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Persistent cognitive impairment, hippocampal atrophy and EEG changes in sepsis survivors

Semmler, Alexander and Widmann, Catherin Nichols and Okulla, Thorsten and Urbach, Horst and Kaiser, Marcus and Widman, Guido and Mormann, Florian and Weide, Julia and Fliessbach, Klaus and Hoeft, Andreas and Jessen, Frank and Putensen, Christian and Heneka, Michael T. (2013) Persistent cognitive impairment, hippocampal atrophy and EEG changes in sepsis survivors. Journal Neurology, Neurosurgery, and Psychiatry, 84 (1). pp. 62-70. ISSN 0022-3050.

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Objectives: The objective of this preliminary study was to explore long-term changes in neurobehavioral parameters, brain morphology and electroencephalography of sepsis patients who received intensive care compared to non-septic intensive care unit (ICU) patients. Methods: Two-centre follow-up study 6–24 months after discharge from hospital using published norms and existing databases of healthy controls for comparison. Patients included 25 septic and 19 non-septic ICU survivors who were recruited from two ICUs of a university and community hospital. Measurements used include brain morphology, standard electroencephalography, cognition and psychiatric health and health-related quality of life. Results: Sepsis survivors showed cognitive deficits in verbal learning and memory and had a significant reduction of left hippocampal volume compared to healthy controls. Moreover, sepsis and to some extent non-septic ICU patients had more low-frequency activity in the EEG indicating unspecific brain dysfunction. No differences were found in health-related quality of life, psychological functioning or depressive symptoms, and depression could be ruled out as a confounding factor. Conclusions: This study demonstrates permanent cognitive impairment in several domains in both septic and non-septic ICU survivors and unspecific brain dysfunction. In the sepsis group, left-sided hippocampal atrophy was found compared to healthy controls. Further study is needed to clarify what contribution sepsis and other factors at the ICU make to these outcomes. Specific neuroprotective therapies are warranted to prevent persisting brain changes in ICU patients.

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Mormann, Florian0000-0003-1305-8028
Additional Information:© 2013 BMJ Publishing Group Ltd. Received 24 April 2012; Revised 24 August 2012; Accepted 28 August 2012; Published Online First; 7 November 2012. We wish to thank Dr Lukas Scheef, MD, of the Radiology Department at the University Hospital of Bonn for discussion of the radiological data and to Dr Malte Bewersdorff, MD, of the Neurology Department at the University Hospital of Bonn for study and technical assistance with MRI and EEG data. Thank you to Dr Rolf Fimmers, of the Biometry Department at the University Hospital of Bonn for statistical consultation. We also thank Alexandra Lindlau, medical student at the University Hospital of Bonn, for acquisition of clinical data from patient files. Contributors: AS: study concept, acquisition of data, drafting/revising manuscript; CNW: drafting/revising manuscript, statistical analysis and interpretation of demographic, clinical, cognitive, psychiatric, life quality and MRI data; TO: study concept, acquisition of data; HU: study concept, acquisition and interpretation of MRI data; MK: study concept, patient selection, patient contact/follow-up, acquisition of data and revision of the manuscript for intellectual content; GW: analysis and interpretation of EEG data; FM: study concept, acquisition and analysis of EEG data; JW: acquisition and interpretation of cognitive data; KF: study concept, interpretation of the data, revising manuscript for intellectual content; AH: acquisition and interpretation of data; FJ: acquisition of MRI data, analysis and interpretation of MRI data, revising manuscript for intellectual content; CP: acquisition of data, revising manuscript for intellectual content; MTH: Guarantor, study concept, study supervision, drafting/revising manuscript for intellectual content. Funding: This work was supported by a grant from the German Research Council (DFG, Clinical Research Group 177) to MTH.
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Deutsche Forschungsgemeinschaft (DFG)UNSPECIFIED
Issue or Number:1
Record Number:CaltechAUTHORS:20130118-102237640
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Usage Policy:No commercial reproduction, distribution, display or performance rights in this work are provided.
ID Code:36472
Deposited By: Jason Perez
Deposited On:22 Jan 2013 18:50
Last Modified:03 Oct 2019 04:38

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