How Well do We Assess Cognitive Function in ICU Survivors? A Systematic Review of the Literature
CCCF ePoster library. Honarmand K. Nov 9, 2018; 233435; 109
Dr. Kimia Honarmand
Dr. Kimia Honarmand
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Cognitive impairment is a common and lasting complication of critical illness. However, given the plethora of available cognitive tests, there is a currently no consensus on the optimal way to assess and define cognitive impairment in ICU survivors. Establishing the feasibility and diagnostic utility of cognitive tests that have been used in ICU studies is an important first step in developing such consensus, which in turn would enable large scale multicentre studies of preventative, therapeutic and rehabilitative interventions of this important complication of critical illness.



We conducted a systematic review to develop a comprehensive compendium of all cognitive instruments used to assess cognitive function in ICU survivors in the extant literature and to summarize the feasibility and diagnostic utility of these cognitive batteries.



We conducted a systematic search of Ovid Medline, EMBASE, and PsycINFO for potentially relevant, English language articles. Two independent reviewers screened titles and abstracts and conducted full-text reviews of selected articles to identify original studies where cognitive function was assessed in adult ICU survivors. We excluded studies that exclusively assessed cognition in cardiac arrest or acute neurological injury survivors.


We graded each cognitive battery with respect to: (1) feasibility, which incorporates mode of administration (in-person, by telephone, or web-based) and duration of testing; and (2) diagnostic utility, which incorporates the sensitivity of the cognitive battery in detecting cognitive impairment and the number and breadth of assessed cognitive domains.



We screened 3351 titles and abstracts and identified 62 relevant studies. Selected studies used a myriad of cognitive instruments and variable criteria to define cognitive impairment. The majority of studies used a single cognitive test, and few used comprehensive cognitive batteries evaluating different cognitive domains.


We identified 17 cognitive batteries, with MMSE the most common, followed by RBANS. The majority of cognitive batteries were deficient in their feasibility or lacked diagnostic utility (Figure 1). We identified no cognitive batteries that were adequate with respect to both feasibility and diagnostic utility.


There was inconsistency in how cognitive impairment was defined across studies. Some, but not all, studies classified patients as cognitively impaired if they scored 1.5 (2 in some studies) standard deviations below population norms on 2 (3 in some studies) within a cognitive battery.



We identified two critical gaps in the assessment of cognition among ICU survivors: (1) lack of cognitive instruments that balanced feasibility and diagnostic utility, and (2) variability in the definition of cognitive impairment between studies. Future studies should focus on developing ICU-specific feasible cognitive batteries with broad diagnostic utility, and establishing a consensus among ICU cognition scientists regarding the definition of cognitive impairment.

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