Research paper|Articles in Press

Verifying the Japanese version of the Healthy Aging Brain Care Monitor self-report tool for evaluating post–intensive care syndrome

Published:March 16, 2023DOI:



      Post–intensive care syndrome (PICS) requires the use of multiple assessment tools because it affects multiple domains: Cognitive, Functional, and Behavioural/Psychological. Therefore, this study translated the self-report (SR) version of the Healthy Aging Brain Care Monitor (HABC-M), spanning multiple domains, into Japanese and analysed its reliability and validity in a post–intensive care setting.


      Patients aged 20 years or older and admitted to the adult intensive care unit from August 2019 to January 2021 were included and surveyed by questionnaire. The 21-item Dementia Assessment Sheet for the Regional Comprehensive Care System was used to validate cognitive and physical aspects, and the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, and the Post Traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders 5th edition were used to validate emotional aspects. Reliability was assessed by Cronbach's alpha, and congruent validity by correlation analysis. Multivariate linear regression models were used to identify potential factors for PICS.


      A total of 104 patients (mean age: 64 ± 14 years) with 3 median mechanical ventilation days (interquartile range: 2–5) were enrolled. The Cognitive domain of the HABC-M SR was highly correlated with memory and disorientation (r = 0.77 for each), while the Functional domain was highly correlated with Instrumental Activities of Daily Living Scale (r = 0.75–0.79). The Behavioural/Psychological domain highly correlated with the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Post Traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders 5th edition (r = 0.75–0.76). Multivariate analysis revealed longer ICU stays associated with lower Cognitive and Functional (p = 0.03 for each) domains and longer mechanical ventilation days with a lower Behavioural/Psychological domain (p < 0.01).


      The translated Japanese HABC-M SR showed high validity for assessment of the Cognitive, Functional, and Behavioural/Psychological domains of PICS. Therefore, we recommend that the Japanese version of the HABC-M SR be routinely used in the assessment of PICS.


