Dementia sometimes starts in the intensive care unit of a hospital: shots

Physicians have slowly realized that people who survive a serious loss of death in the intensive care unit are likely to develop potentially serious problems with memory and thinking process.

This dementia, a side effect of intensive medical care, may be permanent. And that affects up to half of the people who rush to the USI after a medical emergency. Given that 5.7 million Americans find themselves each year in intensive care, it is a major problem that, until recently, was poorly understood by medical caregivers .

Take, for example, the story of Richard Langford, a retired 63-year-old minister who lives with his mother in East Nashville. He went to the hospital for a knee surgery 10 years ago. "Because I played tennis with an 85-year-old and he hit my bottom," Langford said with a chuckle. "So I wanted some cool knees to help me play better."

But after this routine knee operation, Langford developed a severe lung infection, which led him to the intensive care unit. He had developed sepsis, a life-threatening illness, sometimes called blood poisoning. In case of sepsis, the body reacts excessively to an infection, which can lead to a drop in blood pressure, a failure of several organs and often death.

During his four-week stay at the hospital and subsequent rehabilitation, Langford suffered long periods of delirium. It is a state of confusion, confusion and even sometimes hallucinations in some patients. All Langford remembers is the sensation of an impending death experience.

"I saw green grass," says Langford, "and I saw, on the other side of the river, it seemed like there was Elijah" , the prophet whose miracles included the resurrection of the dead.

His mother, Leta, said that at one point, the hospital staff were so certain that he would die overnight, they did not even bother to give him his medical file.

"What's amazing is that he's talking to us – and that he's aware of what we're saying – and that he's not aware of or remembers anything at all. that, "she says.

Nearly ten years later, Richard Langford said that he was still struggling to get away from a clutter of physical, emotional and cognitive deficits. Although he is still subscribed to the New Yorker and remains active in political causes, he periodically feels lost in what seems to him and seems to him – at least at those moments – to be a vast forest in his mind.

"The water is big, there are waterfalls and there are all kinds of animals around," he says. "This forest surrounds me a bit and I can not go out, I do not know how to get out."

Langford is also disoriented and distracted – lost in his basic thoughts and tasks, such as taking the medications he has been prescribed to treat his heart disease and other persistent health problems. Her 89-year-old mother now needs to help her keep her treatment schedule.

Neuropsychologist James Jackson, of the Delirium and Cognitive Impairment Study Group at Vanderbilt Intensive Care Units, states that these cognitive problems result from Langford's fight against delirium in the hospital. The Vanderbilt Medical Center now has a pioneering clinic in its efforts to understand and treat this type of case.

"It's a huge problem," says Dr. E. Wesley "Wes" Ely, an intensive care specialist at the helm of this effort. According to him, the post-ICU syndrome – a cluster of cognitive symptoms that can include anxiety, depression and PTSD, as well as delirium – affects 30 to 50% of patients who have gone from emergency to the USI because of a medical emergency. This includes younger patients who did not have previous mental problems. And in some of these patients, dementia quickly follows.

"Someone arrives in the USI with a brain that worked very well before and left critical care without being able to have a good conversation," Ely said. "They can not balance their checkbook, they can not find the names of the people who attend a party and they are very embarrassed, so they start to isolate themselves socially.Our patients tell us how much form of dementia is a misery. "

Ely has been following his patients for over a decade thanks to scientific studies such as the BRAIN-ICU study. He says that about one-third of patients who have cognitive problems after their stay in ICU are fully recovered. another third remains pretty much the same after their dementia settles – and a third continues to descend.

For many, the damage to mental treatment is similar to that of a traumatic brain injury or a condition called mild cognitive impairment – or even Alzheimer's disease.

Researchers do not yet know how the brain is changing to cause these symptoms, nor how prolonged delirium causes brain damage; Ely is launching a large study to help unravel some of these mechanisms. What parts of the brain are affected and how do the damages differ from those caused by other forms of dementia such as Alzheimer's disease? One idea that he will explore is whether tiny blood clots could form in the brain and play a role in long-term damage.

In the meantime, says Ely, the doctors who treat these patients with sudden dementia We are sure that their mental problems are related to the degree of delirium they experience in resuscitation.

"Every day you go crazy, the risk of dementia increases by about 35%," he says. "So, if you do the math on this – [after] three days of delirium, you almost certainly have some of the characteristics of dementia. "

And the problems do not stop there.

"Unfortunately, many of these patients and their families suffer from depression, anxiety, post-traumatic stress disorder and cognitive impairment," says Joanna Stollings, clinical pharmacist and member of the interdisciplinary team at the clinic.

But there is good news for patients who are asking for help: many of these other problems can be treated, says Stollings, especially anxiety and depression.

People can find help with speech therapy, says Stolling, and "sometimes, if it's okay, we can give them drugs, which can help them too."

The clinic's neuropsychologist, Jackson, explains that the rehabilitation of these patients may look like the therapy prescribed to people after a stroke.

"Even though these patients were not hit on the head with a hammer, [and] they have not fallen off a scale, in many ways what people are suffering is indeed a brain injury, "he says. The route of the injury is just a little different. "

The Vanderbilt Clinic explores various brain training exercises to help people recover.

"It would be nice if [these exercises] Jackson added, "The test scores have been improved. But a bigger problem is: does it make them better able to return to work? Or are they able to balance their checkbook? Do they drive without an accident? "He tries to answer these questions as part of his research.

Nevertheless, getting help for anyone who could use it remains a challenge. The Vanderbilt Clinic, for example, does not have the ability to track all the people coming out of the ICU's intensive care units – and there are very few specialized centers like this one in the country.

Vanderbilt is now working to create a network of such clinics across the United States.

Langford says the support he's received at the post-ICU clinic has helped him progressively regain some of his previous abilities and routines. The day before my visit, he had been delighted to be able to visit the local elections in person.

"I was able to get in the car, go to our little neighborhood, which maybe half a kilometer, and be able to come back," he says. "The forest has become a little smaller."

His mother Leta knows that there are still challenges ahead, but her faith keeps her strong.

"You are here today, I am here today," she said to her son. "So let's enjoy it today, and tomorrow – he'll take care of himself."

You can contact Richard Harris at [email protected].

Richard Langford, 64, and his mother Leta Langford, 89, play piano together at home in East Nashville. Richard almost died ten years ago and still suffers from some cognitive symptoms, but says the music keeps him alive.

Morgan Hornsby for NPR

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Morgan Hornsby for NPR

Richard Langford, 64, and his mother Leta Langford, 89, play piano together at home in East Nashville. Richard almost died ten years ago and still suffers from some cognitive symptoms, but says the music keeps him alive.

Morgan Hornsby for NPR