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- Brück, Emily, et al.
(författare)
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Lack of clinically relevant correlation between subjective and objective cognitive function in ICU survivors : a prospective 12-month follow-up study
- 2019
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Ingår i: Critical Care. - : Springer Science and Business Media LLC. - 1364-8535 .- 1466-609X. ; 23
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundCognitive impairment and psychological distress are common in intensive care unit (ICU) survivors. Early identification of affected individuals is important, so intervention and treatment can be utilized at an early stage. Cognitive Failures Questionnaire (CFQ) is commonly used to screen for subjective cognitive function, but it is unclear whether CFQ scores correlate to objective cognitive function in this population.MethodsBetween 2014 and 2018, 100 ICU survivors aged 18–70 years from the general ICU at the Karolinska University Hospital, Solna, were included in the study. Out of these, 58 patients completed follow-up at 3 months after ICU discharge, 51 at 6 months, and 45 at 12 months. Follow-up included objective cognitive function testing using the Cambridge Neuropsychological Test Automated Battery (CANTAB) and subjective cognitive function testing with the self-rating Cognitive Failures Questionnaire (CFQ), as well as psychological self-rating with the Post-Traumatic Stress Symptoms Scale-10 (PTSS-10) and Hospital Anxiety and Depression Scale (HADS).ResultsThe prevalence of cognitive impairment as measured by four selected CANTAB tests was 34% at 3 months after discharge, 18% at 6 months, and 16% at 12 months. There was a lack of significant correlation between CANTAB scores and CFQ scores at 3 months (r = − 0.134–0.207, p > 0.05), at 6 months (r = − 0.106–0.257, p > 0.05), and at 12 months after discharge (r = − 0.070–0.109, p > 0.05). Correlations between CFQ and PTSS-10 scores and HADS scores, respectively, were significant over the follow-up period (r = 0.372–0.710, p ≤ 0.001–0.023). In contrast, CANTAB test scores showed a weak correlation with PTSS-10 and HADS scores, respectively, at 3 months only (r = − 0.319–0.348, p = 0.008–0.015).ConclusionWe found no clinically relevant correlation between subjective and objective cognitive function in this cohort of ICU survivors, while subjective cognitive function correlated significantly with psychological symptoms throughout the follow-up period. Treatment and evaluation of ICU survivors’ recovery need to consider both subjective and objective aspects of cognitive impairment, and subjective reports must be interpreted with caution as an indicator of objective cognitive function.
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| 2. |
- Brück, Emily
(författare)
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Life after intensive care-post : intensive care syndrome, inflammation, and HMGB1
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Survival rates of intensive care unit (ICU) patients are consistently increasing. This new patient population has recently gained increased recognition as they suffer from psychological, physical, and cognitive impairments in the years to come after ICU discharge. These symptoms are collectively referred to as the post-intensive care syndrome (PICS). Importantly, the underlying pathophysiology of PICS is unclear, but in many ways consistent with a persistent, non-resolving inflamma- tion. In this context, high mobility group box 1 (HMGB1), a prototypical alarmin involved in both sterile and infectious inflammation, has gained interest, particu- larly since animal studies indicate that HMGB1 promotes neuroinflammation and cognitive impairment. This thesis investigates aspects of PICS in ICU survivors, including subjective and objective cognitive function, physical performance, and markers of inflam- mation. Patients were included in two cohorts designed for ICU follow-up studies. In study I, the association between sepsis and delirium during ICU stay and symp- toms of psychological distress (Hospital Anxiety and Depression Scale (HADS) and Post-traumatic Stress Symptoms Scale-10 (PTSS-10)) and self-rated cognitive function (Cognitive Failures Questionnaire (CFQ)) after three months were inves- tigated. There was no significant association between sepsis or delirium at ICU stay and self-rated cognitive function at the three months follow-up. In contrast, there was a strong significant correlation between patients’ self-rated cognitive function and symptoms of depression, anxiety, and PTSD. Studies II-IV investigate a 12 months follow-up cohort of ICU survivors. Patients were examined at the ICU follow-up clinic at three, six, and twelve months after ICU discharge. They underwent formal neuropsychological testing, performed physical tests, and responded to three questionnaires on psychological distress and subjective cognitive function (HADS, PTSS-10, CFQ). Blood samples were collected at the three and six-month follow-up visits. Study II investigates whether patients ́ subjective cognitive function correlates to objectively measured cognitive function. Answers on the CFQ were analyzed together with outcomes on the Cambridge Neuropsychological Test Automated Battery (CANTAB). There was no clinically relevant correlation between subjective and objective cognitive function as measured here. We conclude that subjective cognitive function tests in ICU survivors must be interpreted with caution and that both subjective and objective testing may be necessary to adequately ascertain cognitive function in ICU survivors. In study III, the association between plasma HMGB1 and objective cognitive function measured in four different cognitive domains (executive function, visual memory, sustained attention, working memory) was investigated. Interestingly, plasma levels of HMGB1 were significantly elevated in the ICU, at discharge, and at the three- and six-months follow-up visits as compared with reference popula- tions. Elevated plasma levels of HMGB1 were associated with reduced sustained attention at the three- and six-month follow-up visits. Based on these findings, further follow-up studies on HMGB1 biology in ICU survivors are warranted to investigate the potential for therapeutic targeting of HMGB1 function in preven- tion of cognitive impairment in ICU survivorsIn study IV we explore the association between plasma HMGB1 and physical performance at ICU follow-up. We observed no significant association between levels of plasma HMGB1 and the three physical tests performed (i.e., 6-min walk test, timed stands test, handgrip strength test). In conclusion, this thesis provides new insights on objective and subjective cogni- tive function, psychological distress, and markers of inflammation in ICU survi- vors. Future work may build on this knowledge to improve the identification and treatment of at-risk subjects in this vast and growing patient population.
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