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Long-term Neurocognitive Function After Critical Illness^*

^* From the Department of Internal Medicine (Dr. Hopkins), Pulmonary and Critical Care Division, LDS Hospital, Salt Lake City, UT; and the Division of Allergy/Pulmonary/Critical Care Medicine (Dr. Jackson), Vanderbilt University School of Medicine, Nashville, TN.

Correspondence to: Ramona O. Hopkins, PhD, Critical Care Medicine, LDS Hospital, Eighth Ave and C St, Salt Lake City, UT 84143; e-mail: Ramona.Hopkins{at}intermountainmail.org

Abstract

Background: Until relatively recently, critical care practitioners have focused on the survival of their patients and not on long-term outcomes. The incidence of chronic neurocognitive dysfunction has been underestimated and underreported, and only recently has it been studied in critically ill patients. However, neurocognitive outcomes have been the subject of extensive investigation in other medical populations for many years.

Methods: Review of the current literature regarding long-term neurocognitive outcomes following critical illness.

Results: Data from studies to date indicate that critical illness can lead to significant neurocognitive impairments. The neurocognitive impairments persist for months and years, and may have important consequences for quality of life, the ability to return to work, overall functional ability, and substantial economic costs. The mechanisms of the neurocognitive impairments are not fully understood but likely include delirium, hypoxia, glucose dysregulation, metabolic derangements, inflammation, and the effects of sedatives and narcotics among other factors. The contributions of these factors may be particularly significant in patients with preexisting vulnerabilities for the development of cognitive impairments such as mild cognitive impairment, dementia, prior traumatic brain injury, or other comorbid disorders associated with neurocognitive impairments.

Conclusions: Current research indicates that neurocognitive sequelae following critical illness are common, may be permanent, and are associated with impairments in daily function, decreased quality of life, and an inability to return to work. Research needs to be done to better understand the prevalence, nature, risk factors, and nuances of the neurocognitive impairments observed in ICU survivors.

Key Words: critical care outcomes • critical illness • neurocognitive impairments

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