Cerebral dysfunctions caused by sepsis during ageing.

Area of Science:

• Neurology
• Critical Care Medicine
• Neuroinflammation

Background:

• Sepsis-associated encephalopathy (SAE) is a common acute cerebral dysfunction in sepsis patients.
• SAE exhibits a dynamic trajectory, with some patients experiencing sustained cognitive impairments post-sepsis.

Purpose of the Study:

• To summarize chronic pathology and cognitive changes following sepsis onset.
• To outline the cerebral effects of sepsis, including neuroinflammation, synaptic alterations, and neurovascular changes.
• To discuss factors contributing to SAE development and persistence, particularly in older adults.

Main Methods:

• Literature review and synthesis of existing evidence on sepsis-associated encephalopathy.
• Analysis of chronic pathology, cognitive function dynamics, and cerebral effects of sepsis.
• Identification and discussion of contributing factors to SAE, including patient-specific and treatment-related elements.

Main Results:

• SAE affects up to 50% of intensive care unit sepsis patients.
• Cognitive impairments can persist for several years after sepsis.
• Potential contributing factors include neuroinflammation, synaptic dysfunction, neurovascular changes, premorbid neurodegeneration, sedatives, renal dysfunction, and viral reactivation.

Conclusions:

• The mechanisms underlying SAE neuropathology may overlap with those in delirium and long-term cognitive deficits seen in severe COVID-19.
• Understanding SAE's dynamic nature and contributing factors is crucial for patient management.
• Further research is needed to elucidate the precise mechanisms and identify therapeutic targets.