by Nancy Humphrey
The Critical Illness, Brain Dysfunction and Survivorship Center at Vanderbilt University Medical Center is following patients who have been hospitalized for COVID-19 over time to see if they develop long-term cognitive impairment, depression or post-traumatic stress disorder (PTSD).
These disabling features suffered by millions of ICU survivors are called Post-Intensive Care Syndrome (PICS).
“There is emerging evidence that COVID-19 affects the brain and leads to a wide range of neurological complications such as delirium. Because it affects the brain and causes delirium, we hypothesize that a disproportionate number of patients might develop long-term cognitive impairment, PTSD and depression,” said Jin Han, MD, MSc, associate professor of Emergency Medicine and principal investigator of the study.
“To understand the full impact of this pandemic on the lives of survivors and the magnitude of this public health crisis, we must understand COVID-19’s impact on the brain,” Han said.
The patients will be followed over time, measuring their cognition using a neuropsychological battery and using a PTSD and depression scale to see what proportion of patients will develop these maladies, Han said.
The study of COVID patients is based on prior studies of ICU patients hospitalized for Acute Respiratory Distress Syndrome. In those studies, 75% demonstrate PICS-related acquired dementia. And in a broad group of ICU survivors closely resembling COVID-19 patients, 33-50% have acquired dementia, 10-20%, PTSD and 33%, major depression.
“There have been several small studies reporting that a substantial proportion of COVID-19 patients develop delirium during their illness. Anecdotally, we’re also observing delirium as the first manifestation of COVID-19 in some patients,” Han said.
Delirium, an acute state of confusion, is common during critical illness and is associated with longer hospital stays, higher mortality and long-term cognitive impairment. VUMC studies have shown that delirium is an independent predictor of poor long-term cognitive outcomes.
The VUMC study will be looking at two populations of patients — those who have been in intensive care during their COVID-19 battle and those who have not. “We’re seeing delirium in COVID-19 patients outside the ICU, especially in older adults,” Han said.
Han said that to prevent or lessen delirium in patients in the hospital, the health care team usually encourages contact with family members to help orient the patient and provide them with some familiarity while they are in the hospital.
However, during the COVID-19 pandemic, that has changed.
“Many hospitals, including our own, have strict no visitor policies in place while COVID patients are in isolation. You can imagine what these patients are going through, especially when they’re confused. Not only are they alone and completely separated from their loved ones, but these patients are also interacting with health care providers who are in masks and gowns. We believe this, while necessary for infection control and protection, is exacerbating the problem,” Han said.
Han’s study plans to collect cognitive and psychological outcomes at 12 months in patients from 33 medical centers enrolled in the ORCHID (Outcomes Related to COVID-19 treated with Hydroxychloroquine among In-patients with symptomatic Disease) trial, led by VUMC. This study was conducted in 33 medical centers across the U.S. and included hundreds of patients to determine if hydroxychloroquine is an effective treatment for COVID-19. It ended in June after results provided a high level of certainty that hydroxychloroquine is not a useful treatment for adults admitted to the hospital with COVID-19. This ancillary study is called ORCHID-BUD (Brain Outcomes and Psychological Distress) and is sponsored by the National Institute on Aging.
The trial is being conducted within the Prevention and Early Treatment of Acute Lung Injury (PETAL) Clinical Trials Network, which is a network of approximately 50 medical centers in the U.S. that collaborate to run large research studies. The PETAL Network is funded by the National Heart Lung and Blood Institute, part of the National Institutes of Health.
