Longitudinal Cognitive Recovery After Critical Illness: Trajectories in Sepsis and Non-Sepsis Survivors

Background Post-critical illness cognitive dysfunction (PCICD) is a frequent and debilitating outcome among survivors of critical illness. Although sepsis has been associated with poor cognitive outcomes, its independent contribution remains unclear due to overlapping clinical factors. This study sought to characterize cognitive recovery trajectories over 12 months after intensive care. Methods In this single-center prospective cohort study, adult ICU survivors were assessed at 1, 3, 6 and 12 months post-discharge using telephone-administered Mini-Mental State Examination (MMSE) or Montreal Cognitive Assessment (MoCA-Blind). Total scores were standardized within instrument ( z- scores). Linear mixed-effects models evaluated change in z -scores over time. Domain-specific analyses examined whether any cognitive domain was disproportionately impaired. Logistic regression estimated odds of cognitive impairment adjusting for time, sepsis status, test type, age, Charlson index, peak SOFA, and benzodiazepine exposure; complete-case analyses were used. Results Of 185 eligible patients, 84 (45%) completed at least one cognitive assessment. Standardized scores improved from 1 to 3 months (+0.40 SD; 95% CI 0.02-0.78; p = 0.04) and 6 months (+0.54 SD; 95% CI 0.10-0.98; p = 0.02), with a similar but non-significant rise by 12 months (+0.49 SD; 95% CI −0.05 to 0.95; p = 0.10). Adjusted odds of impairment declined at 6 (OR 0.25, 95% CI 0.12-0.55) and 12 months (OR 0.34, 95% CI 0.14-0.85) versus 1 month; the 3-month reduction did not reach significance (OR 0.48, 95% CI 0.23-1.04). Sepsis was not associated with impairment (OR 1.49, 95% CI 0.63-3.56). No single cognitive domain showed a significant longitudinal slope. Conclusions ICU survivors show measurable cognitive recovery over the first year—most prominently by 3–6 months—with reduced odds of impairment by 6 and 12 months. Sepsis did not independently alter recovery. These findings support early post-ICU cognitive follow-up and rehabilitation within the first six months after discharge.