The number of patients surviving a critical illness is increasing, with an estimated 1.4 million persons over the age of 65 now surviving the ICU annually. Unfortunately, two out of three ICU survivors suffer from long-term cognitive impairment (LTCI) at 1 year after their critical illness. This cognitive impairment persists in man for at least three years following critical illness, preventing these survivors from returning to wrk and diminishing their quality of life. LTCI likely results from the interplay of host baseline facors plus acute problems associated with the patient's illness and ICU management, yet how combinations of risk factors predict development of LTCI is not well understood. Delirium, a potentially modifiable risk factor, is associated with LTCI, but whether milder forms of acute brain dysfunction (e.g., subsyndromal delirium) contribute to the development of LTCI has not been considered to date. Initial attempts at cognitive rehabilitation for suffering ICU survivors b the investigator and his team appear feasible and promising, however, neither clinicians nor researchers currently have the ability to determine who will develop this disabling problem of LTCI. Thus, a key barrier to further study of cognitive interventions for the growing population of critically ill elderly is the inability to identify patients, early in their ICU course, who are atrisk of developing LTCI. Therefore, the proposed research will derive and validate a clinical prediction tool that will accurately identify critically ill patients, early in the course of their illness, a risk of developing LTCI that persists at 1-year follow-up.
The Specific Aims of this proposal are (1) To derive a clinical prediction tool for early identification of ICU patients at risk of developing log-term cognitive impairment, (2) To determine the relative value of delirium severity categorizations within the clinical prediction tool (from Specific Aim 1), and (3) To externally validate the clinical prediction tools (from Specific Aims 1 and 2) for identification of ICU patiets at risk of developing long-term cognitive impairment. This proposal integrates the two largest cohorts (including an NIA sponsored cohort) of ICU survivors with cognitive outcomes testing available to date with state of the art statistical methods for the development of clinical prediction tools to advance the science and understanding of the emerging public health problem of "dementia-like" LTCI for all ICU survivors and will especially benefit the rapidly growing population of elderly ICU patients. In addition to providing clinicians and patient familie with a novel lens through to view a patients'long-term cognitive prognosis, this award will allow the investigator to establish a track record of individual aging research and pave the way to a mentored career development award by allowing identification of the target population for the investigator's next phase of this unique and ground breaking research, cognitive rehabilitation of ICU survivors with LTCI.

Public Health Relevance

An estimated 1.4 million people over the age of 65 survive a critical illness annually and 50-75% of these survivors are left with cognitive impairment following their illness. Despite these staggering statistics, clinicians and researchers do not hav the tools to predict which patients will develop this life-altering syndrome. The proposed research will derive and validate clinical prediction tools that will accurately identify criticall ill patients, early in the course of their illness, at risk of developing long-term cognitive impairmen that persists at 1-year follow-up.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Small Research Grants (R03)
Project #
1R03AG045095-01
Application #
8556788
Study Section
Special Emphasis Panel (ZAG1-ZIJ-9 (M1))
Program Officer
Wagster, Molly V
Project Start
2013-09-01
Project End
2015-07-31
Budget Start
2013-09-01
Budget End
2014-07-31
Support Year
1
Fiscal Year
2013
Total Cost
$78,041
Indirect Cost
$28,041
Name
Vanderbilt University Medical Center
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
004413456
City
Nashville
State
TN
Country
United States
Zip Code
37212
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Brummel, Nathan E; Balas, Michele C; Morandi, Alessandro et al. (2015) Understanding and reducing disability in older adults following critical illness. Crit Care Med 43:1265-75
Robinson, Thomas N; Walston, Jeremy D; Brummel, Nathan E et al. (2015) Frailty for Surgeons: Review of a National Institute on Aging Conference on Frailty for Specialists. J Am Coll Surg 221:1083-92
Brummel, N E; Girard, T D; Ely, E W et al. (2014) Feasibility and safety of early combined cognitive and physical therapy for critically ill medical and surgical patients: the Activity and Cognitive Therapy in ICU (ACT-ICU) trial. Intensive Care Med 40:370-9
Jackson, James C; Pandharipande, Pratik P; Girard, Timothy D et al. (2014) Depression, post-traumatic stress disorder, and functional disability in survivors of critical illness in the BRAIN-ICU study: a longitudinal cohort study. Lancet Respir Med 2:369-79
Brummel, Nathan E; Ely, E Wesley (2014) Sedation level and the prevalence of delirium. Intensive Care Med 40:135