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

 

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")

1 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

2 retired   

adj.隐退的，退休的，退役的

参考例句：

• The old man retired to the country for rest.这位老人下乡休息去了。
• Many retired people take up gardening as a hobby.许多退休的人都以从事园艺为嗜好。

3 saga   

n.(尤指中世纪北欧海盗的)故事，英雄传奇

参考例句：

• The saga of Flight 19 is probably the most repeated story about the Bermuda Triangle.飞行19中队的传说或许是有关百慕大三角最重复的故事。
• The novel depicts the saga of a family.小说描绘了一个家族的传奇故事。

4 butt   

n.笑柄；烟蒂；枪托；臀部；v.用头撞或顶

参考例句：

• The water butt catches the overflow from this pipe.大水桶盛接管子里流出的东西。
• He was the butt of their jokes.他是他们的笑柄。

5 delirious   

adj.不省人事的，神智昏迷的

参考例句：

• He was delirious,murmuring about that matter.他精神恍惚，低声叨念着那件事。
• She knew that he had become delirious,and tried to pacify him.她知道他已经神志昏迷起来了，极力想使他镇静下来。

6 thicket   

n.灌木丛，树林

参考例句：

• A thicket makes good cover for animals to hide in.丛林是动物的良好隐蔽处。
• We were now at the margin of the thicket.我们现在已经来到了丛林的边缘。

7 cognitive   

adj.认知的，认识的，有感知的

参考例句：

• As children grow older,their cognitive processes become sharper.孩子们越长越大，他们的认知过程变得更为敏锐。
• The cognitive psychologist is like the tinker who wants to know how a clock works.认知心理学者倒很像一个需要通晓钟表如何运转的钟表修理匠。

8 remains   

n.剩余物，残留物；遗体，遗迹

参考例句：

• He ate the remains of food hungrily.他狼吞虎咽地吃剩余的食物。
• The remains of the meal were fed to the dog.残羹剩饭喂狗了。

9 helping   

n.食物的一份&adj.帮助人的，辅助的

参考例句：

• The poor children regularly pony up for a second helping of my hamburger. 那些可怜的孩子们总是要求我把我的汉堡包再给他们一份。
• By doing this, they may at times be helping to restore competition. 这样一来, 他在某些时候,有助于竞争的加强。

10 akin   

adj.同族的，类似的

参考例句：

• She painted flowers and birds pictures akin to those of earlier feminine painters.她画一些同早期女画家类似的花鸟画。
• Listening to his life story is akin to reading a good adventure novel.听他的人生故事犹如阅读一本精彩的冒险小说。

11 syndrome   

n.综合病症；并存特性

参考例句：

• The Institute says that an unidentified virus is to blame for the syndrome. 该研究所表示,引起这种综合症的是一种尚未确认的病毒。
• Results indicated that 11 fetuses had Down syndrome. 结果表明有11个胎儿患有唐氏综合征。

12 previously   

adv.以前，先前（地）

参考例句：

• The bicycle tyre blew out at a previously damaged point.自行车胎在以前损坏过的地方又爆开了。
• Let me digress for a moment and explain what had happened previously.让我岔开一会儿，解释原先发生了什么。

13 secluding   

v.使隔开，使隔绝，使隐退( seclude的现在分词 )

参考例句：

14 misery   

n.痛苦，苦恼，苦难；悲惨的境遇，贫苦

参考例句：

• Business depression usually causes misery among the working class.商业不景气常使工薪阶层受苦。
• He has rescued me from the mire of misery.他把我从苦海里救了出来。

15 delirium   

n. 神智昏迷,说胡话;极度兴奋

参考例句：

• In her delirium, she had fallen to the floor several times. 她在神志不清的状态下几次摔倒在地上。
• For the next nine months, Job was in constant delirium.接下来的九个月，约伯处于持续精神错乱的状态。

16 disorder   

n.紊乱，混乱；骚动，骚乱；疾病，失调

参考例句：

• When returning back,he discovered the room to be in disorder.回家后，他发现屋子里乱七八糟。
• It contained a vast number of letters in great disorder.里面七零八落地装着许多信件。

17 hymns   

n.赞美诗，圣歌，颂歌( hymn的名词复数 )

参考例句：

• At first, they played the hymns and marches familiar to them. 起初他们只吹奏自己熟悉的赞美诗和进行曲。 来自英汉非文学 - 百科语料821
• I like singing hymns. 我喜欢唱圣歌。 来自辞典例句

18 coaxed   

v.哄，用好话劝说( coax的过去式和过去分词 )；巧言骗取；哄劝，劝诱

参考例句：

• She coaxed the horse into coming a little closer. 她哄着那匹马让它再靠近了一点。
• I coaxed my sister into taking me to the theatre. 我用好话哄姐姐带我去看戏。 来自《现代汉英综合大词典》

19 ordeal   

n.苦难经历，（尤指对品格、耐力的）严峻考验

参考例句：

• She managed to keep her sanity throughout the ordeal.在那场磨难中她始终保持神志正常。
• Being lost in the wilderness for a week was an ordeal for me.在荒野里迷路一星期对我来说真是一场磨难。