Patients who enter intensive care units with no evidence of cognitive impairment often leave with deficits similar to those seen in patients with traumatic brain injury or mild Alzheimer’s disease, according to a new study.
The study, led by researchers at Vanderbilt University’s ICU Delirium and Cognitive Impairment Group, found that 74 percent of the 821 patients studied — all adults with respiratory failure, cardiogenic shock or septic shock — developed delirium while in the hospital.
According to the researchers, this is a predictor of a dementia-like brain disease even a year after discharge from the ICU.
Delirium, a form of acute brain dysfunction common during critical illness, has consistently been shown to be associated with higher mortality, the researchers noted.
“But this large study of medical and surgical ICU patients demonstrates that it is associated with long-term cognitive impairment in ICU survivors as well,” the researchers said in the study, which was published in the New England Journal of Medicine.
“At three months, 40 percent of patients in the study had global cognition scores similar to patients with moderate TBI, and 26 percent scored similar to patients with AD.”
Deficits occurred in both older and younger patients — regardless of whether they had coexisting illness — and persisted to 12 months, the researchers said. They report that 34 percent still had scores similar to TBI patients, while 24 percent still had scores similar to AD patients.
“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 lead author Pratik Pandharipande, M.D., M.S.C.I., professor of anesthesiology and critical care.
“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 AD 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,” added senior author Wes Ely, M.D., professor of medicine.
Ely said at least some component of this brain injury may be preventable through efforts to shorten the duration of delirium in the ICU by using careful delirium monitoring and management techniques, including earlier attempts at weaning from sedatives and mobility protocols that can save lives and reduce disability.
“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.