Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Association Between Critical Care Admissions and Cognitive Trajectories in Older Adults*

Schulte, Phillip J. PhD1; Warner, David O. MD2; Martin, David P. MD, PhD2; Deljou, Atousa MD2; Mielke, Michelle M. PhD3,4; Knopman, David S. MD4; Petersen, Ronald C. MD, PhD3,4; Weingarten, Toby N. MD2; Warner, Matthew A. MD2; Rabinstein, Alejandro A. MD4; Hanson, Andrew C. BS1; Schroeder, Darrell R. MS1; Sprung, Juraj MD, PhD2

doi: 10.1097/CCM.0000000000003829
Neurologic Critical Care
Buy
SDC

Objectives: Patients requiring admission to an ICU may subsequently experience cognitive decline. Our objective was to investigate longitudinal cognitive trajectories in older adults hospitalized in ICUs. We hypothesized that individuals hospitalized for critical illness develop greater cognitive decline compared with those who do not require ICU admission.

Design: A retrospective cohort study using prospectively collected cognitive scores of participants enrolled in the Mayo Clinic Study of Aging and ICU admissions retrospectively ascertained from electronic medical records. A covariate-adjusted linear mixed effects model with random intercepts and slopes assessed the relationship between ICU admissions and the slope of global cognitive z scores and domains scores (memory, attention/executive, visuospatial, and language).

Setting: ICU admissions and cognitive scores in the Mayo Clinic Study of Aging from October 1, 2004, to September 11, 2017.

Patients: Nondemented participants age 50 through 91 at enrollment in the Mayo Clinic Study of Aging with an initial cognitive assessment and at least one follow-up visit.

Interventions: None.

Measurements and Main Results: Of 3,673 participants, 372 had at least one ICU admission with median (25–75th percentile) follow-up after first ICU admission of 2.5 years (1.2–4.4 yr). For global cognitive z score, admission to an ICU was associated with greater decline in scores over time compared with participants not requiring ICU admission (difference in annual slope = –0.028; 95% CI, –0.044 to –0.012; p < 0.001). ICU admission was associated with greater declines in memory (–0.029; 95% CI, –0.047 to –0.011; p = 0.002), attention/executive (–0.020; 95% CI, –0.037 to –0.004; p = 0.016), and visuospatial (–0.013; 95% CI, –0.026 to –0.001; p = 0.041) domains. ICU admissions with delirium were associated with greater declines in memory (interaction p = 0.006) and language (interaction p = 0.002) domains than ICU admissions without delirium.

Conclusions: In older adults, ICU admission was associated with greater long-term cognitive decline compared with patients without ICU admission. These findings were more pronounced in those who develop delirium while in the ICU.

1Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN.

2Department of Anesthesiology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN.

3Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN.

4Department of Neurology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN.

*See also p. 1164.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Drs. Schulte, Warner, Rabinstein, and Sprung contributed to conception and design of the work, interpretation of data, analysis and interpretation of data, drafting of the work and revisions for important intellectual content, final approval. Drs. Martin, Mielke, Knopman, Petersen, Weingarten, and Warner contributed to critical revisions of the work for important intellectual content and final approval: Dr. Deljou contributed to acquisition and interpretation of data. Drs. Hanson and Schroeder contributed to data analysis, statistical work, critical revisions of the work for important intellectual content, and final approval.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported, in part, by the National Institutes of Health grants U01 AG006786 (principal investigator [PI]: to R.C.P), P50 AG016574 (PI: to R.C.P), RF1 AG55151 (PI: to M.M.M), by the Robert H. and Clarice Smith and Abigail van Buren Alzheimer’s Disease Research Program, the Rochester Epidemiology Project (R01 AG034676) and the Mayo Clinic Center for Translational Sciences Activities (CTSA), grant number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS). In addition, this study was supported, in part, by CTSA Grant Number KL2 TR002379 to M.A.W from NCATS.

Drs. Schulte, Mielke, Knopman, and Petersen received support for article research from the National Institutes of Health. Dr. Martin disclosed that he serves on the Board of Directors for the American Society of Anesthesiologists (ASA), he receives an annual stipend from ASA for contributions to the Patient Safety Continuing Medical Education Editorial Board, and he and Mayo Clinic owns equity and receives royalties for work licensed through Mayo Clinic to Nevro, Inc, a publicly held company, for contributions related to the use of nerve signal modulation to treat central, autonomic, and peripheral nervous system disorders, including pain. Dr. Mielke’s institution received funding from Biogen and Lunbeck, and she received funding from Eli Lilly. Dr. Knopman received funding from Washington University (Data Safety Monitoring Board activities). Dr. Petersen’s institution received funding from National Institute on Aging; he received funding from Roche (consultant), Merck (consultant), Genentech (DSMB), Biogen, Eisai, and GE Healthcare; and he received other support from benefactors through the Mayo Clinic. Dr. Weingarten received funding from Medtronic (served as chairman of the clinical event committee of the PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) trial, which examined postoperative capnography monitoring) and Merck (received an investigator-initiated, unrestricted grant to study the effects of sugammadex on return of postoperative bowel function), and he disclosed work for hire. Dr. Warner’s institution received funding from Center for Translational Sciences Activities Grant Number KL2 TR002379 from the National Center for Advancing Translational Science. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: schulte.phillip@mayo.edu

Copyright © 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.