In Reply

Cognitive Deficits Following Intensive Care by Joel Kohler, Dr. med. Friedrich Borchers, Prof. Dr. med. Matthias Endres, Dr. med. Björn Weiss, Prof. Dr. med. Claudia Spies, and Dr. med. Julius Valentin Emmrich, MPhil in issue 38/2019

We thank our correspondents for their interest in our work and for their responses.

Our article presented a systematic review of studies available to date on long-term cognitive dysfunction after conservative intensive care treatment. It explains the prevalence, disease course, and the risk factors studied so far and pharmacological and non-pharmacological interventions, and discussed them on the basis of the available data (1).

We are grateful for the suggestion of possible pharmacotherapy using piracetam. The long-term sequelae of a critical illness (often months to years) that were the focus of our article are, however, not congruent with the (controversial) term “Durchgangssyndrom” (organic psychosis which is understood to last a few days) (2). The effects of treatment with piracetam have so far not been investigated in studies of the long-term sequelae of conservative intensive care treatment.

We thank our correspondent for mentioning possible pharmacological treatment using vitamin B₁. Alcoholism and associated syndromes and disorders—such as Wernicke encephalopathy or Wernicke-Korsakov syndrome—play an important part in intensive care medicine (3, 4). Studies thus far have, however, not been able to establish any association with the long-term cognitive effects of intensive care treatment for the group of patients with thiamine deficiency or insufficient treatment with thiamine.

DOI: 10.3238/arztebl.2020.0116c

On behalf of the authors
Dr. med. Julius Valentin Emmrich, MPhil
Klinik für Neurologie
mit Abteilung für Experimentelle Neurologie
Charité – Universitätsmedizin Berlin

Conflict of interest statement
The authors of all contributions declare that no conflict of interest exists.

References

1. Kohler J, Borchers F, Endres M, Weiss B, Spies C, Emmrich, JV: Cognitive deficits following intensive care. Dtsch Arztebl Int 2019; 116: 627–34

2. Ewert T: Postoperatives Durchgangssyndrom. Dtsch Arztebl 1986; 83: A-956

3. Singer MV, Teyssen S: Serie – Alkoholismus: Alkoholassoziierte Organschäden. Dtsch Arztebl 2001; 98: A-2109

4. Maschke M, Kommission Leitlinien der Deutschen Gesellschaft für Neurologie: S1-Leitlinie Alkoholdelir und Verwirrtheitszustände. 2015. AWMF-Registernummer: 030/006 .