Evaluation of anticholinergic cognitive burden in patients with post-intensive care syndrome

ABSTRACT

INTRODUCTION: Post-Intensive care syndrome (PICS) is the culmination of cognitive, psychological and physical issues critical illness survivors encounter. More than half of critically ill patients may experience cognitive impairment after hospital discharge. There is limited information on cognitive impairment surrounding PICS in COVID-19 survivors. This study aims to evaluate the impact anticholinergic cognitive burden has on cognitive function in the COVID-19 survivor patient population. METHODS: This retrospective, observational cohort study included patients from the post-intensive care survivor clinic at Indiana University Health that were discharged from April 2020 to March 2021. Patients were excluded if they did not have an admitting diagnosis of respiratory failure secondary to COVID-19 or did not have discharge documentation. Cognitive impairment was evaluated using the Montreal Cognitive Assessment (MoCA). Demographics and anticholinergic cognitive burden (ACB) scores were compared between patients with cognitive impairment (MoCA < 26) versus those without cognitive impairment (MoCA > 26). RESULTS: Twenty-six patients were included in this evaluation. Twelve patients had cognitive impairment and fourteen patients did not have cognitive impairment. ACB score at discharge for those with and without cognitive impairment had a median (IQR) score of 2.5 (0.75-4.25) and 1 (0.25-2), respectively (p=0.208). The patients with cognitive impairment had a median (IQR) ACB score at the start and end of the initial appointment of 1.5 (0.75-2.5) and 1.5 (0.75-2.25), respectively. The median (IQR) ACB score at the start and end of the initial appointment for patients without cognitive impairment was 1 (0-1.75). Delirium was reported 7 patients (58%) with cognitive impairment compared to 5 patients (36%) without cognitive impairment (p=0.431). The Charlston comorbidity score was higher in those with cognitive impairment, with a median (IQR) score of 3.5 (2.75-5) compared to 0 (0-2) for those without cognitive impairment (p=0.002). CONCLUSIONS: The difference in ACB scores at discharge was not statistically different between patients with and without cognitive impairment. Patients with cognitive impairment post ICU discharge tended to have a higher Charlston comorbidity score.