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Hospital patients who go home after a stay in intensive care may leave thinking the worst is over, but 60 to 80 percent are likely going home with a new problem – a brain injury.

A 54-year-old petite and bubbly bookkeeper named Marie Smithers spent six weeks in the ICU at St. Thomas Hospital in Nashville last March. nine months later, she still suffers from memory lapses and balance problems. Smithers is back at work, but it’s a constant struggle for her to remember simple tasks.

“There’s some things…the forgetting. Going down the basement steps, all of a sudden it’s like, I don’t remember exactly how to do this,” says Smithers.

ICU Delirium is triggered by the disease and/or infection that lands patients in the ICU, along with heavy duty drugs meant to keep them comfortable.

Vanderbilt critical care doctor Wes Ely has studied ICU delirium for a decade. As he points to the plastic ventilator tube running into the lungs of ICU patient, Craig Nudds, Dr. Ely says heavy drugs allow the patient to tolerate the tube. But, “We often tend to overshoot,” says Ely.

Dr. Ely estimates 50 percent of the delirium is caused by sedation drugs. he founded what’s now the world’s largest ICU Delirium research group. Its aim is to find the perfect drug cocktail that balances comfort and consciousness to keep the brain from descending into delirium.

Nudds, who has pancreatitis and lung failure, also has ICU delirium, and Dr. Ely has been tracking the depth of it for a few hours. As Nudds opens his eyes, Dr. Ely picks up his hand and starts squeezing it to see if the patient is conscious enough to respond.

It takes Nudds takes a few seconds to return the squeeze. Dr. Ely says he took too long, and Nudds has a classic case of ICU Delirium. “His brain is just swimming through molasses,” says Ely.

To diagnose ICU delirium, Ely and his team developed a simple two-minute test. It’s a series of questions that doctors pose to patients. if the patient responds correctly, a harder question is asked.

Based on Craig Nudds’ responses, Ely says, at the very least, he’ll end up with memory problems for a few days or it could be worse. he could end up with dementia-like symptoms that mimic Alzheimer’s.

“The longer he stays delirious, the more likely he is to have neuropsychological problems on the back end with memory, and processing speed, and executive function, meaning he would have problems like a dementia,” says Ely.

For decades, patients were told their fogginess and memory lapses were temporary. “It’ll get better after you get home,” was the conventional wisdom.

But Ely’s research shows it can be a life-altering, long-term problem. That’s why he’s pushing for every ICU to start testing for delirium. Right now, among Nashville’s major hospitals, only Vanderbilt screens for the condition.

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Dementia treatments can only be assessed once a person is diagnosed with dementia. when a person suffers from loss of cognitive functions as a result of the loss of brain cells it is termed as dementia. This disease is typically characterized by memory loss and may even encompass the inability to function at work or on a social level, difficulty with speech and limited movement. This progressive disease may even bring a person to the point where they cannot take care of themselves properly. They may end up needing aid to eat, get dressed and to get around. Some typical dementia symptoms are listed below:

Dementia is more prevalent in older persons even though it is not referred to as one of the normal aging processes. There are even types of vascular dementia that are mistaken for Alzheimer’s disease.

Other dementia symptoms:

• The blockage of a blood vessel to the brain
• A brain injury
• Huntington’s or Parkinson’s disease
• A tumor in the brain
• Vitamin B deficiencies
• Contact with toxic matter, certain medications and alcohol or drug abuse
• Episodes of hypoglycemia

If a person is thought to be suffering from dementia symptoms they are brought in to the doctor who will rely more on the interviews that he conducts with the affected person and family members as there is nothing specific that can be done to confirm a diagnosis. It may be that the patient is suffering from depression so that has to be eliminated. if the doctor feels that the condition may be as a result of damage to the brain he will order a magnetic resonance imaging (MRI) or computer tomography scan (CT scan) to examine the brain.

Dementia treatment options:

Even though there is no direct cure, there are medications currently available that will slow down the progression of the disease. Some behavioral or psychiatric therapies may also be involved. To help the afflicted person to deal with the emotional challenges that they will face, they will also need a strong support system. Dementia treatments are aimed at slowing down the advance of the disease and lessening the symptoms experienced.

Tags: dementia, dementia symptoms, dementia treatment

By Maggie Fox

WASHINGTON (Reuters) – Scientists reported on Tuesday they have some of the best evidence yet to support long-held theories that repeated blows to the head may cause nerve-degenerative diseases like Lou Gehrig's disease and Alzheimer's.

Autopsies of 12 athletes who died with brain or neurological disease showed a distinctive pattern of nerve damage – and fingered some potential culprits.

All had repeated concussions during their careers. Three of the men had been diagnosed with amyotrophic lateral sclerosis, also known as ALS or Lou Gehrig's disease, the star baseball player who died of it.

Experts in brain injury said the study, published in the Journal of Neuropathology & Experimental Neurology, pointed to new areas of research and possible ways to prevent long-term damage from concussions.

"if you could somehow give a person a drug, you could potentially prevent an illness like amyotrophic lateral sclerosis," Dr. Jeffrey Bazarian of the University of Rochester Medical Center in new York said in a telephone interview.

The findings also point to an urgent need to watch veterans of the wars in Iraq and Afghanistan, many of whom suffer brain injuries from explosions, accidents and blows to the head from other causes, the experts said.

"this is the first pathological evidence that repetitive head trauma experienced in collision sports might be associated with the development of a motor neuron disease," Dr. Ann McKee of Boston University School of Medicine and colleagues wrote in the report, available at link.reuters.com/fab65n.

McKee's team studied the donated brain and spinal cords of 11 professional football players or boxers and one hockey player. all had a newly characterized disease called chronic traumatic encephalopathy, or CTE, in which dementia set in years after repeated concussions.

PROTEIN CULPRIT

Three of the men also were diagnosed with ALS, a member of a family of diseases called motor neuron disease, which cause progressively worse paralysis.

The researchers looked specifically for a protein called TDP-43. they found it in the brain and in the spinal cords of the men – which could explain the ALS-like symptoms.

Scientists know that damaging one nerve can sometimes set off a cascade of other nerves dying, for reasons that remain poorly understood. TDP-43 could be involved.

Bazarian, who was on an Institute of Medicine Committee that released a report in 2008 linking concussions to later-life neurologic diseases, said the finding could help explain studies that show Iraq war veterans have a higher-than-normal rate of ALS, for example.

Drugs including the hormone progesterone, monoclonal antibodies and the antibiotic minocycline are being studied to see if they can stop the process of nerve destruction that follows injuries such as a blow to the head or stroke.

The findings will be difficult to substantiate because ALS is so rare, said ALS expert Martina Wiedau-Pazos of the University of California Los Angeles.

"We think there already are different forms of ALS," she said – potentially with different causes.

David Hovda, director of the UCLA Traumatic Brain Injury Research Center, said brain injury is very common with 1.5 million cases in the United States alone each year.

"Whether by itself in isolation it causes ALS, I do not think that this paper proves that. What I think it does is raise worries that individuals who had a career of exposure to repeat concussions … have a greater likelihood of developing motor neuron disease," he said.