Effects of sepsis on hippocampal volume and memory function

doi:10.5847/wjem.j.1920-8642.2020.04.004

Abstract

Abstract:

BACKGROUND: This study aimed to determine the effects of sepsis on brain integrity, memory, and executive function.

METHODS: Twenty sepsis patients who were not diagnosed with sepsis-associated encephalopathy (SAE) but had abnormal electroencephalograms (EEGs) were included. The control group included twenty healthy persons. A neuropsychological test of memory and executive function and a brain magnetic resonance imaging scan were performed. The volumes of cortex and subcortex were measured using the FreeSurfer software. Acute Physiology and Chronic Health Evaluation II (APACHE II) score was used to determine the disease severity.

RESULTS: In the sepsis group, the levels of immediate free recall, immediate cued recall, and delayed cued recall in the California Verbal Learning Test-II (CVLT-II) were significantly lower; the explicit memory (recollection process) in the process dissociation procedure test was lower; and the volumes of the left and right hippocampi were significantly lower compared with the control group. The volume of the presubiculum in the hippocampus of sepsis patients showed statistically significant decrease. In the sepsis group, the volumes of the left and right hippocampi were negatively correlated with the APACHE II score and positively with immediate free recall, immediate cued recall, and delayed cued recall in the CVLT-II; moreover, the hippocampal volume was significantly correlated with recollection but not with familiarity.

CONCLUSIONS: Patients with abnormal EEGs during hospitalization but with no SAE still have reduced hippocampal volume and memory deficits. This finding indicates that sepsis leads to damage to specific parts of the hippocampus.

Key words: Hippocampus, Magnetic resonance imaging, Memory, Sepsis-associated encephalopathy

Miao Yuan, Ding-yi Yan, Fang-shi Xu, Yi-di Zhao, Yang Zhou, Long-fei Pan. Effects of sepsis on hippocampal volume and memory function[J]. World Journal of Emergency Medicine, 2020, 11(4): 223-230.

Figures/Tables 4

Table 1

Figure 1.

Table 2

The volume of different brain regions (mm3)

Parameters	Sepsis patients (n=20)	Healthy people (n=20)	P-value
Left hippocampal subfields
Whole hippocampus	3,259.72±330.42	3,476.74±292.90	0.034
Subiculum	432.18±108.56	428.61±119.28	0.921
CA1	605.17±98.76	629.19±91.67	0.430
Presubiculum	254.18±61.79	308.78±79.61	0.020
Parasubiculum	72.89±14.72	76.54±19.61	0.510
CA3	241.65±58.67	274.63±62.31	0.093
CA4	286.19±72.06	291.03±68.47	0.829
Hippo-amyg transitional area	65.23±31.76	67.21±24.89	0.827
Molecular layer	576.87±101.27	591.72±98.16	0.640
Granule dentate gyrus cell layer	309.72±65.43	321.58±71.86	0.588
Right hippocampal subfields
Whole hippocampus	3,090.40±347.39	3,367.58±301.87	0.010
Subiculum	418.76±108.53	461.72±107.65	0.216
CA1	654.92±103.68	701.75±115.48	0.185
Presubiculum	308.72±95.46	392.87±86.78	0.005
Parasubiculum	61.65±31.76	67.82±29.74	0.530
CA3	239.74±81.65	261.76±76.49	0.384
CA4	254.82±107.83	286.65±132.74	0.410
Hippo-amyg transitional area	74.73±42.69	78.64±34.73	0.752
Molecular layer	599.78±98.67	621.76±107.64	0.505
Granule dentate gyrus cell layer	317.95±98.65	348.69±87.69	0.304
Left subcortical segmentation
Thalamus	7,243.76±498.57	6,935.64±512.87	0.061
Caudate	3,395.46±329.58	3,492.76±312.75	0.344
Putamen	5,349.82±806.63	5,437.65±798.67	0.731
Pallidum	1,498.47±419.54	1,529.03±452.93	0.826
Amygdala	1,743.67±489.73	1,728.44±521.64	0.925
Ventral diencephalon	3,598.43±112.54	3,655.64±101.65	0.100
Right subcortical segmentation
Thalamus	6,291.64±776.84	5,921.56±881.42	0.167
Caudate	3,154.87±89.76	3,345.26±92.65	0.089
Putamen	5,083.46±119.47	5,143.65±121.65	0.123
Pallidum	1,327.65±64.53	1,293.64±72.47	0.125
Amygdala	1,873.45±175.94	1,908.82±216.72	0.574
Ventral diencephalon	3,728.59±433.29	3,892.39±397.28	0.220

Table 2

Figure 2.

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Parameters	Sepsis patients (n=20)	Healthy people (n=20)	P-value
Sex (F:M)	8:12	9:11	0.749
Age (years)	57.60±3.46	55.80±4.41	0.159
Education (years)	13.50±5.12	12.70±4.87	0.616
LVEF	0.52±0.27	0.58±0.32	0.525
Hypertersion (Y:N)	9:11	10:10	0.752
DM (Y:N)	12:8	10:10	0.525
CHD (Y:N)	4:16	5:15	0.705
Smoking (Y:N)	12:8	16:4	0.168
NSAID use (Y:N)	3:17	1:19	0.292
APACHE II score	11.85	0	-

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