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Delirium, depression, and long-term cognition
- Patricia S. Andrews, Jennifer Thompson, Rameela Raman, Chelsea Rick, Amy Kiehl, Pratik Pandharipande, James C. Jackson, Warren D. Taylor, E. W. Ely, Jo E. Wilson
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- Journal:
- International Psychogeriatrics / Volume 35 / Issue 8 / August 2023
- Published online by Cambridge University Press:
- 12 November 2021, pp. 433-438
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- Article
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Objectives:
We examined whether preadmission history of depression is associated with less delirium/coma-free (DCF) days, worse 1-year depression severity and cognitive impairment.
Design and measurements:A health proxy reported history of depression. Separate models examined the effect of preadmission history of depression on: (a) intensive care unit (ICU) course, measured as DCF days; (b) depression symptom severity at 3 and 12 months, measured by the Beck Depression Inventory-II (BDI-II); and (c) cognitive performance at 3 and 12 months, measured by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) global score.
Setting and participants:Patients admitted to the medical/surgical ICU services were eligible.
Results:Of 821 subjects eligible at enrollment, 261 (33%) had preadmission history of depression. After adjusting for covariates, preadmission history of depression was not associated with less DCF days (OR 0.78, 95% CI, 0.59–1.03 p = 0.077). A prior history of depression was associated with higher BDI-II scores at 3 and 12 months (3 months OR 2.15, 95% CI, 1.42–3.24 p = <0.001; 12 months OR 1.89, 95% CI, 1.24–2.87 p = 0.003). We did not observe an association between preadmission history of depression and cognitive performance at either 3 or 12 months (3 months beta coefficient −0.04, 95% CI, −2.70–2.62 p = 0.97; 12 months 1.5, 95% CI, −1.26–4.26 p = 0.28).
Conclusion:Patients with a depression history prior to ICU stay exhibit a greater severity of depressive symptoms in the year after hospitalization.
4417 Association between Brain Volumes and Posttraumatic Stress Disorder in Intensive Care Unit Survivors
- Jo Ellen Wilson, Kristina Stepanovic, Baxter Rogers, Amy Kiehl, E. “Wes” Ely, James Jackson
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- Journal:
- Journal of Clinical and Translational Science / Volume 4 / Issue s1 / June 2020
- Published online by Cambridge University Press:
- 29 July 2020, p. 22
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- Article
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- Open access
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OBJECTIVES/GOALS: To explore the severity of posttraumatic stress disorder (PTSD) symptoms in association with hippocampal and amygdala volumes in ICU survivors. We hypothesize that the severity of posttraumatic stress symptoms in ICU survivors is associated with lower volumes of both the hippocampus and amygdala. METHODS/STUDY POPULATION: Secondary analysis of the VISIONS study, a prospective sub-study of the BRAIN-ICU cohort, which included survivors of critical illness. Patients were screened for preexisting PTSD before discharge. The PTSD Checklist Specific (PCL-S) was used at 3 and 12 months to evaluate the ICU as a traumatic experience. A score of >30, indicated significant symptoms of PTSD. A Philips Achieva 3T MRI scanner was used to scan patients at both discharge and 3-month follow-up. To compare median brain volumes at discharge and 3 months for those with and without significant PTSD symptomatology (PCL-S ≥30) at 3 and 12 months, we used a Kruskal-Wallis (KW) equality-of-populations rank test. RESULTS/ANTICIPATED RESULTS: The median age for our sample was 58.5 (52.6, 63.7). One-third of the sample was female, and 90% were Caucasian. Fifty-seven percent of individuals (N = 12) had at least one prior mental health diagnosis, with two having a prior history of PTSD. One third of individuals experienced delirium during their critical illness. At 3-month follow up, there were three patients with PTSD symptomatology and one at 12-month follow up. Median brain volumes (hippocampus or amygdala) did not differ between individuals with or without PTSD symptomatology at either 3 or 12 months (p-values for all tests >0.05). DISCUSSION/SIGNIFICANCE OF IMPACT: Although our study did not reveal significant differences in brain volumes between PTSD patients and non-PTSD patients, sample size is a major limitation and larger scale studies should be undertaken to elucidate possible neurobiological markers of PTSD in ICU survivors. CONFLICT OF INTEREST DESCRIPTION: Dr. Wilson would like to acknowledge salary support from the Vanderbilt Faculty Research Scholars Program (1KL2TR002245), HL111111 and GM120484. Drs. Ely and Jackson as well as Mrs. Kiehl all receive funding for their time working on this investigation from AG035117 and HL111111. Dr. Ely would additionally like to acknowledge salary support from the Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center (GRECC). Dr. Ely will also disclose additional funding for his time from AG027472 and having received honoraria from Orion and Hospira for CME activity; he does not hold stock or consultant relationships with those companies. The authors would like to acknowledge the following: this work was conducted in part using the resources of the Center for Computational Imaging at Vanderbilt University Institute of Imaging Science and the Advanced Computing Center for Research and Education at Vanderbilt University, Nashville, TN, and study data were collected and managed using REDCap electronic data capture tools hosted at Vanderbilt University.
List of contributors
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- By Alessandro Aiuppa, Nick T. Arndt, Jean Besse, Benjamin A. Black, Terrence J. Blackburn, Nicole Bobrowski, Samuel A. Bowring, Seth D. Burgess, Kevin Burke, Ying Cui, Vincent Courtillot, Amy Donovan, Linda T. Elkins-Tanton, Anna Fetisova, Frédéric Fluteau, Kirsten E. Fristad, Lori S. Glaze, Thor H. Hansteen, Morgan T. Jones, Jeffrey T. Kiehl, Nadezhda A. Krivolutskaya, Kirstin Krüger, Lee R. Kump, Steffen Kutterolf, Dimitry V. Kuzmin, Jean-François Lamarque, A. Latyshev, Kimberly V. Lau, Tamsin A. Mather, Katja M. Meyer, Clive Oppenheimer, Vladimir Pavlov, Jonathan L. Payne, Ingrid Ukstins Peate, David Pieri, Sverre Planke, Ulrich Platt, Alexander Polozov, Fred Prata, Gemma Prata, David M. Pyle, Andy Ridgwell, Alan Robock, Ellen K. Schaal, Anja Schmidt, Stephen Self, Christine Shields, Juan Carlos Silva-Tamayo, Alexander V. Sobolev, Stephan V. Sobolev, Henrik Svensen, Trond H. Torsvik, Roman Veselovskiy
- Edited by Anja Schmidt, University of Cambridge, Kirsten Fristad, Western Washington University, Linda Elkins-Tanton, Arizona State University
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- Book:
- Volcanism and Global Environmental Change
- Published online:
- 05 February 2015
- Print publication:
- 08 January 2015, pp viii-xii
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