title: In-hospital acute stress symptoms are associated with impairment in cognition 1 year after intensive care unit admission.
abstract: BACKGROUND
  Prior studies have found that cognitive dysfunction is common in intensive care unit (ICU) survivors. Yet, relatively little is known about potentially modifiable risk factors for longer-term post-ICU cognitive impairment.
  
  
  OBJECTIVE
  To determine if in-hospital acute stress symptoms were associated with impaired 12-month cognitive functioning among ICU survivors.
  
  
  METHODS
  We prospectively enrolled 150 nontrauma patients without cognitive impairment or a dementia diagnosis who were admitted to an ICU for more than 24 hours. Patients were interviewed before hospital discharge and again via telephone at 12 months post-ICU.
  
  
  RESULTS
  Demographics and clinical information were obtained through medical record reviews and in-person interviews. In-hospital acute stress symptoms were assessed with the Posttraumatic Stress Disorder Checklist-Civilian Version. Twelve-month post-ICU cognition was assessed with the modified Telephone Interview for Cognitive Status. Follow-up interviews were completed with 120 (80%) patients. Patients' mean age at hospitalization was 48.2 years (SD, 13.7). In unadjusted analyses, a greater number of in-hospital acute stress symptoms was associated with significantly greater impairment in 12-month cognitive functioning (β, -0.1; 95% confidence interval, -0.2 to -0.004; P = 0.04). After adjusting for patient and clinical factors, in-hospital acute stress symptoms were independently associated with greater impairment in 12-month cognitive functioning (β, -0.1; 95% CI, -0.2 to -0.01; P = 0.03).
  
  
  CONCLUSIONS
  In-hospital acute stress symptoms may be a potentially modifiable risk factor for greater impairment in cognitive functioning post-ICU. Early interventions for at-risk ICU survivors may improve longer-term outcomes.
authors.affiliation: 1 Department of Psychiatry and Behavioral Sciences, and.
authors.forename: Dimitry S
authors.initials: DS
authors.lastname: Davydow
authors.forename: Douglas
authors.initials: D
authors.lastname: Zatzick
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Hough
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Katon
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000453:epidemiology*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000523:psychology / Q000706:statistics & numerical data*; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D040701:Stress Disorders, Traumatic, Acute / Q000453:epidemiology; D013315:Stress, Psychological / Q000453:epidemiology*; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data*