Perioperative Research into Memory (PRiMe): Cognitive impairment following a severe burn injury and critical care admission, part 1

Watson, Edward; Nenadlová, Klára; Clancy, Olivia; Farag, Mena; Nordin, N; Nilsen, Agnes; Mehmet, Ashley R.T.; Mandalia, Sundhiya; Williams, Lisa; Edginton, Trudi; Vizcaychipi, Marcela P.

doi:10.1016/j.burns.2018.04.011

Cited by 11 publications

(7 citation statements)

References 83 publications

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“…Of notice, this study showed that cognitive problems after burns persist beyond 18 months in about 35% of the patients, a health domain that has been scarcely studied in burn patients. A prior study reported cognitive problems in burn patients 2 years post-burn [40] and another study indicated that 16.6% of patients with minor burns and 33.3% of patients with severe burns experienced cognitive problems 5-7 years post-burn [41]. A positive association between PTSD symptoms and cognitive problems may be expected, because adults with PTSD show deficits in cognitive processes such as attention and executive functions [42,43].…”

Section: Discussionmentioning

confidence: 96%

Individual recovery of health-related quality of life during 18 months post-burn using a retrospective pre-burn measurement: an exploratory study

et al. 2020

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Purpose This study explored the individual trajectories of health-related quality of life (HRQL) compared to recalled pre-burn level of HRQL and investigated whether burn severity and post-traumatic stress disorder (PTSD) symptoms increase the risk of not returning to pre-burn level of HRQL. Methods Data were obtained from 309 adult patients with burns in a multicenter study. Patients completed the EQ-5D-3L questionnaire with a Cognition bolt-on shortly after hospital admission, which included a recalled pre-injury measure, and, again, at 3, 6, 12 and 18 months post-burn. Burn severity was indicated by the number of surgeries, and PTSD symptoms were assessed with the IES-R at three months post-burn. Pre- and post-injury HRQL were compared to norm populations. Results Recalled pre-injury HRQL was higher than population norms and HRQL at 18 months post-burn was comparable to population norms. Compared to the pre-injury level of functioning, four HRQL patterns of change over time were established: Stable, Recovery, Deterioration, and Growth. In each HRQL domain, a subset of patients did not return to their recalled pre-injury levels, especially with regard to Pain, Anxiety/Depression, and Cognition. Patients with more severe burns or PTSD symptoms were less likely to return to pre-injury level of functioning within 18 months post-burn. Conclusion This study identified four patterns of individual change. Patients with more severe injuries and PTSD symptoms were more at risk of not returning to their recalled pre-injury HRQL. This study supports the face validity of using a recalled pre-burn HRQL score as a reference point to monitor HRQL after burns.

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Section: Discussionmentioning

confidence: 96%

Individual recovery of health-related quality of life during 18 months post-burn using a retrospective pre-burn measurement: an exploratory study

et al. 2020

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“…Burns have been shown to induce cognitive impairment and abnormal behavior (4,(8)(9)(10)(11)(12). Given the fact that BBB dysfunction is the key factor in cognitive impairment (50)(51)(52)(53)(54)(55)(56)(57) and that MSCs can effectively improve the integrity of BBB, we investigated whether burns could induce BBB dysfunction and neuroinflammation as well as evaluated its potential mechanism and the best time point for intervention to improve these effects after burn.…”

Section: Discussionmentioning

confidence: 99%

“…Cognitive dysfunction caused by peripheral trauma has been frequently reported, especially postoperative cognitive dysfunction (1)(2)(3) and cognitive dysfunction after burns (4)(5)(6)(7)(8)(9)(10)(11)(12). These severe central nervous system (CNS) complications burden the patients' families and the society.…”

Section: Introductionmentioning

confidence: 99%

Burns Impair Blood-Brain Barrier and Mesenchymal Stem Cells Can Reverse the Process in Mice

Yang

Zhang

et al. 2020

Front. Immunol.

