Significant cognitive dysfunction in non-delirious patients identified during and persisting following critical illness
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Recent studies have shown significant cognitive problems some months after critical illness. However there has been no research examining cognitive function within the intensive care unit (ICU) in non-delirious patients.
Design and setting
A prospective study in an ICU.
Patients and participants
Using the Cambridge Neuropsychological Test Automated Battery (CANTAB), 30 long-stay, tracheal-intubated ICU patients were tested. Prior to testing on ICU the Confusion Assessment Measure (CAM-ICU) was administered and only those patients clearly not delirious and off sedation for several days were tested. The CANTAB tests were repeated a week after ICU discharge on the general ward and then again at 2 months. Sixteen patients completed the follow-up.
While on ICU all 30 patients showed significant problems with strategic thinking and problem solving; 20 patients had some problems with memory. The degree of difficulty with problem solving on ICU was correlated with length of ICU stay (p = 0.011), age (p = 0.036) and length of hospital stay post ICU (p = 0.044). Problems with memory in ICU and on the general ward were correlated with admission APACHE II score (p = 0.004 and p = 0.005 respectively). At the 2-month follow-up 5 of 16 patients (31%) scored below the 25 percentile for memory and 8 of 16 (50%) below the 25 percentile for problem solving (Slater TA, Jones C, Griffiths RD, Wilson S, Benjamin K (2004) Cognitive impairment during and after intensive care: a pilot study. Intensive Care Med 30 [Suppl 1]:S199).
Difficulties with problem solving and poor memory remained a significant issue for 2 months after ICU discharge.
- Sharshar T, Gray F, Lorin de la Grandmaison G, Hopkinson NS, Ross E, Dorandeu A, Orlikowski D, Raphael J-C, Gajdos P, Annane D (2003) Apoptosis of neurons in cardiovascular autonomic centres triggered by inducible nitric oxide synthase after death from septic shock. Lancet 362:1799–1805 CrossRef
- Zauner C, Gendo A, Kramer L, Funk GC, Bauer E, Schenk P, Ratheiser K, Madl C (2002) Impaired subcortical and cortical sensory evoked potential pathways in septic patients. Crit Care Med 30(5):1136–1139 CrossRef
- 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
- Jackson JC, Hart RP, Gordon SM, Shintani A, Truman B, May L, Ely EW (2003) Six month neuropsychological outcome from medical intensive care unit patients. Crit Care Med 31(4):1226–1234 CrossRef
- Ambrosino N, Bruletti G, Scala V, Porta R, Vitacca M (2000) Cognitive and perceived health status in patients with chronic obstructive pulmonary disease surviving acute on chronic respiratory failure: a controlled study Intensive Care Med 28:170–177
- Hopkins RO, Weaver LK, Chan KJ, Orme JF (2004) Quality of life, emotional and cognitive function following acute respiratory distress syndrome. J Int Neuropsychol Soc 10(7):1005–1017
- Ely W, Margolin R, Francis J et al (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 CrossRef
- Downes JJ et al (1989) Impaired extra-dimensional shift performance in medicated and unmedicated Parkinson's disease: evidence for a specific attentional dysfunction. Neuropsychologia 27:1329–1343 CrossRef
- Ely EW, Gautam S, Margolin R, Francis J, May L, Speroff T, Truman B, Dittus B, Bernard GR, Inouye SK (2001) The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med 27:1892–1900 CrossRef
- Baddeley AD, Wilson BA (1988) Frontal amnesia and the dysexecutive syndrome. Brain Cogn 7:212–230 CrossRef
- Baddeley AD, Hitch G (1974) In: Bower GA (ed) The psychology of learning and motivation, vol 8. Academic Press, New York
- Sukantarat KT, Burgess PW, Williamson RCN, Brett SJ (2005) Prolonged cognitive dysfunction in survivors of critical illness. Anaesthesia 60:847–853 CrossRef
- Significant cognitive dysfunction in non-delirious patients identified during and persisting following critical illness
Intensive Care Medicine
Volume 32, Issue 6 , pp 923-926
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Critical illness
- Problem solving
- Industry Sectors
- Author Affiliations
- 1. Intensive Care Unit, Whiston Hospital, L35 5DR, Prescot, UK
- 2. Department of Work Psychology, Health and Safety Laboratory, Buxton, UK
- 3. Sheffield Institute for Studies on Aging, University of Sheffield, Sheffield, UK