title: The adult respiratory distress syndrome cognitive outcomes study: long-term neuropsychological function in survivors of acute lung injury.
abstract: BACKGROUND
  Cognitive and psychiatric morbidity is common and potentially modifiable after acute lung injury (ALI). However, practical measures of neuropsychological function for use in multicenter trials are lacking.
  
  
  OBJECTIVE
  To determine whether a validated telephone-based neuropsychological test battery is feasible in a multicenter trial. To determine the frequency and risk factors for long-term neuropsychological impairment.
  
  
  METHODS
  As an adjunct study to the Acute Respiratory Distress Syndrome Clinical Trials Network Fluid and Catheter Treatment Trial, we assessed neuropsychological function at 2 and 12 months post-hospital discharge.
  
  
  RESULTS
  Of 406 eligible survivors, we approached 261 to participate and 213 consented. We tested 122 subjects at least once, including 102 subjects at 12 months. Memory, verbal fluency, and executive function were impaired in 13% (12 of 92), 16% (15 of 96), and 49% (37 of 76) of long-term survivors. Long-term cognitive impairment was present in 41 of the 75 (55%) survivors who completed cognitive testing. Depression, post-traumatic stress disorder, or anxiety was present in 36% (37 of 102), 39% (40 of 102), and 62% (63 of 102) of long-term survivors. Enrollment in a conservative fluid-management strategy (P = 0.005) was associated with cognitive impairment and lower partial pressure of arterial oxygen during the trial was associated with cognitive (P = 0.02) and psychiatric impairment (P = 0.02).
  
  
  CONCLUSIONS
  Neuropsychological function can be assessed by telephone in a multicenter trial. Long-term neuropsychological impairment is common in survivors of ALI. Hypoxemia is a risk factor for long-term neuropsychological impairment. Fluid management strategy is a potential risk factor for long-term cognitive impairment; however, given the select population studied and an unclear mechanism, this finding requires confirmation.
authors.affiliation: Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, 836 W. Gates Pavilion, 3400 Spruce Street, Philadelphia, PA 19104, USA. mark.mikkelsen@uphs.upenn.edu
authors.forename: Mark E
authors.initials: ME
authors.lastname: Mikkelsen
authors.forename: Jason D
authors.initials: JD
authors.lastname: Christie
authors.forename: Paul N
authors.initials: PN
authors.lastname: Lanken
authors.forename: Rosette C
authors.initials: RC
authors.lastname: Biester
authors.forename: B Taylor
authors.initials: BT
authors.lastname: Thompson
authors.forename: Scarlett L
authors.initials: SL
authors.lastname: Bellamy
authors.forename: A Russell
authors.initials: AR
authors.lastname: Localio
authors.forename: Ejigayehu
authors.initials: E
authors.lastname: Demissie
authors.forename: Ramona O
authors.initials: RO
authors.lastname: Hopkins
authors.forename: Derek C
authors.initials: DC
authors.lastname: Angus
mesh_terms: D055371:Acute Lung Injury / Q000150:complications* / Q000401:mortality / Q000523:psychology / Q000628:therapy; D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D016638:Critical Illness; D003863:Depression / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000150:complications* / Q000401:mortality / Q000523:psychology / Q000628:therapy; D018570:Risk Assessment; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D017741:Survivors; D013997:Time Factors