Flanker task assessment of inhibitory control in ICU survivors: Preliminary insights into cognitive impairment

Background and purpose

Cognitive assessment tools for ICU survivors often lack sensitivity to detect subtle impairments. This study examines whether combining standard screening instruments with computerized inhibitory control measures enhances post-ICU cognitive evaluation.

Methods

In this prospective cohort study conducted at a university-affiliated hospital, participants included ICU survivors aged ≥ 40 years, functionally independent prior to admission, and alert upon ICU discharge. Assessments included the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and a computerized Flanker task evaluating response accuracy and reaction time. The Stroop task was used to validate agreement with the Flanker task.

Results

Among 34 participants, median MMSE and MoCA scores were 25.5 and 24, respectively. Cognitive scores ≥ 25 were observed in 55.9 % (MMSE) and 44.1 % (MoCA). Participants in the highest MoCA tertile (>26) demonstrated preserved attention and inhibitory control. MoCA scores were more strongly associated with Flanker task accuracy than MMSE, particularly in the combined condition (adjusted β = 2.7 per MoCA point, p = 0.026; β = 27.2 for MoCA ≥ 25 vs <25, p = 0.026) versus MMSE (adjusted β = 2.8 per point, p = 0.044; β = 20.6 for MMSE ≥ 25 vs <25, p = 0.074). Bland–Altman analysis indicated strong agreement between Flanker and Stroop task accuracy in high-performing individuals.

Conclusions

Integrating the Flanker task with MoCA may offer a more nuanced assessment of post-ICU cognitive function. This combined approach enhances detection of cognitive deficits and supports early intervention strategies in ICU recovery care.