Long-Term Cognitive Impairment Too Common After Critical Illness

They come in to intensive care very sick — being treated for a critical illness – and doctors now know many leave with long-term cognitive impairment. They came in with a problem that was a neck down issue. They left with this new problem which is a neck up issue. In a newly released Brain ICU study published in the New England Journal of Medicine, Vanderbilt researchers determined that 74 percent of patients studied developed delirium — a predictor of developing a dementia-like brain disease. Hold up this many fingers. Very good. Even more startingly, the study of more than 800 ICU patients found that 40 percent of the patients had symptoms similar to moderate traumatic brain injury. Twenty-six percent had symptoms similar to Alzheimer’s, even several months after their hospital stay. Most strikingly, we found that even if you were a young person, 30 and 40 years old, and even if you had no preexisting illnesses, if you came into a medical or surgical ICU those young people and the older people aren’t able to think clearly, their memory is impaired, they are not able to organize the way that they are thinking, this is a real significant problem in their life and their ability in day-to-day living. Researchers say at least some of this brain injury may be prevented. Squeeze my hands. We think we should less sedation have them more awake and alert and earlier to walk in the ICU even on the ventilator. And doctors say doing brain exercises once released from the hospital will help. We have some early evidence to say that you can build their brain back by using cognitive rehabilitation. When the patients get well enough to get out of the ICU, we are putting them through brain exercises like Sudoku and Scrabble that can help them get that cognitive function, that memory rebuilt, so they can get on with their life. We consider survival a successful outcome, and it is a successful outcome, but I think the second part to this is making sure we get them back to where they were prior to them coming to the ICU. The greater the duration of delirium, the worse your outcome. So every day matters. In Nashville, Barb Cramer reporting.

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