Dementia starts in the ICU

Thursday, October 11th, 2018

Doctors are gradually realizing that a trip to the intensive care unit can lead to serious memory problems:

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 which, until recently, has been poorly appreciated by medical caregivers.


“This is a huge problem,” says Dr. E. Wesley “Wes” Ely, an intensive care specialist who heads that effort. He says post-ICU syndrome — a cluster of cognitive symptoms that can include anxiety, depression and PTSD, 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 following their ICU stay fully recover; another third stay about the same after their dementia sets in — and a third continue to go downhill.

For many, the damage to mental processing is akin to what’s seen with a traumatic brain injury, or in a condition called mild cognitive impairment — or even Alzheimer’s disease.

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.

In the meantime, Ely says, one thing the doctors treating these patients with sudden dementia are certain of is that their mental problems are linked to the degree of delirium they experience while in the ICU.

“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.”


  1. Ross says:

    Inflammation, hyperactivation of the brain’s immune system — the microglia — an assault of God knows what kind of chemicals, stimulants, heroic levels of cortisol. And hospital food. Fun for the whole family.

  2. Steve Johnson says:

    Ross, don’t forget sleep deprivation to top it off.

    Have you ever tried to sleep in a brightly lit room, with tubes and wires attached, and with people periodically talking, touching, and moving you? It is not surprising that sleep disturbances and fatigue are among the most common symptoms in critically ill adults, regardless of the type of acute care hospital unit or disease process.1, 2 Many factors contribute to sleep and fatigue symptoms during recovery from acute illness or injury. Pre-existing sleep disorders, pathophysiology of the underlying illness/injury, therapeutic interventions, medications, and the intensive care unit (ICU) environment are major contributing factors in sleep disruption and fatigue.2–6 Regardless of the cause, consequences of sleep disturbances and fatigue include diminished physical and cognitive functioning, mood instability, emotional distress, and amplification of concurrent symptoms.2, 7 Sleep disruption is a significant stressor in the ICU that can negatively affect recovery and even survival.

  3. Rocky Ballmer says:

    The U.S. medical industry is the third leading cause of death among Americans, via preventable medical errors.

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