Intensive Care: Enter With Your Wits, Leave With Dementia


Clinician in intensive care unit: image via commons.wikimedia.orgClinician in intensive care unit: image via commons.wikimedia.orgYou may have noticed that when a relative or friend is hopitalized for a heart attack, respiratory failure, serious infection, or any serious illness that impacts the body's vital organs, they may return home somewhat mentally diminished. They may seem foggy or confused, they don't remember familiar people, or they have difficulty making simple decisions. Your relative or friend is not alone. 

According to a study, Long Term Cognitive Impairment After Critical Illness, conducted by Vanderbilt University's ICU Delirium and Cognitive Impairment Group, and published in the New England Journal of Medicine, 74 percent of 821 adults who were treated for respiratory failure, cardiogenic shock, or septic shock developed delirium while in the hospital. Delirium, common among patients who have critical illnesses is associated with higher mortality.  But if the patient survives, delirium is associated with long term cognitive dysfunction.

Of the original 821 patients admitted to the Vanderbilt study, 6 percent were diagnosed with impaired cognition prior to hospital treatment and that group is not included in the 74 percent who were followed by the reseachers for a period of a year after their ICU releases.  At three months after release, 40 percent of the group had global cognition scores similar to patients with moderate traumatic brain injury (TBI) and 26 percent had scores similar to those with moderate Alzheimer's disease.

After 12 months, the scores were still similar, with 36 percent having scores consistent with TBI and 24 percent with scores consistent with Alzheimer's disease. The outcomes were similar with young and older adult patients.

The astounding thing about these numbers is that most medical staff members don't even know when a patient is experiencing delirium and don't understand its serious implications for the patient.

Wes Ely, M.D., senior author of the study and professor of medicine at Vanderbilt, believes that at least some things can be done to shorten the duration of the delirium, including earlier weaning from sedatives and more mobility earlier in therapy.  He also recommends early cognitive therapy for delirium patients, which, he says, is supported by preliminary data.

source:  Vanderbilt University Reporter