Assessment Tools for Cognitive Impairment in Critically Ill Patients Post-ICU Transfer: A Comparative Study.

Abstract

Background: Although the survival rates of patients in the Intensive Care Unit (ICU) have improved, cognitive impairments following ICU discharge continue to be a significant concern, directly impacting long-term rehabilitation and quality of life. Consequently, the research and implementation of effective assessment tools for these cognitive impairments are particularly critical.

Aim: The aim of this study was to evaluate the comparative effectiveness of the Montreal Cognitive Assessment (MoCA) and the Telephone Interview for Cognitive Status-modified (TICS-m) for assessing cognitive impairment in critically ill individuals after leaving the ICU.

Study design: Using convenience sampling, we recruited ICU patients admitted from January 2021 to November 2022 at a hospital in China. We assessed their cognitive status using the MoCA and TICS-m scales on the day of hospital discharge, comparing the efficacy of the two scales in identifying cognitive impairment after ICU and analysing their correlation.

Results: A total of 396 patients were recruited for the study. The total scores of MoCA and TICS-m scales were 24.73 ± 4.64 and 33.20 ± 8.38, respectively, showing a correlation of r = 0.570 (p < 0.001). The incidence of cognitive impairment as assessed by the MoCA was 41.4%, compared to 44.2% for the TICS-m, with no significant difference between the two (χ² = 1.571, p = 0.152). 51.01% of ICU patients were assessed with normal cognitive function on both MoCA and TICS-m scales, whereas 36.62% were assessed with cognitive impairment on both MoCA and TICS-m scales. The Kappa consistency test results showed a value of 0.747, p < 0.001. The sensitivity of the TICS-m scale compared to the MoCA scale is 0.884, specificity is 0.871, positive predictive value is 0.829, and negative predictive value is 0.914.

Conclusions: Both the MoCA and TICS-m scales demonstrated strong consistency and reliability in assessing cognitive impairment among ICU patients. The TICS-m scale, with its telephone questionnaire format, enables effective follow-up on patients' cognitive status post-ICU.

Relevance to clinical practice: Given the efficacy of the TICS-m scale in detecting cognitive dysfunction among critically ill patients post-discharge, it is recommended that healthcare professionals incorporate its use for the ongoing assessment of cognitive function in patients following their discharge from the ICU. Future research could assess the scale's predictive value across different clinical settings.