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Critical Care Medicine:
doi: 10.1097/CCM.0b013e318250acc0
Feature Articles

The association between brain volumes, delirium duration, and cognitive outcomes in intensive care unit survivors: The VISIONS cohort magnetic resonance imaging study*

Gunther, Max L. PhD; Morandi, Alessandro MD, MPH; Krauskopf, Erin BS; Pandharipande, Pratik MD, MSCI; Girard, Timothy D. MD, MSCI; Jackson, James C. PsyD; Thompson, Jennifer MPH; Shintani, Ayumi K. PhD; Geevarghese, Sunil MD, MSCI; Miller, Russell R. III MD, MPH; Canonico, Angelo MD; Merkle, Kristen BA; Cannistraci, Christopher J. MS; Rogers, Baxter P. PhD; Gatenby, J. Chris PhD; Heckers, Stephan MD, MSC; Gore, John C. PhD; Hopkins, Ramona O. PhD; Ely, E. Wesley MD, MPH; for the VISIONS Investigation (VISualizing Icu SurvivOrs Neuroradiological Sequelae)

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Objective: Delirium duration is predictive of long-term cognitive impairment in intensive care unit survivors. Hypothesizing that a neuroanatomical basis may exist for the relationship between delirium and long-term cognitive impairment, we conducted this exploratory investigation of the associations between delirium duration, brain volumes, and long-term cognitive impairment.

Design, Setting, and Patients: A prospective cohort of medical and surgical intensive care unit survivors with respiratory failure or shock.

Measurements: Quantitative high resolution 3-Tesla brain magnetic resonance imaging was used to calculate brain volumes at discharge and 3-month follow-up. Delirium was evaluated using the confusion assessment method for the intensive care unit; cognitive outcomes were tested at 3- and 12-month follow-up. Linear regression was used to examine associations between delirium duration and brain volumes, and between brain volumes and cognitive outcomes.

Results: A total of 47 patients completed the magnetic resonance imaging protocol. Patients with longer duration of delirium displayed greater brain atrophy as measured by a larger ventricle-to-brain ratio at hospital discharge (0.76, 95% confidence intervals [0.10, 1.41]; p = .03) and at 3-month follow-up (0.62 [0.02, 1.21], p = .05). Longer duration of delirium was associated with smaller superior frontal lobe (−2.11 cm3 [−3.89, −0.32]; p = .03) and hippocampal volumes at discharge (−0.58 cm3 [−0.85, −0.31], p < .001)—regions responsible for executive functioning and memory, respectively. Greater brain atrophy (higher ventricle-to-brain ratio) at 3 months was associated with worse cognitive performances at 12 months (lower Repeatable Battery for the Assessment of Neuropsychological Status score −11.17 [−21.12, −1.22], p = .04). Smaller superior frontal lobes, thalamus, and cerebellar volumes at 3 months were associated with worse executive functioning and visual attention at 12 months.

Conclusions: These preliminary data show that longer duration of delirium is associated with smaller brain volumes up to 3 months after discharge, and that smaller brain volumes are associated with long-term cognitive impairment up to 12 months. We cannot, however, rule out that smaller preexisting brain volumes explain these findings.

© 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

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