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        • Herridge M.S.
        • Tansey C.M.
        • Matté G.
        • Diaz-Granados N.
        • Cooper A.
        • et al.
        Functional disability 5 years after acute respiratory distress syndrome.
        N Engl J Med. 2011; 364: 1293-1304
        • Elliott D.
        • Davidson J.E.
        • Harvey D.A
        • Hopkins R.O.
        • Iwashyna T.J.
        • et al.
        Exploring the scope of post-intensive care syndrome therapy and care: engagement of non-critical care providers and survivors in a second stakeholders meeting.
        Crit Care Med. 2014; 42: 2518-2526
        • Needham D.M.
        • Davidson J.
        • Cohen H.
        • Hopkins R.O.
        • Weinert C.
        Wunsch H,et al. Improving long-term outcomes after discharge from intensive care unit.
        Crit Care Med. 2012; 40: 502-509
        • Kawakami D.
        • Fujitani S.
        • Morimoto T.
        • Dote H.
        • Takita M.
        • Takaba A.
        • et al.
        Prevalence of post-intensive care syndrome among Japanese intensive care unit patients: a prospective, multicenter, observational J-PICS study.
        Crit Care. 2021; 25: 1-12
        • Pandharipande P.P.
        • Girard T.D.
        • Jackson J.C.
        • Thompson J.L.
        • Pun B.T.
        • et al.
        Long-term cognitive impairment after critical illness.
        N Engl J Med. 2013; 369: 1306-1316
        • Sivanathan L.
        • Wunsch H.
        • Vigod S.
        • Hill A.
        • Pinto R.
        • Scales D.C.
        Mental illness after admission to an intensive care unit.
        Intensive Care Med. 2019; 45: 1550-1558
        • Brummel N.E.
        • Girard T.D.
        • Pandharipande P.P.
        • Thompson J.L.
        • Jarrett R.T.
        • Raman R.
        • et al.
        Prevalence and course of frailty in survivors of critical illness.
        Crit Care Med. 2020; 48: 1419-1426
        • Hung M.C.
        • Yan Y.H.
        • Fan P.S.
        • Lin M.S.
        • Chen C.R.
        • Kuo L.C.
        • et al.
        Estimation of quality-adjusted life expectancy in patients under prolonged mechanical ventilation.
        Value Health. 2011; 14: 347-353
        • Monahan P.O.
        • Alder C.A.
        • Khan B.A.
        • Stump T.
        • Boustani M.A.
        The healthy aging brain care (HABC) monitor: validation of the patient self-report version of the clinical tool designed to measure and monitor cognitive, functional, and psychological health.
        Clin Interv Aging. 2014; 9: 2123-2132
        • Fage B.A.
        • Chan C.C.H.
        • Gill S.S.
        • Noel S.A.H.
        • Herrmann N.
        • Smailagic N.
        • et al.
        Mini-Cog for the detection of dementia within a community setting.
        Cochrane Database Syst Rev. 2021; : 2021
        • Koroukian S.M.
        • Schiltz N.
        • Warner D.F.
        • Sun J
        • Bakaki P.M.
        • Smyth K.A.
        • et al.
        Combinations of chronic conditions, functional limitations, and geriatric syndromes that predict health outcomes.
        J Gen Intern Med. 2016; 31: 630-637
        • Bartels S.J.
        • Naslund J.A.
        The underside of the silver tsunami — older adults and mental health care.
        N Engl J Med. 2013; 368: 493-496
        • Boustani M.
        • Callahan C.M.
        • Unverzagt F.W.
        • Austrom M.G.
        • Perkins A.J.
        • Fultz B.A.
        • et al.
        Implementing a screening and diagnosis program for dementia in primary care.
        J Gen Intern Med. 2005; 20: 572-577
        • Wang S.
        • Allen D.
        • Perkins A.
        • Monahan P
        • Khan S.
        • Lasiter S.
        • et al.
        Validation of a new clinical tool for post–intensive care syndrome.
        Am J Crit Care. 2019; 28: 10-18
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chron Dis. 1987; 40: 373-383
        • Quan H.
        • Sundararajan V.
        • Halfon P.
        • Fong A.
        Coding algorithms for defining comorbidities in.
        Med Care. 2005; 43
        • Kimura T.
        • Sugitani T.
        • Nishimura T.
        • Ito M.
        Validation and recalibration of Charlson and Elixhauser comorbidity indices to predict in-hospital mortality in hospitalized patients in a Japanese hospital-based administrative database.
        Jpn J Pharmacoepidemiol Yakuzai ekigaku. 2020; 25: 1-14
        • Knaus W.A.
        • Draper E.A.
        • Wagner D.P.
        • Zimmerman J.E.
        APACHE II: a severity of disease classification system.
        Crit Care Med. 1985; 13: 818-829
        • Sakuma N.
        • Inagaki H.
        • Ogawa M.
        • Edahiro A.
        • Ura C.
        • Sugiyama M.
        • et al.
        Cognitive function, daily function and physical and mental health in older adults: a comparison of venue and home-visit community surveys in Metropolitan Tokyo.
        Arch Gerontol Geriatr. 2022; 100 (December 2021): 104617
        • Ueba Y.
        • Murakami T.
        • Yamamoto T.
        • Kuroe A
        • Yamasaki M
        • Kaneda D.
        • et al.
        Voxel-based specific regional analysis system for Alzheimer’s disease utility as a screening tool for unrecognized cognitive dysfunction of elderly patients in diabetes outpatient clinics: multicenter retrospective exploratory study.
        J Diabetes Investig. 2022; 13: 177-184
        • Shoji T.
        • Nakatani S.
        • Kabata D.
        • Mori K
        • Shintani A
        • Yoshida H.
        • et al.
        Comparative effects of etelcalcetide and maxacalcitol on serum calcification propensity in secondary hyperparathyroidism a randomized clinical trial.
        Clin J Am Soc Nephrol. 2021; 16: 599-612
        • Awata S.
        • Sugiyama M.
        • Ito K.
        • Ura C
        • Miyamae F
        • Sakuma N.
        • et al.
        Development of the dementia assessment sheet for community-based integrated care system.
