PREVALENCE OF EXECUTIVE DYSFUNCTION IN ICU SURVIVORS AND ITS ASSOCIATION WITH DAILY FUNCTIONAL ABILITY

Abstract

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Cognitive impairment is common in survivors of critical illness and occurs in between 30% and 50% of individuals in the first year after discharge from the ICU. While cognitive impairment has been widely studied in this population, relatively little attention has been paid to the characterization of executive functioning. We undertook the current study both to describe the prevalence and nature of executive deficits in survivors of critical illness and to determine which dimensions of executive functioning were the most predictive of daily functional decrements. METHODS: A total of 184 participants were prospectively enrolled in a sub-study nested within an NIH-funded parent study (BRAIN-ICU). Patients were adult mechanically ventilated ICU survivors from two large medical centers who were followed at 3 months and 12 months after discharge with a comprehensive testing of both executive functioning and daily functional ability (via the Functional Activities Questionnaire or FAQ). Descriptive statistics were employed to characterize patient demographics and the prevalence of executive impairment. Proportional odds logistic regression was used to find the association between executive dysfunction and functional difficulties RESULTS: At 3- and 12-month follow-up, 135 and 105 patients were assessed, respectively. Global executive functioning was impaired (reflecting pervasive deficits across multiple domains) in nearly a quarter (22%) of study subjects at 3-month follow-up and in 10% at 12-months. Executive dysfunction was highly prevalent on tests of fluency (verbal and figural) and set-shifting, reflected in impairment on the Ruff Figural Fluency Test (44 % at 3 months and 30% at 12 months), the Controlled Oral Word Association (COWA) Test (39% at 3 months and 32% at 12 months), and the Trails B Test (31% at 3 months and 24% at 12 months). Deficits in executive ability were closely associated with impaired daily functional ability as seen in significant associations between scores on the Ruff, COWA, and Trails B tests and the FAQ, particularly at 3 months (p<0.001), with this relationship decreasing slightly at 12 months on Trails B. Analysis also revealed that lower (worse) scores on the Ruff, COWA, Trails B, and Color Word tests at 3 months predicted the presence of greater functional impairment (FAQ) (p<0.01) CONCLUSIONS: Executive dysfunction is highly prevalent in ICU survivors up to a year after discharge particularly in areas of fluency and set shifting. The presence of early executive dysfunction appears to be correlated with longer-term deficits in daily functioning. CLINICAL IMPLICATIONS: Future investigations should strive to better characterize executive functioning after critical illness and researchers and clinicians should seek to identify ways to improve executive dysfunction in this ICU survivors DISCLOSURES: no disclosure on file for Wes Ely; No relevant relationships by Timothy Girard, source=Web Response no disclosure on file for James Jackson; No relevant relationships by Amy Kiehl, source=Web Response no disclosure on file for Caroline Lassen Green; No relevant relationships by Deepanjali Radhakrishnan Nair, source=Web Response No relevant relationships by Rameela Raman, source=Web Response