Long-term cognitive impairment after critical illness
Open accessAbstract
BACKGROUND: Survivors of critical illness often have a prolonged and disabling form of cognitive impairment that remains inadequately characterized. METHODS: We enrolled adults with respiratory failure or shock in the medical or surgical intensive care unit (ICU), evaluated them for in-hospital delirium, and assessed global cognition and executive function 3 and 12 months after discharge with the use of the Repeatable Battery for the Assessment of Neuropsychological Status (population age-adjusted mean [±SD] score, 100±15, with lower values indicating worse global cognition) and the Trail Making Test, Part B (population age-, sex-, and education-adjusted mean score, 50±10, with lower scores indicating worse executive function). Associations of the duration of delirium and the use of sedative or analgesic agents with the outcomes were assessed with the use of linear regression, with adjustment for potential confounders. RESULTS: Of the 821 patients enrolled, 6% had cognitive impairment at baseline, and delirium developed in 74% during the hospital stay. At 3 months, 40% of the patients had global cognition scores that were 1.5 SD below the population means (similar to scores for patients with moderate traumatic brain injury), and 26% had scores 2 SD below the population means (similar to scores for patients with mild Alzheimer's disease). Deficits occurred in both older and younger patients and persisted, with 34% and 24% of all patients with assessments at 12 months that were similar to scores for patients with moderate traumatic brain injury and scores for patients with mild Alzheimer's disease, respectively. A longer duration of delirium was independently associated with worse global cognition at 3 and 12 months (P=0.001 and P=0.04, respectively) and worse executive function at 3 and 12 months (P=0.004 and P=0.007, respectively). Use of sedative or analgesic medications was not consistently associated with cognitive impairment at 3 and 12 months. CONCLUSIONS: Patients in medical and surgical ICUs are at high risk for long-term cognitive impairment. A longer duration of delirium in the hospital was associated with worse global cognition and executive function scores at 3 and 12 months. (Funded by the National Institutes of Health and others; BRAIN-ICU ClinicalTrials.gov number, NCT00392795.).
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People recovering from critical illness in general experience high rates of long-term cognitive impairment, and persistent cognitive impairment is an important component of post-intensive care syndrome (PICS).
“People recovering from critical illness in general experience high rates of long-term cognitive impairment, and persistent cognitive impairment is an important component of post-intensive care syndrome (PICS; Pandharipande et al., 2013).”
From Mild respiratory COVID can cause multi-lineage neural cell and myelin dysregulation (2022) · cites this paper as Pandharipande et al., 2013
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- Authors
- Pandharipande, P. P., Girard, T. D., Jackson, J. C., Morandi, A., Thompson, J. L., Pun, B. T., Brummel, N. E., Hughes, C. G., Vasilevskis, E. E., Shintani, A. K., Moons, K. G., Geevarghese, S. K., Canonico, A., Hopkins, R. O., Bernard, G. R., Dittus, R. S., & Ely, E. W.
- Affiliations
- Vanderbilt University (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2013-10-03
- Volume
- 369
- Issue
- 14
- Pages
- 1306-1316
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC3922401
- OpenAlex
- W2108485082
- Cited by
- 2,842
- References
- 38
- Citations by year
- 2026: 210 · 2025: 217 · 2024: 219 · 2023: 234 · 2022: 266 · 2021: 320 · 2020: 272 · 2019: 237 · 2018: 220 · 2017: 198 · 2016: 175 · 2015: 135 · 2014: 118 · 2013: 10 · 2012: 3
- FWCI
- 127.34
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (AG035117, AG031322, R01AG035117, K23AG040157, AG034257, K23AG031322, K23AG034257, AG027472, R01AG027472, AG040157)
- National Heart, Lung, and Blood Institute (R01HL111111, HL111111, T32HL087738)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Life Sciences › Neuroscience › Developmental Neuroscience › Anesthesia and Neurotoxicity Research
- Keywords
- critical illness, post-intensive care syndrome, long-term cognitive impairment, delirium, delirium duration, global cognition, executive function, sedatives, analgesics, intensive care unit survivors, respiratory failure, shock
- MeSH terms
- Aged, Cognition Disorders, Delirium, Female, Humans, Intensive Care Units, Male, Middle Aged, Prospective Studies, Respiratory Insufficiency, Shock, Linear Models, Critical Illness, Executive Function
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