• Max L Gunther, Alessandro Morandi, Erin Krauskopf, Pratik Pandharipande, Timothy D Girard, James C Jackson, Jennifer Thompson, Ayumi K Shintani, Sunil Geevarghese, Russell R Miller, Angelo Canonico, Kristen Merkle, Christopher J Cannistraci, Baxter P Rogers, J Chris Gatenby, Stephan Heckers, John C Gore, Ramona O Hopkins, E Wesley Ely, and VISIONS Investigation, VISualizing Icu SurvivOrs Neuroradiological Sequelae.
• Department of Psychiatry, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN 37232-8300, USA
• Crit. Care Med.. 2012 Jul 1;40(7):2022-32.

ObjectiveDelirium duration is predictive of long-term cognitive impairment in intensive care unit survivors. Hypothesizing that a neuroanatomical basis may exist for the relationship between delirium and long-term cognitive impairment, we conducted this exploratory investigation of the associations between delirium duration, brain volumes, and long-term cognitive impairment.Design, Setting, And PatientsA prospective cohort of medical and surgical intensive care unit survivors with respiratory failure or shock.MeasurementsQuantitative high resolution 3-Tesla brain magnetic resonance imaging was used to calculate brain volumes at discharge and 3-month follow-up. Delirium was evaluated using the confusion assessment method for the intensive care unit; cognitive outcomes were tested at 3- and 12-month follow-up. Linear regression was used to examine associations between delirium duration and brain volumes, and between brain volumes and cognitive outcomes.ResultsA total of 47 patients completed the magnetic resonance imaging protocol. Patients with longer duration of delirium displayed greater brain atrophy as measured by a larger ventricle-to-brain ratio at hospital discharge (0.76, 95% confidence intervals [0.10, 1.41]; p = .03) and at 3-month follow-up (0.62 [0.02, 1.21], p = .05). Longer duration of delirium was associated with smaller superior frontal lobe (-2.11 cm(3) [-3.89, -0.32]; p = .03) and hippocampal volumes at discharge (-0.58 cm(3) [-0.85, -0.31], p < .001)--regions responsible for executive functioning and memory, respectively. Greater brain atrophy (higher ventricle-to-brain ratio) at 3 months was associated with worse cognitive performances at 12 months (lower Repeatable Battery for the Assessment of Neuropsychological Status score -11.17 [-21.12, -1.22], p = .04). Smaller superior frontal lobes, thalamus, and cerebellar volumes at 3 months were associated with worse executive functioning and visual attention at 12 months.ConclusionsThese preliminary data show that longer duration of delirium is associated with smaller brain volumes up to 3 months after discharge, and that smaller brain volumes are associated with long-term cognitive impairment up to 12 months. We cannot, however, rule out that smaller preexisting brain volumes explain these findings.

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