Sepsis-Associated Encephalopathy: From Delirium to Dementia?

Abstract

Sepsis is a major cause of death in intensive care units worldwide. The acute phase of sepsis is often accompanied by sepsis-associated encephalopathy, which is highly associated with increased mortality. Moreover, in the chronic phase, more than 50% of surviving patients suffer from severe and long-term cognitive deficits compromising their daily quality of life and placing an immense burden on primary caregivers. Due to a growing number of sepsis survivors, these long-lasting deficits are increasingly relevant. Despite the high incidence and clinical relevance, the pathomechanisms of acute and chronic stages in sepsis-associated encephalopathy are only incompletely understood, and no specific therapeutic options are yet available. Here, we review the emergence of sepsis-associated encephalopathy from initial clinical presentation to long-term cognitive impairment in sepsis survivors and summarize pathomechanisms potentially contributing to the development of sepsis-associated encephalopathy.

Keywords: SAE; brain dysfunction; cognitive deficits; delirium; dementia; encephalopathy; long-term sequelae; pathophysiology; sepsis.

Figure 1

Schematic overview of probable pathophysiological and molecular alterations underlying sepsis-associated encephalopathy.

Figure 2

Symptoms, diagnostics, risk factors, and schematic overview of the cognitive performance in acute and chronic sepsis-associated encephalopathy (SAE).