When icu delirium leads to symptoms of dementia after discharge peoria public radio georgia state university application fee

This dementia, a side effect of intensive medical care, can be permanent. And it affects as many as half of all people who are rushed to the ICU after a medical emergency. Considering that 5.7 million americans end up in intensive care every year, this is a major problem that until recently, has been poorly appreciated by medical caregivers.

Take, for example, the story of richard langford, a retired minister in his 60s who lives with his mother in east nashville. He went into the hospital for knee surgery 10 years ago "because I was playing tennis with an 85-year-old and he beat my butt," langford says with a chuckle. "So I wanted fresh knees to help me play better."

But after that routine knee surgery, langford developed a serious lung infection that sent him to the intensive care unit.

He had sepsis, a life-threatening condition sometimes called blood poisoning. With sepsis, the body overreacts to an infection; it can lead to crashing blood pressure, multiple organ failure and often death.

During his four-week stay in the hospital and the rehab that followed, langford suffered from long spells of delirium. That’s a state of muddled thought, confusion and even at times hallucinations in some patients. All langford remembers is the sensation of a near-death experience.

Nearly a decade later, richard langford says he is still struggling to work his way out of a thicket of deficits that are physical, emotional and cognitive. Though he still subscribes to the new yorker and remains active in political causes, he periodically feels like he’s lost in what looks and seems to him — at least in those moments — to be a vast forest inside his mind.

Langford also finds himself confused and distracted — lost in thought and losing track of basic tasks, such as when to take the medicines he has been prescribed to treat his heart disease and other lingering health issues. His 89-year-old mother now has to help him with his medication schedule.

Neuropsychologist james jackson, of the vanderbilt ICU delirium and cognitive impairment study group, says these cognitive problems are the result of langford’s struggle with delirium in the hospital. Georgia southwestern state university nursing vanderbilt medical center now has a clinic that is pioneering efforts to understand and treat these sorts of cases.

"This is a huge problem," says dr. E. Wesley ely, an intensive care specialist who heads that effort. Georgia state university football conference he says post-ICU syndrome — a cluster of cognitive symptoms that can include anxiety, depression and post-traumatic stress disorder, as well as delirium — affects 30 to 50 percent of all patients who are rushed to the ICU because of a medical emergency. That’s including younger patients who had no prior mental challenges. And in some of those patients, dementia soon follows.

"You have somebody coming into the ICU with a previously very well-working brain, and they leave critical care not being able to have a good conversation," ely says. "They can’t balance their checkbook, they can’t find the names of people at a party and they get very embarrassed, so they start socially secluding themselves. Our patients tell us what a misery this form of dementia is."

Ely has been tracking his patients for more than a decade through scientific studies such as the BRAIN-ICU study. He says about one-third of patients who have cognitive problems after their ICU stay fully recover, another third stay about the same after their dementia sets in, and a third continue to go downhill.

Researchers don’t yet know how the brain is changing to give rise to these symptoms or how extended delirium leads to that brain damage; ely is launching a large study to help tease out some of those mechanisms. What parts of the brain are affected, and how does the damage differ from that caused by other forms of dementia such as alzheimer’s? One idea he will explore is whether tiny blood clots might be forming in the brain and playing a role the long-term damage.

"Every day you’re delirious you have about a 35 percent increased risk of this dementia," he says. "So if you do the math on that — [after] three days of delirium, you have almost a sure thing you’re going to have some elements of the dementia."

"Unfortunately a lot of these patients and their family members have depression, anxiety, post-traumatic stress disorder and cognitive impairment," says joanna stollings, a clinical pharmacist and member of the interdisciplinary team that staffs the clinic.

"It would be nice if [these exercises] improved test scores," jackson says. "But a bigger issue is, does it make them more adept at returning to work? Or are they able to balance their checkbook? Are they driving without accidents?" he’s trying to answer those questions in his research.

Still, getting help to everyone who could use it remains a challenge. Vanderbilt’s clinic, for example, doesn’t have the capacity to follow up with everyone who has been discharged from the medical center’s own icus — and there are very few specialized centers like this in the country.

Langford says the support he has received at the post-ICU clinic helped him gradually recover some of his previous abilities and routines. The day before I visited him, he had been pleased to be able to venture out to vote in person in a local election.

More than 5 million americans every year fall critically ill and end up in an intensive care unit, and doctors are now coming to realize that as many as half of the people who’ve been rushed to the ICU for a medical emergency will go on to suffer serious mental problems like dementia. Here’s more from NPR’s richard harris.

HARRIS: but after that routine knee surgery, langford developed a lung infection, which sent him to the intensive care unit. He had developed sepsis, a life-threatening condition sometimes called blood poisoning. And all he remembers from his delirious weeks in the hospital was a near-death experience.

HARRIS: now, a decade later, richard langford says he’s still struggling to work his way out of a thicket that’s physical, emotional and cognitive. Though he still reads the new yorker and remains active in politics, he says sometimes he feels like he’s lost in a vast forest.

LETA: now, this last time, they – when he went into the hospital, they changed a strong medication, a warfarin, and took him off of that and put him on the eliquis. Georgia state university alpharetta campus address so each morning, I change and each evening what I’m doing – I’m taking one medicine out and putting another one in.

ELY: I mean, you have somebody coming into the ICU with a previously very well working brain, and they leave critical care not being able to have a good conversation. They can’t balance their checkbook. They can’t find the names of people at a party, and they get very embarrassed, so they start socially secluding themselves. Our patients tell us what a misery this form of dementia is.

HARRIS: overall he estimates that a third improve, a third stay the same and a third end up on a slow decline. For many, the mental damage is akin to a traumatic brain injury, pre alzheimer’s or even sometimes alzheimer’s itself. These problems are linked to the degree of delirium people experience while in the ICU, ely says.

HARRIS: he can’t say exactly why delirium leads to dementia, but ely has developed strategies to sharply reduce delirium in his ICU. We have a separate story about that later today on all things considered and available online. But for those patients who are already facing these issues, it’s more than just about memory and focus. Joanna stollings, a clinical pharmacist, is part of the team at the clinic that sees these patients.

HARRIS: vanderbilt is now helping a few dozen hospitals around the country establish clinics like this. She says the unmet need is enormous. The clinic in nashville has gradually helped richard langford to recover some of his routines. For example, the day before I visited him, he said he’d been able to go out and vote in a local election.