HIV Patients Get a Mental Lift From Exercise, Study Finds

FRIDAY, Aug. 16 (HealthDay News) -- Regular exercise can give a brain boost to people with HIV, according to a new study.

Trouble with memory and thinking, something doctors call "neurocognitive impairment," affects nearly half of people infected with HIV, the virus that causes AIDS. It can interfere with the ability to do daily tasks such as handling finances, driving and taking medication as scheduled, experts say.

However, the new study suggests that exercise "may reduce or potentially prevent neurocognitive impairment in HIV-infected persons," according to a team led by Dr. David Moore of the University of California, San Diego.

Their study included 335 people with HIV who were asked how much they exercised. They also underwent testing to assess seven brain functions commonly affected by HIV: verbal fluency, working memory, speed of information processing, learning, recall, executive function and motor function.

Those who got regular exercise were half as likely to show signs of impaired mental function as those who did not exercise, according to the study published in the August issue of the Journal of NeuroVirology.

The major benefit of exercise in people with HIV seems to be the reduction of risk factors that can affect the brain such as high blood pressure and abnormally high levels of fats in the blood, Moore said.

The findings add to previous research showing a link between exercise and brain health in people with HIV.

"Physical exercise, together with other modifiable lifestyle factors such as education, social engagement, cognitive [mental] stimulation and diet could be fruitful interventions to support people living with HIV," Moore said in a journal news release.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Journal of NeuroVirology, news release, Aug. 13, 2013

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Long Periods of Delirium in ICU May Raise Risk of Mental Impairment

By Dennis Thompson
HealthDay Reporter

WEDNESDAY, Oct. 2 (HealthDay News) -- Patients who suffer longer bouts of delirium during lengthy stays in an intensive care unit stand a higher chance of developing mental deficits similar to those seen with a brain injury or early Alzheimer's disease, new research says.

Two of every five critical care patients developed thinking and memory difficulties like those in people with traumatic brain injuries after just three months' stay, while one in four had mental impairments similar to those seen in people with mild Alzheimer's.

"Even though our survival after critical illness has improved, a significant number of patients will suffer cognitive [mental] impairment after spending a long period in an ICU," said study author Dr. Pratik Pandharipande, a professor of anesthesiology and surgery at Vanderbilt University Medical Center in Nashville.

Delirium appeared to play the main role in this mental impairment, the researchers found. The more time an ICU patient spent in a state of delirium, the more likely that patient was to suffer thinking or memory problems.

"That provides us with the potential to reduce the duration of delirium we see in ICU patients," Pandharipande said. "That may impact the cognitive impairment we see after critical illness."

The study, which is published in the Oct. 3 issue of the New England Journal of Medicine, involved 821 ICU patients. Researchers monitored their progress and tested their ability to plan and solve problems at regular intervals.

At three months, 40 percent of patients displayed scores similar to patients with moderate traumatic brain injury and 26 percent had scores similar to those for patients with mild Alzheimer's.

These mental deficits persisted. A year later, about 34 percent of patients had scores similar to people with brain injuries and 24 percent had scores similar to those with mild Alzheimer's, the investigators found.

There didn't seem to be any particular type of patient more likely to suffer from impairment, Pandharipande said. The researchers found no significant differences based on gender, age or pre-existing health problems. Medical and surgical ICU patients both showed the same amount of risk.

"There was not a particular patient population that got separated out," he said. "All populations had the same risk of having cognitive impairment."

A long period of delirium was the only common denominator among those suffering impairment, the researchers noted.

"We think it's a brain organ dysfunction," Pandharipande said. "Delirium has been associated with cerebral atrophy, inflammation and changes in the brain's white matter. All these potentially could be the connection between delirium and long-term cognitive impairment."

While the study found an association between long periods of delirium and later mental impairment, it did not prove a cause-and-effect link.

Critical care physicians have been wrangling with this problem for decades, said Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association, in Washington, D.C.

"This is a helpful look at an issue that has long puzzled clinicians and hospital leaders -- what leads to some patients having continuing cognitive problems after being released from an ICU," Foster said. "It's really helping identify where further focus should be placed while we unravel the mystery here."

Pandharipande said critical care physicians should consider taking steps to limit the amount of time patients spend in a delirious state. Moderating the use of sedatives, working to keep patients awake and active, and getting them mobile as soon as possible all could help stave off the potential damage of delirium.

Physicians also might consider how to best prepare a person mentally, as well as physically, to leave the hospital.

"Perhaps at the back end of ICU we should start doing a cognitive rehabilitation at the same time we provide physical rehabilitation," he said.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Pratik Pandharipande, M.D., professor, anesthesiology and surgery, Vanderbilt University Medical Center, Nashville, Tenn.; Nancy Foster, vice president, quality and patient safety policy, American Hospital Association, Washington, D.C.; Oct. 3, 2013, New England Journal of Medicine

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