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Open Access Study protocol

Long-term sequelae of severe sepsis: cognitive impairment and structural brain alterations – an MRI study (LossCog MRI)

Theresa Götz13*, Albrecht Günther23, Otto W Witte23, Frank M Brunkhorst34, Gundula Seidel35 and Farsin Hamzei35

Author Affiliations

1 Biomagnetic Center, Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany

2 Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany

3 Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany

4 Paul-Martini-Clinical Sepsis Research Unit, Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany

5 Moritz Klinik GmbH & Co. KG, Department of Neurology, Bad Klosterlausnitz, Germany

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BMC Neurology 2014, 14:145  doi:10.1186/1471-2377-14-145

Published: 15 July 2014

Abstract

Background

The number of patients with cognitive impairment after sepsis or septic shock is high. However, the underlying neurophysiological basis of sepsis induced cognitive impairment is not fully understood.

Methods/Design

This is a prospective, controlled observational study. We are in the process of recruiting 25 survivors of severe sepsis or septic shock who will be investigated with functional MRI (fMRI), T1-weighted MRI und Diffusion Tensor Imaging (DTI) as well as Magnetoencephalography (MEG). Furthermore, patients will undergo neuropsychological evaluation using the DemTect and the clock drawing tests. In addition, verbal and declarative memory is assessed by the Verbal Learning and Memory Test. The primary aim is to determine the volumetry of the amygdala and the hippocampus. The secondary aim is to analyze the relationship between cognitive tests and MEG, and the (f)MRI results. Moreover, a between-group comparison will be evaluated to an age-matched group of healthy controls.

Discussion

In a previous MEG study, we observed a significant slowing of the prominent background activity in sepsis survivors and hepatic encephalopathy patients in particular shortly after discharge from the ICU. Intriguingly, the rhythmic brain activity after visual flickering stimulation was altered in sepsis survivors in comparison to age-matched healthy volunteers. We propose that this desynchronization is based on affected underlying neuronal responses between various interconnected brain regions. The current project will analyze whether the modifications are related to a damage of the fibers connecting different brain regions or to a disturbance of the functional interaction between different brain regions or even due to an atrophy of certain brain regions.

Trial registration

“Langzeitfolgen nach schwerer Sepsis: Kognitive Beeinträchtigungen und strukturelle Veränderungen am Gehirn, eine MRT Studie”; German Clinical Trials Register (DRKS00005484).

Keywords:
Magnetoencephalography (MEG); Magnet resonance imaging (MRI); fMRI; Neuropsychological tests; Severe sepsis and septic shock