2003) Monitoring delirium in critically ill patients: using the Confusion Assessment Method for the ICU. Crit Care Nurse 23:25–36

    Google Scholar 

  18. Meagher DJ (2001) Delirium: optimising management. BMJ 322:144–149

    Article  CAS  PubMed  Google Scholar 

  19. Jackson JC, Gordon SM, Hart RP, Hopkins RO, Ely EW (2004) The association between delirium and cognitive decline: a review of the empirical literature. Neuropsychol Rev 14:87–98

    Article  PubMed  Google Scholar 

  20. Hopkins RO, Kesner RP (1995) Item and order recognition memory in subjects with hypoxic brain injury. Brain Cogn 27:180–201

    Article  CAS  PubMed  Google Scholar 

  21. Hopkins RO, Gale SD, Johnson SC, Anderson CV, Bigler ED, Blatter DD, Weaver LK (1995) Severe anoxia with and without concomitant brain atrophy and neuropsychological impairments. J Int Neuropsychol Soc 1:501–509

    CAS  PubMed  Google Scholar 

  22. Lezak MD (1995) Neuropsychological assessment. Oxford University Press, New York

  23. Mitrushina MN, Boone KB, D’Elia LF, D’Elia L (1999) Handbook of normative data for neuropsychological assessment. Oxford Univeristy Press, New York

  24. Bigler ED, Clement PF (1997) Diagnostic clinical neuropsychology. University of Texas Press, Austin

  25. Heilman KM, Valenstein E (2003) Clinical neuropsychology. Oxford University Press, New York

  26. Bennett TL (2001) Neuropsychological evaluation in rehabilitation planning and evaluation of functional skills. Arch Clin Neuropsychol 16:237–253

    Article  CAS  PubMed  Google Scholar 

  27. Bell-McGinty S, Podell K, Franzen M, Baird AD, Williams MJ (2002) Standard measures of executive function in predicting instrumental activities of daily living in older adults. Int J Geriatr Psychiatry 17:828–834

    Google Scholar 

  28. Groth-Marnat G, Teal M (2000) Block design as a measure of everyday spatial ability: a study of ecological validity. Percept Mot Skills 90:522–526

    CAS  PubMed  Google Scholar 

  29. Heaton RK, Miller SW, Taylor MJ, Grant I (2004) Revised comprehensive norms for an expanded Halstead-Reitan battery: demographically adjusted neuropsychological norms for African American and Caucasian adults. Psychological Assessment Resources, Lutz, Florida

  30. Wechsler D (1997) Wechsler Adult Intelligence Scale. The Psychological Corporation, San Antonio

  31. Wechsler D (1997) Wechsler Memory Scale. The Psychological Corporation, San Antonio

  32. Spreen O, Strauss E (1998) A compendium of neuropsychological tests: administration, norms and commentary. Oxford University Press, New York

    Google Scholar 

  33. Hilsabeck RC, Perry W, Hassanein TI (2002) Neuropsychological impairment in patients with chronic hepatitis C. Hepatology 35:440–446

    Article  PubMed  Google Scholar 

  34. Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A (2000) The mini-cog: a cognitive vital signs measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry 15:1021–1027

    Article  CAS  PubMed  Google Scholar 

  35. Keith JR, Puente AE (2002) Deficiencies in the detection of cognitive deficits. Neuropsychology 16:434–439

    Article  PubMed  Google Scholar 

  36. Stump DA (1995) Selection and clinical significance of neuropsychological tests. Ann Thorac Surg. 59:1340–1344

    Google Scholar 

  37. Pisani MA, Redlich C, McNicoll L, Ely EW, Inouye SK (2003) Underrecognition of preexisting cognitive impairment by physicians in older ICU patients. Chest 124:2267–2274

    Article  PubMed  Google Scholar 

  38. Jorm A (2004) The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): a review. Int Psychogeriatr (in press)

  39. Jorm AF (1996) Assessment of cognitive impairment and dementia using informant reports. Clin Psychol Rev 16:51–73

    Article  Google Scholar 

  40. Jorm AF (1997) Methods of screening for dementia: a meta-analysis of studies comparing an informant questionnaire with a brief cognitive test. Alzheimer Dis Assoc Disord 11:158–162

    CAS  PubMed  Google Scholar 

  41. Jorm AF (1994) A short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) development and cross validation. Psychol Med 24:145–153

    CAS  PubMed  Google Scholar 

  42. Blessed G, Tomlinson BE, Roth M (1968) The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. Br J Psychiatry 114:797–811

    CAS  PubMed  Google Scholar 

  43. Rincon HG, Granados M, Unutzer J, Gomez M, Duran R, Badiel M, Sal C, Martinez J, Mejia J, Ordonez C, Florez N, Rosso F, Echeverri P (2001) Prevalence, detection and treatment of anxiety, depression and delirium in the adult critical care unit. Psychosomatics 42:391–396

    Article  CAS  PubMed  Google Scholar 

  44. Michaels AJ, Michaels CE, Smith JS, Moon CH, Peterson C and Long WB (2000) PTSD in critical care. J Trauma 48:841–850

    CAS  PubMed  Google Scholar 

  45. Scragg P, Jones A, Fauvel N (2001) Psychological problems following ICU treatment. Anaesthesia 56:9–14

    Article  CAS  PubMed  Google Scholar 

  46. Szokol JW, Vender JS (2001) Anxiety, delirium and pain in an intensive care unit. Crit Care Clin 17:821–842

    Google Scholar 

  47. Nelson BJ, Weinert CR, Bury CL, Marinelli WA, Gross CR (2000) Intensive care unit drug use and subsequent quality of life in acute lung injury patients. Crit Care Med 28:3626–3630

