Life support of the patient. Photo with space for text.

A new study led by Western University and Lawson
Health Research Institute has found that most patients entering hospital
intensive care units (ICU) for non-brain-related injuries or ailments also
suffer from some level of related cognitive dysfunction that currently goes
undetected in most cases.

The findings were published in the influential scientific
journal, PLOS One

Many patients spend time in the ICU for reasons that have
nothing to do with a known brain injury, and most healthcare providers and
caregivers don’t have any evidence to believe there is an issue with the brain.
For example, a patient may have had a traumatic injury that does not involve
the brain, yet still requires breathing support to enable surgeons to fix
damaged organs, they may have issues with their heart or lungs, they may
contract a serious infection, or they may simply be recovering from a surgical
procedure like an organ transplant that has nothing directly to do with their
brain.

For the study, Western investigators from the Schulich
School of Medicine & Dentistry and the Brain and Mind Institute and
researchers from Lawson assessed 20 such patients as they left the ICU
and every single patient had detectable cognitive deficits in two or
more cognitive areas of investigation, including memory, attention,
decision-making and reasoning. Again, this is in spite of the fact that, on the
face of it, they had no clear brain injury.

The discovery was made using online tests, developed by
renowned Western neuroscientist Adrian Owen and his teams at the Brain and Mind
Institute and BrainsCAN, which were originally designed to examine cognitive
ability in patients following brain injuries but for this purpose, are being
used to detect cognitive deficits in people who have spent time in an intensive
care unit without a diagnosed brain injury.

“Many people spend time in an intensive care unit following
a brain injury and, of course, they often experience deficits in memory,
attention, decision-making and other cognitive functions as a result,” explains
Owen, a professor at Schulich Medicine & Dentistry. “In this study, we were
interested to see how patients without a specific brain injury fair after
leaving the ICU. The results were astonishing.”

Why cognitive ability declines even in non-brain related
visits to the ICU likely varies from patient to patient, but Dr Kimia Honarmand
from Schulich Medicine & Dentistry says the lesson to be learned is that
many conditions affect brain function, even though they might not
directly involve the brain.

“If you are having trouble breathing, your brain may be
starved of oxygen. If you have a serious infection, the inflammation that
occurs as a result of infection may affect brain function. If you are
undergoing major surgery, you might be given drugs and have procedures that may
affect your breathing, which in turn may affect the flow of oxygen to the
brain,” explains Dr Honarmand. “What we have shown here is that all or any of
these events can lead to deficits in brain function that manifest as impairments
in cognition. And healthy cognition is a vital determinant of functional
recovery.”

Dr Marat Slessarev, Lawson Scientist, says these findings
can shift how the medical community treats incoming patients and more
importantly, outpatients following ICU visits.

“Historically, the clinical focus has been on just survival.
But now we can begin to focus on good survival,” says Dr  Slessarev, also an associate member at the
Brain and Mind Institute and an assistant professor at Schulich Medicine &
Dentistry. “These sensitive tests will enable doctors to both detect cognitive
impairment and track cognitive performance over time, which is the first step
in developing processes for optimizing brain recovery.”

Source: https://mediarelations.uwo.ca/2019/04/12/icu-patients-with-non-brain-related-injuries-may-suffer-undetected-cognitive-dysfunction/

Reference: Honarmand
K, et al. Feasibility of a web-based neurocognitive battery for assessing
cognitive function in critical illness survivors. PLOS ONE. Published 12 April
2019. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0215203