Assessing Cognitive Function at Hospital Discharge Helps Identify Post-ICU Needs

Assessing patients for cognitive impairment at hospital discharge can help identify those who are at higher risk of developing new severe physical disabilities, according to new research published in American Journal of Critical Care (AJCC).

Researchers at Montefiore Medical Center, the university hospital for Albert Einstein College of Medicine, Bronx, New York, found that about 30% of critically ill patients could not complete a simple screening assessment for cognitive impairment about the time of their discharge from the hospital, mostly due to physical or cognitive impairment at the time. They also found that about 47% of the surviving patients who were able to complete the assessment at this early point in their recovery scored at a level consistent with severe cognitive impairment.

“Utility of Screening for Cognitive Impairment at Hospital Discharge in Adult Survivors of Critical Illness” looked at disability and mortality outcomes for patients following their stay in an intensive care unit (ICU), with a focus on whether screening for cognitive impairment when they left the hospital could inform strategies for post-hospital interventions.

“Leaving the hospital after surviving critical illness is only the beginning of a patient’s recovery. Months later, we found that ICU survivors often had cognitive impairment and new physical challenges,” said co-author Gerardo Eman, MD, an internal medicine resident in critical care at Montefiore. “Early and ongoing assessments of ICU survivors are crucial to developing post-ICU treatment plans and improving long-term outcomes.”  

The researchers conducted post hoc analyses with data from two observational cohort studies. The FRAIL-STOOP study involved adult patients ages 50 years or older who were admitted to medical or surgical ICUs between January 2016 and July 2017. The second study, called CAMINANDO, involved adults ages 18 years or older with acute respiratory failure who were admitted between July 2018 and December 2019.

Patients in each cohort completed various cognitive and physical assessments during their hospital stay, and hospital treatment variables were collected via medical record review.

Within a few days of the patients’ discharge from the hospital, trained research coordinators administered a simplified version of the Montreal Cognitive Assessment (MoCA-Blind). Before administering the tool, they assessed whether the patient could follow at least three of five simple commands, including looking at them, nodding their head and opening or closing their eyes.

For patients unable to complete the assessment, the research coordinators classified the reason as due to cognitive impairment, physical impairment, refusal, leaving the hospital before the MoCA-Blind could be completed or another reason that didn’t fit one of the more specific categories. They also collected information on the patients’ disability status at that time.

Follow-up telephone interviews with hospital survivors and/or their surrogates were completed about six months after patients left the hospital, to assess vital and physical disability status.

The study population consisted of 423 adults across the two observational cohort studies, 320 of whom survived to hospital discharge.

Among the survivors, 213 completed the MoCA-Blind about the time of their hospital discharge. Six months later, 37 (17.4%) had died, and 41 (23.3%) survivors had new severe disability based on their baseline in-hospital assessments. 

Of the 107 hospital survivors who could not complete a MoCA-Blind assessment at discharge, cognitive impairment was the primary reason for 47 (43.9%) of them. Six months later, 28 (26.2%) had died, and 30 (38%) had new severe disability.

Importantly, cognitive impairment at hospital discharge was not associated with an increased risk of death within six months, but it was associated with a higher risk of new severe physical disability.

The inability to complete a screening test may provide important prognostic data. The fact that a significant percentage of adults in this study could not complete the cognitive assessment at hospital discharge suggests there may still be a role for developing and validating a cognitive assessment tool specific to ICU survivors to gain a fuller picture of post-ICU needs.

To access the article and full-text PDF, visit the AJCC website at www.ajcconline.org.

About the American Journal of Critical Care: The American Journal of Critical Care (AJCC), a bimonthly scientific journal published by the American Association of Critical-Care Nurses, provides leading-edge clinical research that focuses on evidence-based-practice applications. Established in 1992, the award-winning journal includes clinical and research studies, case reports, editorials and commentaries. AJCC enjoys a circulation of more than 130,000 acute and critical care nurses and can be accessed at www.ajcconline.org.

About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with more than 130,000 members and over 200 chapters in the United States.

American Association of Critical-Care Nurses, 27071 Aliso Creek Road, Aliso Viejo, CA 92656; 949-362-2000; www.aacn.org; facebook.com/aacnface; twitter.com/aacnme