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Neurological syndromes are observed in numerous patients who suffer burns, which add to the economic burden of societies and families. Recent studies have implied that bloodbrain barrier (BBB) dysfunction is the key factor that induces these central nervous system (CNS) syndromes in peripheral traumatic disease, e.g., surgery and burns. However, the effect of burns on BBB and the underlying mechanism remains, largely, to be determined. The present study aimed to investigate the effect of burns on BBB and the potential of umbilical cord-derived mesenchymal stem cells (UC-MSCs), which have strong antiinflammatory and repairing ability, to protect the integrity of BBB. BBB permeability was evaluated using dextran tracer (immunohistochemistry imaging and spectrophotometric quantification) and western blot, interleukin (IL)-6, and IL-1b levels in blood and brain were measured by enzyme-linked immunosorbent assay. Furthermore, transmission electron microscopy (TEM) was used to detect transcellular vesicular transport (transcytosis) in BBB. We found that burns increased mouse BBB permeability to both 10-kDa and 70-kDa dextran. IL-6 and IL-1b levels increased in peripheral blood and CNS after burns. In addition, burns decreased the level of tight junction proteins (TJs), including claudin-5, occludin, and ZO-1, which indicated increased BBB permeability due to paracellular pathway. Moreover, increased vesicular density after burns suggested increased transcytosis in brain microvascular endothelial cells. Finally, administering UC-MSCs at 1 h after burns effectively reversed these adverse effects and protected the integrity of BBB. These results suggest that burns increase BBB permeability through both paracellular pathway and transcytosis, the potential mechanism of which might be through increasing IL-6 and IL-1b levels and decreasing Mfsd2a level, and appropriate treatment with UC-MSCs can reverse these effects and protect the integrity of BBB after burns.

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“…In addition, patients with severe burn injury are more likely to be hospitalized in the intensive care unit (ICU), having a higher risk of long-term cognitive impairments with common symptoms of memory defects (Duggan et al, 2017). The memory defects became the most distressing problems in these patients discharged from ICU (Pandharipande et al, 2013;Duggan et al, 2017), which affected up to two-thirds of patients (Wolters et al, 2013) and last for at least 2 years (Watson et al, 2018).…”

Section: Clinical Presentations and Outcomes Of Post-burn Cognitive S...mentioning

confidence: 99%

Researches on cognitive sequelae of burn injury: Current status and advances

Xie

Cheng

et al. 2022

Front. Neurosci.

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Burn injury is a devastating disease with high incidence of disability and mortality. The cognitive dysfunctions, such as memory defect, are the main neurological sequelae influencing the life quality of burn-injured patients. The post-burn cognitive dysfunctions are related to the primary peripheral factors and the secondary cerebral inflammation, resulting in the destruction of blood-brain barrier (BBB), as is shown on Computed Tomography (CT) and magnetic resonance imaging examinations. As part of the neurovascular unit, BBB is vital to the nutrition and homeostasis of the central nervous system (CNS) and undergoes myriad alterations after burn injury, causing post-burn cognitive defects. The diagnosis and treatment of cognitive dysfunctions as burn injury sequelae are of great importance. In this review, we address the major manifestations and interventions of post-burn cognitive defects, as well as the mechanisms involved in memory defect, including neuroinflammation, destruction of BBB, and hormone imbalance.

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Perioperative Research into Memory (PRiMe): Cognitive impairment following a severe burn injury and critical care admission, part 1

Abstract: Severe burns injuries are associated with a significant, global, cognitive deficit. Patients also report worse QoL, depression and post-traumatic stress. Perceived QoL from cognitive impairment was more closely associated with depression than cognitive impairment.

Cited by 11 publications

References 83 publications

Individual recovery of health-related quality of life during 18 months post-burn using a retrospective pre-burn measurement: an exploratory study

Individual recovery of health-related quality of life during 18 months post-burn using a retrospective pre-burn measurement: an exploratory study

Burns Impair Blood-Brain Barrier and Mesenchymal Stem Cells Can Reverse the Process in Mice

Researches on cognitive sequelae of burn injury: Current status and advances

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