I'm studying the effect of continuous flow LVAD on cognitive performance. I know the neurological effects and I like to know if anyone has experience with the neuropsychological disorders in these patients.
Dear David, As you know, there is a risk of stroke with LVAD insertion and on an ongoing basis related to hardware being present in the systemic circulation with causes any number of neurological sequelae. In regards to neuropsychological disorders, anecdotally, I have observed a high level of ongoing anxiety in patients with long-term LVADs. I have thought this to be related to the ongong fear of pump failure, the immediate anxiety of alarms being triggered, fear of batteries running low, etc. Patients with less technical savvy experience for anxiety. In certain patients this anxiety is debilitating enough that it requires medication, keeps patients at home tethered to wall outlets, and limits overall activity and relationships.
Best Regards,
Kenton J. Zehr
No but I assume you are aware of the literature on LVH and lowered cognitive performance which is important in terms of controls when looking at these devices. Elias et l. Hypertension and other studies.
P
Thank you very much Kenton, I agree with you about anxiety o depressive mood in LVAD patients, I believe that some subjects show a PTSD diagnosis, Did you observe any disorders in memory domain or executive function correlated to continuous flow?
That is a difficult question to answer because we have no head to head comparisons of cognitive function in the early trials comparing the pulsitile XVE Thoratec pump with the continuous flow HeartMate II and that trial will never be completed. In that trial the only endpoints were survival free from disabling stroke or device replacement or repair. There is published data of worse cognitive dysfunction in patients awaiting heart transplant with LVAD compared to those without. One of the best manuscripts reviewing these neurological and neuropsychological issues is Quality of Life and Left Ventricular Assist Device Support, McIver et al, Circulation 2012;126:866-874. A long term prospective study of cognitive function in patients with continuous flow LVADs is due. I would presume that some of the same organ dysfunction that we observe related to continuous flow in the kidney and GI tract also occur in the brain.
Kenton
Hello David, I did have any experience about patients with Left ventricular assist devices, but I agree about the quality of life and the increase about the anxiety and I have reading something about the memory disorders and executive function. My experience with stroke in young patients have contributed to agree with the hypothesis about that because they show at neuropsychological tests some decrease about these functions.
Mara
Recently one of our paper entitled "Life and Consciousness - The Vedāntic View" has been published in the Journal Communicative & Integrative Biology. An interesting discussion on this paper can be found at: https://groups.google.com/forum/#!topic/online_sadhu_sanga/Mcv2O-yhqLE
From paper:
"The scientific confirmation of the existence of consciousness in unicellular organisms and plants certainly establishes that the brain is not the source of consciousness. Several decades back, research in medical science has also proven that the brain is not the source of consciousness. In 1970, Robert White and his team successfully transferred the head of a rhesus monkey to the headless body of another monkey. The monkey survived for 8 days.68 Researchers are also attempting to perform the same scenario with human beings.69 It is reported that if a human head has been detached under controlled conditions, it must be reconnected to the circulatory flow of other person's body (which is conscious or living) within one hour.70 Therefore, brain-based analysis for understanding consciousness (neuronal analysis) does not have very bright prospects."
Paper: Life and Consciousness - The Vedāntic View
DOI: http://dx.doi.org/10.1080/19420889.2015.1085138
Journal: Communicative & Integrative Biology
Publication date - 09 Oct 2015
Author: Bhakti Niskama Shanta - http://orcid.org/0000-0002-2039-3249
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