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

Abstract

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.

Keywords: Attention; Cognition; Executive function; Intensive care units; Mental status and dementia tests.