Utility of Screening for Cognitive Impairment at Hospital Discharge in Adult Survivors of Critical Illness

Abstract

Background Few studies have explored the utility of screening for cognitive impairment near hospital discharge in intensive care unit survivors. Objectives To explore baseline and hospitalization characteristics associated with cognitive impairment at hospital discharge and the relationship between cognitive impairment and 6-month disability and mortality outcomes. Methods Hospital disability status and treatment variables were collected from 2 observational cohort studies. Patients were screened for cognitive impairment at hospital discharge using the Montreal Cognitive Assessment (MoCA)–Blind, and telephone follow-up was conducted 6 months after discharge to assess vital and physical disability status. Results Of 423 patients enrolled, 320 were alive at hospital discharge. A total of 213 patients (66.6%) were able to complete the MoCA near discharge; 47 patients (14.7%) could not complete it owing to cognitive impairment. In MoCA completers, the median (IQR) score was 17 (14-19). Older age (β per year increase, −0.09 [95% CI, −0.13 to −0.05]) and blood transfusions during hospitalization (β, −1.20 [95% CI, −2.26 to −0.14]) were associated with lower MoCA scores. At 6-month follow-up, 176 of 213 patients (82.6%) were alive, of whom 41 (23.3%) had new severe physical disabilities. Discharge MoCA score was not significantly associated with 6-month mortality (adjusted odds ratio, 1.03 [95% CI, 0.93-1.14]) but was significantly associated with risk of new severe disability at 6 months (adjusted odds ratio, 0.85 [95% CI, 0.76-0.94]). Conclusion Assessing for cognitive impairment at hospital discharge may help identify intensive care unit survivors at higher risk of severe physical disabilities after critical illness.