        Geriatr Gerontol Int. 2016; 16: 123-131
        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.W.
        The PHQ-9.
        J Gen Intern Med. 2001; 16: 606-613
        • Spitzer R.L.
        • Kroenke K.
        • Williams J.B.W.
        • Löwe B.
        A brief measure for assessing generalized anxiety disorder: the GAD-7.
        Arch Intern Med. 2006; 166: 1092-1097
        • Umberger R.
        What is the best core measure after critical illness when the IES-R is no longer accessible for new researchers?.
        Crit Care. 2019; 23: 313
        • Muramatsu K.
        • Miyaoka H.
        • Kamijima K.
        • Muramatsu Y
        • Tanaka Y
        • Hosaka M.
        • et al.
        Performance of the Japanese version of the Patient Health Questionnaire-9 (J-PHQ-9) for depression in primary care.
        Gen Hosp Psychiatry. 2018; 52: 64-69
        • Doi S.
        • Ito M.
        • Takebayashi Y.
        • Muramatsu K.
        • Horikoshi M.
        Factorial validity and invariance of the 7-Item Generalized Anxiety Disorder Scale (GAD-7) among populations with and without self-reported psychiatric diagnostic status.
        Front Psychol. 2018; 9: 1-6
        • Ito M.
        • Takebayashi Y.
        • Suzuki Y.
        • Horikoshi M.
        Posttraumatic stress disorder checklist for DSM-5: psychometric properties in a Japanese population.
        J Affect Disord. 2019; 247: 11-19
        • Guilford J.P.
        Fundamental statistics in psychology and education.
        McGraw-Hill, New York1956
        • Faul F.
        • Erdfelder E.
        • Lang A.G.G.
        • Buchner A.
        G ∗ Power 3: a flexible statistical power analysis program for the social, behavioral , and biomedical sciences.
        Behav Res Methods. 2007; 39: 175-191
        • Brislin R.W.
        Back-translation for cross-cultural research.
        J Cross Cult Psychol. 1970; 1: 185-216
        • Lawton M.P.
        • Brody E.M.
        Assessment of older people: self-maintaining and instrumental activities of daily living.
        Gerontologist. 1969; 9: 179-186
        • Bossers W.J.R.
        • van der Woude L.H.V.
        • Boersma F.
        • Scherder E.J.A.
        • van Heuvelen M.J.G.
        Recommended measures for the assessment of cognitive and physical performance in older patients with dementia: a systematic review.
        Dement Geriatr Cogn Disord Extra. 2012; 2: 589-609
        • Milton A.
        • Brück E.
        • Schandl A.
        • Bottai M.
        • Sackey P.
        Early psychological screening of intensive care unit survivors: a prospective cohort study.
        Crit Care. 2017; 21: 1-7
        • Hatch R.
        • Young D.
        • Barber V.
        • Griffiths J.
        • Harrison D.A.
        • Watkinson P.
        Anxiety, depression and post traumatic stress disorder after critical illness: a UK-wide prospective cohort study.
        Crit Care. 2018; 22: 1-13
        • Hatch R.
        • Young D.
        • Barber V.S.
        • Griffiths J.
        • Harrison D.A.
        • Watkinson P.J.
        Anxiety, depression and post-traumatic stress disorder management after critical illness: a UK multi-centre prospective cohort study.
        Crit Care. 2020; 24: 1-8
        • Ullman A.J.
        • Aitken L.M.
        • Rattray J.
        • Kenardy J
        • Le B.R.
        • MacGillivray S.
        • et al.
        Diaries for recovery from critical illness.
        Cochrane Database Syst Rev. 2014; 2019: 44-45
        • Riegel B.
        • Huang L.
        • Mikkelsen M.E.
        • Kutney L.A.
        • Hanlon A.L.
        • Murtaugh C.M.
        • et al.
        Early post-intensive care syndrome among older adult sepsis survivors receiving home care.
        J Am Geriatr Soc. 2019; 67: 520-526
        • Cuthbertson B.H.
        • Hull A.
        • Strachan M.
        • Scott J.
        Post-traumatic stress disorder after critical illness requiring general intensive care.
        Intensive Care Med. 2004; 30: 450-455
        • Jubran A.
        • Lawm G.
        • Duffner L.A.
        • Collins E.G.
        • Lanuza D.M.
        • Hoffman L.A.
        • et al.
        Post-traumatic stress disorder after weaning from prolonged mechanical ventilation.
        Intensive Care Med. 2010; 36: 2030-2037
        • Kress J.P.
        • Gehlbach B.
        • Lacy M.
        • Pliskin N.
        • Pohlman A.S.
        • Hall J.B.
        The long-term psychological effects of daily sedative interruption on critically III patients.
        Am J Respir Crit Care Med. 2003; 168: 1457-1461
        • Jackson J.C.
        • Girard T.D.
        • Gordon S.M.
        • Thompson J.L.
        • Shintani A.K.
        • Thomason J.W.W.
        • et al.
        Long-term cognitive and psychological outcomes in the awakening and breathing controlled trial.
        Am J Respir Crit Care Med. 2010; 182: 183-191
        • Strøm T.
        • Stylsvig M.
        • Toft P.
        Long-term psychological effects of a no-sedation protocol in critically ill patients.
        Crit Care. 2011; 15: R293
        • Treggiari M.M.
        • Romand J.A.
        • Yanez N.D.
        • Deem S.A.
        • Goldberg J.
        • Hudson L.
        • et al.
        Randomized trial of light versus deep sedation on mental health after critical illness.
        Crit Care Med. 2009; 37: 2527-2534
        • Towfighi A.
        • Ovbiagele B.
        • El Husseini N.
        • El Husseini N
        • Hackett M.L.
        • Jorge R.E.
        • et al.
        Poststroke depression: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association.
        Stroke. 2017; 48: e30-e43
        • Hinkle J.L.
        • Becker K.J.
        • Kim J.S.
        • Choi K.S
        • Saban K.L.
        • McNair N.
        • et al.
        Poststroke fatigue: emerging evidence and approaches to management: a scientific statement for healthcare professionals from the American Heart Association.
        Stroke. 2017; 48: e159-e170