October 3, 2013
ICU Visits Leave Many Patients With Alzheimer’s-Like Symptoms
Brett Smith for redOrbit.com - Your Universe Online
When a patient gets treatment in an intensive care unit, they may come out of the ICU with an entirely different problem – cognitive impairment.
According to a new study in the New England Journal of Medicine, 74 percent of trips to the ICU for respiratory failure, cardiogenic shock or septic shock result in some kind of delirium – a sign of developing a dementia-like brain disease that could persist for up to a year after the patient is discharged.
The study's authors told CBS News that survivors of a critical illness often reported developing cognitive troubles or experiencing the further deterioration of a pre-existing mental condition.
"We knew that something was going wrong with people's brains when they were getting out of medical and surgical ICUs but we didn't understand to what degree their brains were being disabled and then having to live with that throughout their life," Dr. Wes Ely, a professor of medicine and critical care at Vanderbilt University Medical Center in Nashville. "So, we set out to define exactly what was going on with the survivors of critical care in terms of brain function."
In the study, 40 percent of the over 820 participants performed similar to patients with moderate traumatic brain injury (TBI) on cognitive tests. Twenty-six percent of ICU patients in the study scored similar to patients with Alzheimer’s disease.
The researchers emphasized that their study cohort included both elderly patients as well as younger patients in their 30s and 40s, and many experienced symptoms that persisted to 12 months, with 34 percent and 24 percent still scoring similar to TBI and Alzheimer’s patients, respectively.
"As medical care is improving, patients are surviving their critical illness more often, but if they are surviving their critical illness with disabling forms of cognitive impairment then that is something that we will have to be aware of because just surviving is no longer good enough," said study author Dr. Pratik Pandharipande, a professor of anesthesiology at Vanderbilt.
"Regardless of why you come in to an ICU, you have to know that, on the back end of your critical care, you are very likely to be suffering cognitively in ways similar to a TBI patient or an (Alzheimer’s) patient, except that most of the medical profession doesn't even know that this is happening and few around you suspect anything, leaving most to suffer in silence," Ely added.
"Delirium in critically ill, hospitalized adults is a serious yet understudied issue," said co-author Molly Wagster, a chief neuroscientist at the National Institute on Aging, part of the National Institute of Health (NIH). "These new findings provide important evidence of the extent of the problem, the imperative for greater recognition and the pressing need for solutions."
Ely suggested that at least some component of this phenomenon may be preventable by minimizing the length of delirium through careful monitoring and management methods, including a minimal use of sedatives and getting patients up and alert as soon as possible.
"Even after the patient leaves the hospital, we think that cognitive rehabilitation might be helpful to somebody like this, and we have some early preliminary data supporting this," he said.