November 7, 2013 - Volume 13 - Issue 21
pp: 1-42


Creator: Neurology Today
Duration: 8:38
Journal: Neurology Today November 7, 2013, Volume 13, Issue 21;
The DDR, a standard established in the 1960s to safeguard critically ill patients and their families from unethical practices in organ donation, ensured that patients were declared dead — applying criteria for cardiac and brain death — before any organs could be removed for donation. In opposing perspectives in the Oct. 3 issue of the New England Journal of Medicine, two neuroethicists offer reasons why the standard should or should not be changed. Now, in an exclusive video interview, Neurology Today Editor-in-chief Steven P. Ringel, MD, and Associate Editor Robert G. Holloway Jr., MD, provide insights to these, among other, questions: Is the DDR still relevant? Should patients and their families be allowed the autonomy to opt for donation before death?

If the rule changes, how would that affect laws and medical practice? Watch the video for more discussion about the standards in place for the DDR, concerns about the variability in applying criteria for brain death, and the issue of patient autonomy in the context of shortages of organs for donation. For discussion from other leading neuroethicists and neurointensivists, read the Nov. 7 Neurology Today article, “A Matter of Debate: Is it Time to Revisit the Dead Donor Rule?”

Creator: Neurology Today
Duration: 7:16
Journal: Neurology Today November 7, 2013, Volume 13, Issue 21;

Two separate studies have identified metabolic syndrome and time spent in the intensive care unit (ICU) as independent risk factors for cognitive decline. The first analysis, which used data on 2,975 people, ages 60 and older, from the Centers for Disease Control and Prevention’s National Health and Nutrition Examination Survey, found that those respondents with metabolic syndrome had an odds ratio of 1.40 for cognitive decline, compared to those without metabolic syndrome (p=.034). These data were presented at the American Neurological Association’s annual meeting last October; the full discussion and findings are available here: http://bit.ly/IFc3y9.

The second report, from the Bringing to Light the Risk Factors and Incidence of Neuropsychological Dysfunction in ICU Survivors (BRAIN-ICU) study, found that among 821 adult patients who had experienced episodes of delirium while in the ICU for respiratory failure, cardiogenic or septic shock, although only 6 percent had cognitive deficits at baseline, more than 50 percent developed measurable symptoms of cognitive impairment three and 12 months after discharge. The findings were reported in the Oct. 3 issue of the New England Journal of Medicine, and in a Nov. 7 article in Neurology Today: http://bit.ly/IKCJ10.

Here, in a video interview, Neurology Today Editor-in-chief Steven P. Ringel, MD, and Associate Editor Robert G. Holloway Jr., MD, MPH, provide insights into these two analyses, and discuss their potential clinical implications for treating patients in the ICU setting and after discharge.