(From the application): Global deficits in cognition in the form of delirium, stupor, or coma are extremely common and hazardous in older ICU patients. Cognitive impairment is associated with prolonged hospital stays, institutionalization, and death. Because acute cognitive impairment compromises patients' ability to be removed from mechanical ventilation and may be a factor associated with long-term neuropsychological sequelae, physicians and nurses need to be able to identify patients at high risk for cognitive impairment and understand potentially modifiable aspects of care that may reduce cognitive impairment. Consciousness is defined as having two components: arousal (wakefulness) and content (attentiveness). Arousal, a basic process of mental function, is commonly monitored in ICU patients. Attentiveness, which results from more complex neurologic interactions, is often impaired yet rarely objectively monitored. There are no validated instruments available for bedside use by nurses or physicians to monitor both components of consciousness in mechanically ventilated patients. We propose to modify existing instruments for use in the ICU in order to develop and validate a system for monitoring the brain and its function in mechanically ventilated patients during and after ICU care (Aim 1). Once validated, we can determine the prevalence of acute cognitive impairments in elderly ICU patients and its association with clinical outcomes (Aim 2). This cohort of patients will be used to determine factors associated with neuro-psychological deficits at 6 months following the ICU stay (Aim 3). This builds on the candidate's previous work in the ICU and gerontology and extends into an important new area, which is cognitive impairment in critically ill older persons. The long-term goal is to improve health outcomes for elderly ICU patients through future studies which will seek to reduce the incidence of cognitive impairment, to enhance liberation from mechanical ventilation, to integrate these observations into routine ICU monitoring, and to improve the understanding and prevention of post-ICU neuropsychological deficits. To prepare for this goal, his proposed career development plan includes advanced training in geriatric cognitive assessment, epidemiology and biostatistics, psychometrics and research methodology through clinical training, course work, and independent reading. Along with the candidate's record of publications and achievement, he will have rich academic surroundings, excellent mentors and strong institutional commitment to ensure that he achieve these goals.
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