    CAS  PubMed  Google Scholar 

  48. Jones C, Skirrow P, Griffiths RD, Humphris GH, Ingleby S, Eddleson J, Waldmann C, Gager M (2003) Rehabilitation after critical illness: a randomized, controlled trial. Crit Care Med 31:2456–2461

    Article  PubMed  Google Scholar 

  49. Stoll C, Kapfhammer HP, Rothenhausler HB, Haller M, Briegel J, Schmidt M, Krauseneck T, Durst K, Schelling G (1999) Sensitivity and specificity of a screening test to document traumatic experiences and to diagnose post-traumatic stress disorder in ARDS patients after intensive care treatment. Intensive Care Med 25:697–704

    Article  CAS  PubMed  Google Scholar 

  50. Schelling G, Stoll C, Haller M, Briegel J, Manert W, Hummel T, Lenhart A, Heyduck M, Polasek J, Meier M, Preuss U, Bullinger M, Schuffel W, Peter K (1998) Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome. Crit Care Med 26:651–659

    Article  CAS  PubMed  Google Scholar 

  51. Massman PJ, Delis DC, Butters N et al. (1992) The subcortical dysfunction model of memory deficits in depression: neuropsychological validation in a subgroup of patients. J Clin Exp Neuropsychol 14:687–706

    CAS  PubMed  Google Scholar 

  52. Richards PM, Ruff RM (1989) Motivational effects on neuropsychological functioning: comparison of depressed versus nondepressed individuals. J Consult Clin Psychol 57:396–402

    Article  CAS  PubMed  Google Scholar 

  53. Buckelew SP, Hannay HJ (1986) Relationships among anxiety, defensiveness, sex, task difficulty and performance on various neuropsychological tasks. Percept Mot Skills 63:711–718

    CAS  PubMed  Google Scholar 

  54. Eysenck MW (2003) Anxiety and cognitive functioning: a multifaceted approach. In: Lister RG, Weingartner HJ (eds) Perspectives of cognitive neuroscience. Oxford University Press, New York

  55. Murkin JM, Newman SP, Stump DA, Blumenthal JA (1995) Statement of consensus on assessment of neurobehavioral outcomes after cardiac surgery. Ann Thorac Surg 59:1289–1295

    Article  CAS  PubMed  Google Scholar 

  56. Axelrod BN, Vanderploeg RD, Schinka JA (1999) Comparing methods for estimating premorbid intellectual functioning. Arch Clin Neuropsychol 14:341–346

    Article  CAS  PubMed  Google Scholar 

  57. Grober E, Sliwinski M (1991) Development and validation of a model for estimating premorbid verbal intelligence in the elderly. J Clin Exp Neuropsychol 13:933–949

    CAS  PubMed  Google Scholar 

  58. Barona A, Reynolds CR, Chastain R (1984) A demographically based index of premorbid intelligence for the WAIS-R. J Consult Clin Psychol 52:885–887

    Article  Google Scholar 

  59. Beck AT, Brown G, Steer RA (1988) An inventory for assessing clinical anxiety: psychometric properties. J Consult Clin Psychol 56:893–897

    Article  CAS  PubMed  Google Scholar 

  60. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370

    CAS  PubMed  Google Scholar 

  61. Beck AT (1996) BDI-II depression inventory manual. Harcourt Brace, New York

  62. Sheikh JL, Yesavage JA (1986) Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clin Gerontol 5:165–173

    Google Scholar 

  63. Radloff LS (1977) The CES-D Scale: a self report depression scale for research in the general population. Appl Psychol Measurement 1:385–401

    Google Scholar 

  64. Weiss D, Marmar CR (1996) The Impact of Events Scale—revised. In: Wilson J, Keane TM (eds) Assessing psychological trauma and PTSD. Guilford, New York

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Author information

Authors and Affiliations

  1. Division of Allergy, Pulmonary and Critical Care Medicine, T-1218 Medical Center North, Vanderbilt University School of Medicine, Nashville, TN 37232, USA

    James C. Jackson & E. Wesley Ely

  2. Medical Center East Suite 6100, Center for Health Services Research, 1215 21st Avenue South, Nashville, TN 37232, USA

    James C. Jackson, Sharon M. Gordon & E. Wesley Ely

  3. Geriatric Research Education and Clinical Center of the Veterans Administration Tennessee Valley Healthcare System, 1310 24th Avenue South, Nashville, TN 37212, USA

    Sharon M. Gordon & E. Wesley Ely

  4. Department of Psychiatry, Vanderbilt University School of Medicine, 122 Medical center North, Nashville, TN 37232, USA

    James C. Jackson, Sharon M. Gordon & Candice Burger

  5. Psychology Department and Neuroscience Center, Brigham Young University, Provo, Utah, USA

    Ramona O. Hopkins

  6. Department of Medicine, Pulmonary and Critical Care Divisions, LDS Hospital, Salt Lake City, Utah, USA

    Ramona O. Hopkins

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  1. James C. Jackson
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  2. Sharon M. Gordon
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  3. E. Wesley Ely
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  4. Candice Burger
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  5. Ramona O. Hopkins
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Correspondence to James C. Jackson.

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Jackson, J.C., Gordon, S.M., Ely, E.W. et al. Research issues in the evaluation of cognitive impairment in intensive care unit survivors. Intensive Care Med 30, 2009–2016 (2004). https://doi.org/10.1007/s00134-004-2422-2

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  • DOI: https://doi.org/10.1007/s00134-004-2422-2

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