Dear Dr. Roach: Two years ago, my wife (age 62, nonsmoker, nondrinker) was hospitalized for a case of septicemia. Her doctor at the time described her blood as 鈥渂asically toxic sludge.鈥� He said that she had gone into septic shock and her prognosis was poor. However, after a period in intensive care and being flooded with antibiotics, she was released from the hospital.
She had some difficulty in motor co-ordination, memory and such, but she is doing much better. She joined a weight-reduction program, has lost a little over 100 pounds and is currently 145 pounds (she鈥檚 five feet, six inches tall). The one continuing area of concern is her memory. She forgets just about everything. Are there any known treatments, food supplements, vitamins or anything else that we might look at to help improve her overall mental functions?
C.H.
It sounds like your wife has a condition called post-intensive-care syndrome. This syndrome is just beginning to be recognized, and often is not recognized or is attributed to something else.
After a serious illness requiring a stay in the ICU, declines in cognitive function occur in at least 25 per cent of people. The number might be as high as 78 per cent. Sepsis, in particular, seems to have a high risk for development of the cognitive effects of PICS.
Psychiatric illnesses such as anxiety, depression and post-traumatic stress disorder are also common after an ICU stay. Women are at higher risk than men, and again sepsis seems to be particularly prone to causing psychiatric illness.
Physical issues also happen post-ICU stay. Difficulty with mobility (64听per cent), chronic pain (73 per cent) and the need for help with activities of daily living (80 per cent) are much more common than previously recognized. These changes can have many causes, and separating out the effects of the underlying illness versus the detrimental effects of the ICU stay is challenging.
PICS can have a powerful effect on families, with caregivers themselves having increased risk for anxiety, depression and PTSD. In your wife鈥檚 case, it seems like the major issue is cognitive impairment. In general, this is treated the same way that mild cognitive impairment of any cause is treated, and, unfortunately, very little has been proven to be effective.
Medicines for Alzheimer鈥檚 disease, such as donepezil (Aricept), have been studied and were found to have little benefit, while carrying a significant risk of side effects.
Herbs, such as ginkgo biloba, have been found to have no benefit. Physical exercise has been helpful in some studies, and memory-training programs have been shown in research studies to improve function.
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