Browsing by Subject "MoCA"

Objective: Accumulating research has shown that severe illness and ICU care seem to affect the cognitive functioning of ICU survivors in many different patient populations. So far, there seems to be little research focusing on the cognitive functioning of circulatory shock patients. The purpose of this thesis was to investigate the cognitive functioning of circulatory shock patients during the first three months after ICU care. The study aimed to compare the level of cognitive functioning of circulatory shock patients with control subjects at the time of ICU discharge and three months thereafter. Further, a temporal viewpoint was added to explore the recovery of cognitive functioning within the first three months following ICU care. Methods: This study is part of the ASSESS-SHOCK 2 project. The sample (N = 99) included 51 circulatory shock patients and 48 control subjects. The cognitive functioning of circulatory shock patients was assessed at ICU discharge and 3 months thereafter with the MoCA test. The assessment 3 months after ICU discharge also included a comprehensive domain-specific neuropsychological evaluation including 23 tests. The control subjects were assessed once with the same methods. Both the performance means, and frequency of cognitive impairment were considered in the analyses. Group differences were studied with general linear models and analysis of covariance, with age and level of education as factors and covariates. The temporal change was studied with a general linear mixed model, with age, level of education, delirium, and severity of illness as factors and covariates. Results and conclusions: This study was one of the first to focus on the post-ICU cognitive functioning of all types of circulatory shock patients. As hypothesised, circulatory shock patients had a lower level of overall cognitive functioning at ICU discharge than the control subjects. The prevalence of cognitive impairment was 77% for the patients at ICU discharge and 43% three months thereafter, compared to 33% for the control subjects. The significant cognitive differences between the two groups disappeared during the first three months after ICU discharge, as the patients’ cognitive functioning seemed to recover during that period. A closer look at the performance on different cognitive domains revealed, however, that circulatory shock patients still seemed to perform worse than the control subjects in the domains of executive functions and attention, and visuomotor and visual functions at the 3-month follow-up. Based on the results, circulatory shock patients seem to be particularly vulnerable to experiencing cognitive difficulties after ICU care. The findings of this study highlight the importance of screening for post-ICU cognitive difficulties in patients treated for circulatory shock. Identifying the cognitive difficulties already at the hospital could help to set up rehabilitation programs, ensuring that the patients would receive the support needed for the best possible recovery.