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Cognitive Dysfunction in ICU Patients: Risk Factors, Predictors, and Rehabilitation Interventions

Wilcox, M. Elizabeth MD, MPH1; Brummel, Nathan E. MD, MSCI2; Archer, Kristin DPT, PhD3; Ely, E. Wesley MD, MPH2,4,5; Jackson, James C. PsyD2,5,6; Hopkins, Ramona O. PhD7,8

doi: 10.1097/CCM.0b013e3182a16946
Creating and Implementing the 2013 ICU Pain, Agitation, and Delirium Guidelines for Adult Icu Patients

In contrast to other clinical outcomes, long-term cognitive function in critical care survivors has not been deeply studied. In this narrative review, we summarize the existing literature on the prevalence, mechanisms, risk factors, and prediction of cognitive impairment after surviving critical illness. Depending on the exact clinical subgroup, up to 100% of critical care survivors may suffer some degree of long-term cognitive impairment at hospital discharge; in approximately 50%, decrements in cognitive function will persist years later. Although the mechanisms of acquiring this impairment are poorly understood, several risk factors have been identified. Unfortunately, no easy means of predicting long-term cognitive impairment exists. Despite this barrier, research is ongoing to test possible treatments for cognitive impairment. In particular, the potential role of exercise on cognitive recovery is an exciting area of exploration. Opportunities exist to incorporate physical and cognitive rehabilitation strategies across a spectrum of environments (in the ICU, on the hospital ward, and at home, posthospital discharge).

1Interdepartmental Division of Critical Care Medicine, Toronto Western Hospital, Toronto, ON, Canada.

2Division of Allergy, Pulmonary, and Critical Care Medicine and Center for Health Services Research, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN.

3Division of Orthopaedic Surgery and Rehabilitation, Vanderbilt University School of Medicine, Nashville, TN.

4Department of Medicine, Center for Quality of Aging, Vanderbilt University School of Medicine, Nashville, TN.

5Geriatric Research, Education and Clinical Center Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN.

6Department of Psychiatry, Vanderbilt University Medical Center, and Clinical Research Center of Excellence, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN.

7Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, UT.

8Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT.

Dr. Brummel has received a grant from the National Institutes of Health (NIH). Dr. Archer has held a consultancy with Synergy; received grants from American Physical Therapy Association, Foundation for Physical Therapy, Department of Defense, National Institute of Arthritis and Musculoskeletal Skin Disease, and National Institute of Disability and Rehabilitation Research; received payment for travel/accommodations/meeting expenses from the NIH; and received payment from the American Pain Society for development of educational presentations. Dr. Ely holds consultancies with Hospira, Abbott, Masimo, and Orion and has received honoraria for lectures from Hospira, Orion, and Abbott. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins