美国国家公共电台 NPR When ICU Delirium Leads To Symptoms Of Dementia After Discharge

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DAVID GREENE, HOST:

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.

RICHARD HARRIS, BYLINE¹: Richard Langford is a 63-year-old retired² minister who lives with his mother in East Nashville, Tenn. He says his medical saga³ began a decade ago.

RICHARD LANGFORD: In 2008, I went in because I was playing tennis with an 85-year-old, and he beat my butt⁴, and so I wanted fresh knees to help me play better.

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 delirious⁵ weeks in the hospital was a near-death experience.

LANGFORD: I saw green grass and I saw - on the other side of a river, it looked like there was Elijah.

HARRIS: Elijah, the prophet whose miracles included resurrection of the dead. His mother Leta says at one point hospital staff were so sure he would die overnight, they didn't even bother to pass on his medical chart to the day shift.

LETA: The thing that's amazing is his talking to us and his, like, being aware of what we were saying and yet then not knowing and not remembering any of that for I would say it - we were at the rehab about four weeks.

HARRIS: Now, a decade later, Richard Langford says he's still struggling to work his way out of a thicket⁶ that's physical, emotional and cognitive⁷. Though he still reads The New Yorker and remains⁸ active in politics, he says sometimes he feels like he's lost in a vast forest.

LANGFORD: And it is flourishing. And there's - the water is big. There's waterfalls, and there are all kinds of animals around. And that forest is kind of surrounding me, and I can't get out. I can't - I don't know how to get out.

HARRIS: His mother, who is now 89 years old, is helping⁹ him through by, among other things, managing his medications.

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. So each morning, I change and each evening what I'm doing - I'm taking one medicine out and putting another one in.

HARRIS: The Langfords are grateful to get support from a clinic at nearby Vanderbilt University, which has pioneered efforts to understand and treat patients like him.

EUGENE WESLEY ELY: This is a huge problem.

HARRIS: Dr. Wes Ely, an intensive care specialist, heads that effort. He says post-ICU syndrome¹¹ affects 30 to 50 percent of all patients who are in the ICU due to a medical emergency - even younger people.

ELY: I mean, you have somebody coming into the ICU with a previously¹² 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 secluding¹³ themselves. Our patients tell us what a misery¹⁴ this form of dementia is.

HARRIS: Is it permanent?

ELY: It's permanent in some. We've been following people for over 10 years now from the brain ICU study, which we did here Vanderbilt. And many of them a decade out still have elements of the dementia.

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 akin¹⁰ to a traumatic brain injury, pre Alzheimer's or even sometimes Alzheimer's itself. These problems are linked to the degree of delirium¹⁵ people experience while in the ICU, Ely says.

ELY: Every day you're delirious, you have about a 35 percent increased risk of this dementia. So if you do the math on that, three days of delirium, you've got almost a sure thing that you're going to have some elements of the dementia.

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.

JOANNA STOLLINGS: Unfortunately, a lot of these patients and their family members have depression, anxiety, post-traumatic stress disorder¹⁶ and cognitive impairment.

HARRIS: These are often treatable conditions, especially the anxiety and depression.

STOLLINGS: They can go see a therapist. Sometimes, if it's appropriate, we can even put them on medications to help with this as well.

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.

LANGFORD: I was able to get in the car, go to our little precinct, which is maybe a half mile, and then I was able to come back. The forest got a little bit smaller.

HARRIS: His mother Leta knows there are challenges ahead, but her faith keeps her strong.

LETA: You're here today. I'm here today, so let's enjoy today, and then tomorrow, it'll take care of itself.

HARRIS: One great source of joy for them both is music. Richard plays piano and organ, as does his mother, and he loves to sing. She sits down at the piano and pulls out one of his favorite hymns¹⁷.

LETA: (Playing piano).

LANGFORD: (Laughter) It's accurate. This one's about the blood. (Singing) The blood that Jesus died for me.

HARRIS: Leta says the clinic had suggested music would help him recover, so over the years, she has coaxed¹⁸ him to the keyboard. Happily, music is one skill Richard held onto throughout his medical ordeal¹⁹.

LETA: You did good.

LANGFORD: (Laughter) That's my mama. That's what she's supposed to say (laughter).

HARRIS: Richard Harris, NPR News.

(SOUNDBITE OF YANN TIERSEN'S "COMPTINE D'UN AUTRE ETE: L'APRES MIDI")