Socioeconomic Factors and Intensive Care Unit-Related Cognitive Impairment

Area of Science:

• Neuroscience
• Critical Care Medicine
• Public Health

Background:

• Post-intensive care unit (ICU) long-term cognitive impairment (LTCI) is a recognized complication.
• Socioeconomic factors have been under-recognized in LTCI research.
• Delirium during ICU stay is a known risk factor for cognitive decline.

Purpose of the Study:

• To identify socioeconomic and clinical risk factors for post-ICU long-term cognitive impairment (LTCI).
• To investigate the association of various demographic, clinical, and hospital-related factors with cognitive outcomes after ICU discharge.

Main Methods:

• Prospective, multicenter cohort study of 1040 ICU survivors with shock or respiratory failure.
• Cognitive function assessed using the Repeatable Battery for Assessment of Neuropsychological Symptoms (RBANS) at 3 and 12 months post-discharge.
• Multivariable linear regression adjusted for age, race, education, socioeconomic status, comorbidities, and ICU-specific factors.

Main Results:

• 71% of patients experienced delirium during their ICU stay.
• 47% and 41% of survivors exhibited LTCI at 3 and 12 months, respectively.
• Delirium, non-White race, lower education, and civilian hospital type were significantly associated with worse cognitive scores.

Conclusions:

• Socioeconomic factors (race, education) and clinical factors (delirium duration, hospital type) are linked to worse post-ICU cognitive impairment.
• Improved identification of high-risk groups is crucial for enhancing survivorship and cognitive rehabilitation.
• Targeted interventions may mitigate the long-term cognitive sequelae of critical illness.