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Investigations on Alterations of Hippocampal Circuit Function Following Mild Traumatic Brain Injury

Investigations on Alterations of Hippocampal Circuit Function Following Mild Traumatic Brain Injury

Published on: November 19, 2012

Long-term cognitive impairment after critical illness.

P P Pandharipande¹, T D Girard, J C Jackson

¹Department of Anesthesiology, Division of Critical Care, Vanderbilt University School of Medicine, Nashville, USA. pratik.pandharipande@vanderbilt.edu

The New England Journal of Medicine

|October 4, 2013

Summary

Intensive care unit (ICU) survivors face significant long-term cognitive impairment, particularly with longer delirium durations. This cognitive decline impacts global cognition and executive function months after hospital discharge.

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Area of Science:

Neuroscience
Critical Care Medicine
Public Health

Background:

Survivors of critical illness frequently experience prolonged and disabling cognitive impairment.
The precise characterization of this post-ICU cognitive dysfunction remains an area of active research.

Purpose of the Study:

To characterize long-term cognitive impairment in survivors of critical illness.
To investigate the association between in-hospital delirium and post-discharge cognitive outcomes.

Main Methods:

Adults with respiratory failure or shock in the ICU were assessed for delirium.
Global cognition and executive function were evaluated at 3 and 12 months post-discharge using standardized neuropsychological tests.
Linear regression analysis examined the association of delirium duration and sedative/analgesic use with cognitive outcomes.

Main Results:

74% of patients developed in-hospital delirium.
At 3 months post-discharge, 40% had global cognition deficits comparable to moderate traumatic brain injury.
A longer duration of delirium was independently associated with worse global cognition and executive function at both 3 and 12 months.

Conclusions:

Medical and surgical ICU patients are at high risk for persistent cognitive impairment.
Prolonged in-hospital delirium duration is a significant predictor of worse long-term cognitive function.
Further research and interventions are needed to mitigate post-ICU cognitive deficits.