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

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 (ß per year increase, -0.09 [95% CI, -0.13 to -0.05]) and blood transfusions during hospitalization (ß, -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.