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A prospective cohort study of cognitive function in ICU survivors using the Cambridge Brain Sciences 6-test battery (CBS-6)
CCCF Academy. Honarmand K. 11/13/19; 283402; EP118
Dr. Kimia Honarmand
Dr. Kimia Honarmand
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Abstract
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ePoster
Topic: Retrospective or Prospective Cohort Study or Case Series

Honarmand, Kimia1; Tamasi, Tanya1; Aboutaka, Maria2; Wild, Conor3; McIntyre, Christopher2,4; Owen, Adrian M3; Slessarev, Marat1,3

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


Introduction
Long-term cognitive impairment is a common consequence of critical illness (1). Various instruments are often used to assess cognitive function in intensive care unit (ICU) survivors. Cambridge Brain Sciences (CBS) is a 12-test, web-based, self-administered neurocognitive test battery that has been widely validated in various patient populations. We previously conducted a pilot feasibility study to show that the CBS battery to assess cognition in ICU patients is feasible and that the 6-test version of the battery (CBS-6) was adequate in detecting cognitive impairment relative to the 12-test battery (2).
 
Objectives
We conducted a prospective cohort study to describe the cognitive performance of ICU survivors using the CBS-6 battery.
 
Methods
We recruited adult (≥ 18 years of age) ICU patients who were intubated for a minimum of 24 hours and had recovered from critical illness from two ICUs in London, Ontario. Patients who were actively delirious, or had a documented history of dementia or neurological diseases were excluded. Demographic and disease-related characteristics were recorded from patients' medical records. Patients completed the CBS-6 while in the ICU or shortly after discharge from ICU. Z-scores were calculated using age- and sex-matched normative data for each CBS-6 test and for three cognitive domains: short-term memory, reasoning skills, and verbal skills.
 
Results
Thirty-six ICU survivors (12 women) underwent cognitive testing. Median age was 56.5 years (IQR: 45.25, 63.75), median MODS was 6 (IQR: 4, 8), and median ICU length of stay was 8 days (IQR: 5, 14.25). Twenty-four patients were tested in the ICU and 12 were tested within 1-4 days of transfer to ward. All but two patients were impaired on at least one test and 32 of 36 were impaired on at least two tests. Patients were impaired on a median of 3 tests (IQR: 2.25, 4). Patients' performance on all 6 CBS tests are shown in Figure 1 and performance on the cognitive domains are shown in Figure 2.
 
Conclusion
The CBS-6 can help detect cognitive impairment in ICU survivors. Patients were impaired on all CBS-6 tests and all 3 cognitive domains (short-term memory, reasoning skills, and verbal skills). Longitudinal studies using the CBS-6 can establish the natural history of cognitive impairment in ICU survivors.


Image Image

References:

  1. Pandharipande PP et al, N Engl J Med. 2013; 369(14):1306–16.
  2. Honarmand K et al, PLoS ONE. 2019; 14(4): e0215203.
ePoster
Topic: Retrospective or Prospective Cohort Study or Case Series

Honarmand, Kimia1; Tamasi, Tanya1; Aboutaka, Maria2; Wild, Conor3; McIntyre, Christopher2,4; Owen, Adrian M3; Slessarev, Marat1,3

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


Introduction
Long-term cognitive impairment is a common consequence of critical illness (1). Various instruments are often used to assess cognitive function in intensive care unit (ICU) survivors. Cambridge Brain Sciences (CBS) is a 12-test, web-based, self-administered neurocognitive test battery that has been widely validated in various patient populations. We previously conducted a pilot feasibility study to show that the CBS battery to assess cognition in ICU patients is feasible and that the 6-test version of the battery (CBS-6) was adequate in detecting cognitive impairment relative to the 12-test battery (2).
 
Objectives
We conducted a prospective cohort study to describe the cognitive performance of ICU survivors using the CBS-6 battery.
 
Methods
We recruited adult (≥ 18 years of age) ICU patients who were intubated for a minimum of 24 hours and had recovered from critical illness from two ICUs in London, Ontario. Patients who were actively delirious, or had a documented history of dementia or neurological diseases were excluded. Demographic and disease-related characteristics were recorded from patients' medical records. Patients completed the CBS-6 while in the ICU or shortly after discharge from ICU. Z-scores were calculated using age- and sex-matched normative data for each CBS-6 test and for three cognitive domains: short-term memory, reasoning skills, and verbal skills.
 
Results
Thirty-six ICU survivors (12 women) underwent cognitive testing. Median age was 56.5 years (IQR: 45.25, 63.75), median MODS was 6 (IQR: 4, 8), and median ICU length of stay was 8 days (IQR: 5, 14.25). Twenty-four patients were tested in the ICU and 12 were tested within 1-4 days of transfer to ward. All but two patients were impaired on at least one test and 32 of 36 were impaired on at least two tests. Patients were impaired on a median of 3 tests (IQR: 2.25, 4). Patients' performance on all 6 CBS tests are shown in Figure 1 and performance on the cognitive domains are shown in Figure 2.
 
Conclusion
The CBS-6 can help detect cognitive impairment in ICU survivors. Patients were impaired on all CBS-6 tests and all 3 cognitive domains (short-term memory, reasoning skills, and verbal skills). Longitudinal studies using the CBS-6 can establish the natural history of cognitive impairment in ICU survivors.


Image Image

References:

  1. Pandharipande PP et al, N Engl J Med. 2013; 369(14):1306–16.
  2. Honarmand K et al, PLoS ONE. 2019; 14(4): e0215203.
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