Detection and Management of Preexisting Cognitive Impairment in the Critical Care Unit

Mark A Oldham; Walter Piddoubny; Ryan Peterson; Hochang B Lee

doi:10.1016/j.ccc.2017.03.001

Detection and Management of Preexisting Cognitive Impairment in the Critical Care Unit

Crit Care Clin. 2017 Jul;33(3):441-459. doi: 10.1016/j.ccc.2017.03.001. Epub 2017 Apr 20.

Authors

Mark A Oldham¹, Walter Piddoubny², Ryan Peterson², Hochang B Lee²

Affiliations

¹ Department of Psychiatry, Yale School of Medicine, 20 York Street, Fitkin 615, New Haven, CT 06510, USA. Electronic address: mark.oldham@yale.edu.
² Department of Psychiatry, Yale School of Medicine, 20 York Street, Fitkin 615, New Haven, CT 06510, USA.

PMID: 28601131
DOI: 10.1016/j.ccc.2017.03.001

Abstract

Older adults account for half of intensive care unit (ICU) admissions and ICU days, and approximately 2 in 5 older adults in the ICU have preexisting cognitive impairment (PCI). PCI identification is important for risk stratification and may influence ICU utilization and decision-making surrogacy. PCI is overlooked in more than half of patients without screening; however, screening instruments can identify PCI in less than 5 minutes. Management of PCI in the ICU involves addressing associated neuropsychiatric symptoms. Nonpharmacological interventions should be considered the mainstay of treatment; psychotropics may be considered, although available data on their efficacy is limited.

Keywords: Behavioral and psychological symptoms in dementia; Cognitive impairment; Delirium; Dementia; Neuropsychiatric symptoms.

Publication types

Review

MeSH terms

Aged
Cognitive Dysfunction / diagnosis*
Cognitive Dysfunction / therapy*
Critical Care*
Decision Making
Humans
Intensive Care Units