Severe sepsis can lead to memory problems

Advances in intensive care medicine are helping older Americans survive severe sepsis, an overwhelming infection, but according to new research these survivors are often left with major memory problems and physical limitations for years after their infection.

Researchers presenting their findings in the Journal of the American Medical Association found that even older adults who were functioning independently before sepsis often came home from the hospital needing full time care because they now had pre-dementia.

"If you look at the risk of moderate to severe cognitive impairment, people with severe sepsis were three times more likely to develop that after sepsis than before," says study author Theodore Iwashyna, critical care doctor at the University of Michigan Medical School.

The study monitored the health of more than 1,000 older adults who developed sepsis, comparing their physical and mental capabilities when healthy to those after they got sick. The researchers used data from a study nationally representative of older Americans called the Health and Retirement Study and had access to years of detailed health information on the patients.

Previous research often attributed declines in mental and physical health after sepsis to underlying health problems beforehand. But these researchers, finding that even healthy, mentally sharp adults experienced significant declines, suggest that the sepsis itself and the treatment strategies afterwards may be playing a major role in the downturns in health.

"This new disability that people develop is often associated with 40 hours of care a week. People come home from the hospital after having survived and their loved ones have a new full time job," explains Iwashyna. "Overall 60 percent of people had worse function afterwards than they did before," he adds.

Dr. Derek Angus, chairman of the Department of Critical Care Medicine at the University of Pittsburgh School of Medicine, wrote an accompanying editorial. He has no ties to the current study and says the research may help change current medical practice. "The major advance in this study is it took a concern that was being raised amongst a number of investigators, but a concern that couldn't be proven and has shown this is very likely a real phenomenon," he said.

Severe sepsis is the most common non-heart related reason for a person to end up in a hospital's intensive care unit. More than 750,000 people in the United States are affected by this condition each year, mostly the elderly. Iwashyna says sepsis can develop in patients with a wide range of illnesses such as pneumonia, diabetes, urinary tract infections, those with compromised immune systems and other health problems.

When someone develops sepsis, instead of attacking the infection at the site, the body mounts an overly aggressive immune response and ends up turning on itself, often damaging vital organs such as the heart, lungs and kidneys. If blood pressure drops too drastically doctors suspect the brain and other vital organ don't get enough oxygen to function properly often leaving people physically and mentally impaired.

Iwashyna says more research is needed to develop better treatment strategies for patients with severe sepsis and therapies to minimize the mental and physical impairments seen in patients. In the mean time he suggests people try to prevent the condition by getting pneumonia and flu vaccines and, if diabetic, getting excellent care.

If a loved one does develop sepsis, it's important to talk to your doctor about physical mobility and rehabilitation exercises, but just as importantly, strategies and therapies to help the brain function better.