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Study: Hospital-Based Delirium May Cause Long-Term Cognitive Harm

A study just published in the New England Journal of Medicine found that some 40 percent of people who experience delirium in hospital intensive-care units may still be affected by cognitive problems similar to those from traumatic brain injuries three months later. Another 26 percent may still be experiencing issues similar to those of mild Alzheimer’s disease.

The researchers asked people who experienced delirium during a hospital stay to undergo cognitive testing three months after their release and again after 12 months. Fewer participated in the 12-month test, but many still had problems. The percentage of those suffering from symptoms similar to a traumatic brain injury dropped by only 6 percent, while the percentage experiencing Alzheimer’s-like symptoms dropped by only 2 percent after a year. A few patients began showing impairments only in the 12-month test.

Delirium is a condition in which patients experience sudden, severe confusion and changes in brain function, often causing their mental states or movements to swing back and forth between lethargy to hyperactivity. Patients may be disoriented, incoherent, and unable to stop certain speech or behavior patterns. They often suffer from short-term memory loss, disorganized thinking, and emotional or behavioral changes.

A variety of medical conditions can cause delirium, but some — such as oxygen deprivation and the use of benzodiazepine sedatives such as Ativan, Klonopin and Xanax — could potentially be the result of doctor or hospital negligence.

The researchers found that people who were given benzodiazepine sedatives performed worse in the cognitive testing than those given other types. The duration of the patient’s delirium appears to be an important factor, as those who suffered for five or more days performed worse on the cognitive tests than those with shorter-term delirium. Surprisingly, age did not appear to be a factor.

The study’s lead author told NPR that ICU staff should never disregard patient reports of memory loss. “We all need to be aware of it,” he said. “And perhaps in the future we will start thinking about cognitive rehab just like we do physical rehab.”

Hospitals should also consider strategies to combat delirium and shorten its duration including, perhaps reconsidering whether to prescribe benzodiazepine sedatives, because negligence could cause long-term cognitive losses. Healthcare professions are only just beginning to appreciate the seriousness of delirium, the president of the Society for Critical Care Medicine told NPR.

Source: National Public Radio’s Shots blog, “Delirium In The ICU May Pose Ongoing Risk Of Thinking Problems,” Thomas Andrew Gustafson, Oct. 3, 2013