This mental fuzziness was akin to a really bad hangover. Even at the time I could not pull apart the mental deficits from the physical ones. I could hardly stand, my hands shook because of muscle loss, and I was always out of breath. None of that is conducive to feeling and being mentally sharp.I pushed my rehabilitation very hard selleck catalog and 8 months after discharge, apparently back to something approximating normal, I gave a talk to the philosophy heavyweights in Oxford. It was a disaster. I seemed not to have the lung capacity to speak to a large audience, and I felt unable to grasp the complex and tough questions that were thrown at me. I could see the shape of the question (‘That’s the objection from the principle of bivalence. I know what I have to say about that.’), but I couldn’t actually formulate the answer.

Things got better with each subsequent talk, but it still isn’t clear to me whether this gradually improving problem was cognitive dysfunction, a lack of confidence, or a physical/pulmonary deficit.What I want to point to is a potential looping effect, which might further skew the estimation of rates of cognitive impairment. For those who are suffering from mental fuzziness, the inference that one is permanently cognitively damaged sits there, waiting to be drawn. Drawing it, I suggest, might also affect the results of neurocognitive tests to which the patient is subjected. Studies show that the impact of stereotypes and expectations of how one is likely to perform affect performance on cognitive function tests [22].

We also know from our own experience how confidence is fragile and interwoven with success. Not being sure that you can hit that backhand drive results in a truncated and useless shot; not being confident about speaking in public diminishes your performance. Thinking that you are likely to be cognitively impaired may affect your performance on cognitive function tests. Indeed, the very fact that the medical community is interested in your neurocognitive status is an alert that there is an expectation of cognitive damage.Practical and ethical upshotsIt might be asked whether poor performance, induced either by some organic/biochemical problem (such as hypoxia or liver failure) or by some functional problem (such as psychological fallout from delirium, fatigue, or a lack of confidence), is poor performance nonetheless.

That is, whatever the cause, the brain is not working properly and there is impairment. However, the difference in what induces poor performance plays out both in terms of interventions and ethical outcomes.If the injury in a particular case is such that there is no actual physical damage to the brain, AV-951 but rather a reversible metabolic injury, then it might be advisable for the patient to engage in cognitive and cardiovascular exercises to improve mental functioning.