Feasibility of a web-based neurocognitive battery for assessing cognitive function in ICU survivors: a pilot study.
CCCF ePoster library. Malik S. 10/04/17; 198170; 96
Sabhyata Malik
Sabhyata Malik
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Feasibility of a web-based neurocognitive battery for assessing cognitive function in ICU survivors: a pilot study.

Malik, Sabhyata1; Patel, Neil1; Honarmand, Kimia2; Tamasi, Tanya2; McIntyre, Christopher2,3; Owen, Adrian4; Slessarev, Marat2,3


1 Faculty of Science, University of Western Ontario, London, Canada; 2 Department of Medicine, University of Western Ontario, London, Canada; 3 Department of Medical Biophysics, University of Western Ontario, London, Canada; 4 Brain and Mind Institute, University of Western Ontario, London, Canada

Long-term cognitive dysfunction is common in ICU survivors (1). Its temporal course remains unclear, impeding identification of appropriate time windows for therapeutic target discovery and interventions. This is partly due to lack of neurocognitive tests that are comprehensive, easy to administer and do not require presence of trained personnel. Cambridge Brain Sciences (CBS) is a validated web-based neurocognitive test battery previously used in large cohort studies, can be self-administered by patients, and allows testing frequencies not feasible with standard paper-based methods, making it an attractive method for objectively quantifying ICU-related cognitive dysfunction. However, CBS has never been evaluated in ICU patients.
To determine the feasibility of using web-based neurocognitive battery for assessment of cognitive function in ICU survivors.
We recruited adult (age ≥ 18 years), non-delirious patients who were intubated for a minimum of 24 hours from two ICUs in London, Ontario. Patients with a documented history of dementia or neurological diseases were excluded. Demographic and clinical variables were recorded from medical records.  Patients completed at least one CBS battery in the ICU, or shortly after discharge from ICU. Patients were considered impaired on a cognitive test if they scored > 2 standard deviations (SD) below the healthy population norms corrected for age and sex. Feasibility issues associated with web-based cognitive testing in ICU patients were recorded.
Of 44 patients approached, 21 underwent cognitive testing and 18 (6 females) were included in the analysis, with 15 of these completing the full 12-test battery. Median age was 62 years (SD 13.2), NEMS score 18 (SD 5.6), and ICU length of stay 5 days (SD 5.0). Twelve patients were tested in the ICU and 6 were tested within 1-4 days of transfer to ward. Fifteen of 18 patients were impaired on at least one test, with the median impairment of 2 tests (range 0-8).
Feasibility issues with CBS included: unclear test interface (difficulty focusing on the appropriate part of computer monitor); patient fatigue due to battery length (with 3 of 18 completing partial battery only); complex test instructions; lack of progress feedback; test sounds disturbing other patients in shared rooms; and patient inexperience with using a computer mouse.
Web-based cognitive testing is feasible in ICU patients. Feasibility issues need to be addressed in order to optimize this form of testing in ICU survivors. Our results will inform modification of a web-based battery for ICU needs, and help with the design of future observational studies.

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