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Mitzi L. Wasserstein, M.D.

Title: Assistant Professor, Clinical
Current Position: Staff Psychiatrist, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT

Education/Training

• B.S. 1989, Duke University
• M.D. 1993, Wake Forest University
• Psychiatry Residency 1993-1997, University of Utah

Certifications

• American Board of Psychiatry & Neurology (Psychiatry), Certified 1999

Honors

• Phi Beta Kappa, Duke University 1988
• Dean's List with Distinction, Duke University 1988
• Allison Bracey Von Brock Teaching Assistantship for the Duke University Talent Identification 1988
• Magna Cum Laude, Duke University 1988
• Senior Psychiatry Resident, VASLCHCS 1995

Publications

• Thilo EH, Andersen D, Wasserstein ML, Schmidt J, Luckey D. (1993). Saturation by pulse oximetry: comparison of the results obtained by instruments of different brands. J Pediatr, 122(4), 620-6.
• Gingras JL, Long WA, Segreti T, Wasserstein M. (1995). Pre- and postnatal effects of chronic maternal hypoxia on substance-P immunoreactivity in rabbit brainstem regions. Dev Neurosci, 17(5-6), 350-6.
• Wasserstein ML, Hedges DW. (1995). Neurovascular anomaly in a patient with VATER association: coincident or syndromal? [Letter to the editor]. Am J Med Genet, 58(4), 38

Academic Activities

• Delirium, also called “ICU psychosis” or “acute confusional state” is present in 10-30% of the hospitalized medically ill and 60-80% of ICU patients, but it often goes unrecognized.  Delirium is best defined as a disturbance of consciousness with reduced ability to focus, sustain or shift attention.  This disturbance tends to fluctuate throughout the day, such that a patient may be lucid and fully oriented at one point in the day, but is difficult to arouse and/or disoriented several hours later.  The Veteran population is at even higher risk for delirium due to a high incidence of increased age with associated multiple medical problems and cognitive impairment (eg. dementia).   Acute medical issues prompting admission, as well as medications, surgery, restraints, mechanical ventilation, disrupted sleep, etc. frequently are enough to tip the scale to delirium.  Delirium can prolong hospitalization and contribute to medical complications.  It has also been shown to contribute to new or exacerbate prior cognitive impairment, and that impairment may accompany the patient when they return home and attempt to resume their previous activities.  There is a lack of scientific data about the relationships between delirium and long-term cognitive impairment (LTCI), and I believe it is vital to gather this data so that we can better understand and prevent long-term impairment.  I am working with the ICU Delirium and Cognitive Impairment Study Group at Vanderbilt University and the Tennessee Valley VAMC as the VASLCHCS Co-Principal Investigator in a multi-center, VA merit grant funded study entitled “MIND-ICU (Measuring the Incidence and Determining Risk Factors for Neuropsychological Dysfunction in ICU Survivors).” This will be the first study to define the epidemiology of and identify modifiable risk factors for LTCI and functional deficits of ICU survivors.
• MIND-ICU (Measuring the Incidence and Determining Risk Factors for Neuropsychological Dysfunction in ICU Survivors) will measure the independent contribution of risk factors such as delirium and exposure to sedative and analgesic medications to the incidence of long-term CI, controlling for established risk factors (e.g., age, pre-existing cognitive impairment, and apoE genotype).  Defining the contributions of these risk factors will make it possible to develop preventive and/or treatment strategies to reduce the incidence, severity and/or duration of long-term cognitive impairment (LTCI) and improve functional recovery of patients with acute critical illness.  We hypothesize that 1) duration of delirium is causally associated with LTCI in patients at 3 and 12 months post ICU discharge, 2) sedative and analgesic exposure will be independently related to LTCI at 3 and 12 months post ICU discharge, 3) duration of delirium is independently associated with impaired health related quality of life (HRQL) and functional status, and 4) the extent of sedative and analgesic medication exposure will be independently related to HRQL and functional status. To test these hypotheses, we are conducting a prospective cohort study of mechanically ventilated adults that will be monitored daily for delirium and sedative and analgesic medication exposure.  Relative covariates will be measured, and survivors will be studied via neuropsychological testing and questionnaires at 3 and 12 months after discharge to determine incidence, severity, and duration of LTCI, HRQL, functional status, and frailty.  The battery of neuropsychological tests and questionnaires has high sensitivity to even mild levels of cognitive impairment and has well-described population norms and excellent validity and reliability.  Premorbid cognitive status, mental health, quality of life, and functional status will be assessed via chart review, discussion with patient and significant others, questionnaires, and neuropsychological testing instruments.  A small amount of blood will be drawn for analysis (for levels of sedative medications and genomic data).   There are no interventions involved.

Websites

• http://icudelirium.org/delirium/index.html