Delirium pathophysiology: An updated hypothesis of the etiology of acute brain failure

International Journal of Geriatric Psychiatry, Journal Year: 2017, Volume and Issue: 33(11), P. 1428 - 1457

Published: Dec. 26, 2017

Delirium is the most common neuropsychiatric syndrome encountered by clinicians dealing with older adults and medically ill best characterized 5 core domains: cognitive deficits, attentional circadian rhythm dysregulation, emotional alteration in psychomotor functioning.An extensive literature review consolidation of published data into a novel interpretation known pathophysiological causes delirium.Available suggest that numerous pathological factors may serve as precipitants for delirium, each having differential effects depending on patient-specific patient physiological characteristics (substrate). On basis an search, newly proposed theory, systems integration failure hypothesis, was developed to bring together salient previously described theories, describing various contributions from complex web pathways-highlighting areas intersection commonalities explaining how variable contribution these lead development behavioral dysfunctions characteristic delirium. The specific manifestations delirium picture result combination neurotransmitter function availability, variability processing sensory information, motor responses both external internal cues, degree breakdown neuronal network connectivity, hence term acute brain failure.The hypothesis attempts explain pathophysiologic theories interact other, causing clinically observed phenotypes. A better understanding underlying pathophysiology eventually assist designing prevention management approaches.

Language: Английский

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Delirium

Annals of Internal Medicine, Journal Year: 2020, Volume and Issue: 173(7), P. ITC49 - ITC64

Published: Oct. 5, 2020

Delirium is an acute confusional state that common and costly associated with significant functional decline distress. It the manifestation of encephalopathy variably called brain failure, dysfunction, or altered mental status. All patients are at risk for delirium, although those more vulnerabilities (such as advanced age, exposures to other stressors like infection, certain medications) higher risk. The pathophysiologic cause delirium not well understood. important recognize immediately identify treat factors contributing it. There no single intervention medication making it challenging manage. Therefore, mitigation prompt treatment rely on a sophisticated strategy address factors. may be prevented attenuated when multimodal strategies used, thereby improving patient outcomes.

Language: Английский

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Predisposing and Precipitating Factors Associated With Delirium

JAMA Network Open, Journal Year: 2023, Volume and Issue: 6(1), P. e2249950 - e2249950

Published: Jan. 6, 2023

Despite discrete etiologies leading to delirium, it is treated as a common end point in hospital and clinical trials, delirium research may be hampered by the attempt treat all instances of similarly, leaving management an unmet need. An individualized approach based on unique patterns pathophysiology, reflected predisposing factors precipitants, necessary, but there exists no accepted method grouping into distinct etiologic subgroups.To conduct systematic review identify potential precipitating associated with adult patients agnostic setting.A literature search was performed PubMed, Embase, Web Science, PsycINFO from database inception December 2021 using Medical Subject Headings (MeSH) terms consciousness disorders, confusion, causality, disease susceptibility, constraints cohort or case-control studies. Two reviewers selected studies that met following criteria for inclusion: published English, prospective study, at least 50 participants, assessment person physician trained personnel reference standard, results including multivariable model independent delirium.A total 315 were included mean (SD) Newcastle-Ottawa Scale score 8.3 (0.8) out 9. Across 101 144 (50 006 [50.0%] male 49 766 [49.1%] female patients) represented (24 015 delirium), reported 33 112 delirium. There diversity substantial physiological heterogeneity.In this review, comprehensive list found across settings. These findings used inform more precise study delirium's heterogeneous pathophysiology treatment.

Language: Английский

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Clinical Assessment and Management of Delirium in the Palliative Care Setting

Drugs, Journal Year: 2017, Volume and Issue: 77(15), P. 1623 - 1643

Published: Sept. 1, 2017

Delirium is a neurocognitive syndrome arising from acute global brain dysfunction, and prevalent in up to 42% of patients admitted palliative care inpatient units. The symptoms delirium its associated communicative impediment invariably generate high levels patient family distress. Furthermore, with significant morbidity increased mortality many populations, especially where refractory common the dying phase. As clinical diagnosis frequently missed by healthcare team, case for regular screening arguably very compelling. Depending on precipitating factors, episode often reversible, earlier stages life-threatening illness. Until recently, antipsychotics have played pivotal role management, but this now requires critical re-evaluation light recent research that failed demonstrate their efficacy mild- moderate-severity occurring patients. Non-pharmacological strategies management play fundamental should be optimized through collective efforts whole interprofessional team. Refractory agitated last days or weeks life may require use pharmacological sedation ameliorate distress patients, which juxtaposed increasing members. Further evaluation multicomponent prevention treatment population urgently required.

Language: Английский

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Delirium

American Journal of Psychiatry, Journal Year: 2019, Volume and Issue: 176(10), P. 785 - 793

Published: Oct. 1, 2019

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Applying machine learning to continuously monitored physiological data

Journal of Clinical Monitoring and Computing, Journal Year: 2018, Volume and Issue: 33(5), P. 887 - 893

Published: Nov. 11, 2018

Language: Английский

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Perioperative dexmedetomidine administration to prevent delirium in adults after non-cardiac surgery: A systematic review and meta-analysis

Journal of Clinical Anesthesia, Journal Year: 2021, Volume and Issue: 73, P. 110308 - 110308

Published: April 28, 2021

Language: Английский

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Postoperative delirium in geriatric patients with hip fractures

Frontiers in Aging Neuroscience, Journal Year: 2022, Volume and Issue: 14

Published: Dec. 22, 2022

Postoperative delirium (POD) is a frequent complication in geriatric patients with hip fractures, which linked to poorer functional recovery, longer hospital stays, and higher short-and long-term mortality. Patients increased age, preoperative cognitive impairment, comorbidities, perioperative polypharmacy, delayed surgery are more prone develop POD after fracture surgery. In this narrative review, we outlined the latest findings on postoperative focusing its pathophysiology, diagnosis, prevention, treatment. Perioperative risk prediction, avoidance of certain medications, orthogeriatric comprehensive care all examples effective interventions. Choices anesthesia technique may not be associated significant difference incidence fractures. There few pharmaceutical measures available for Dexmedetomidine multimodal analgesia managing delirium, adverse complications should considered when using antipsychotics. conclusion, intervention based most strategy preventing

Language: Английский

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The association between the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio and delirium in ischemic stroke patients

Frontiers in Medicine, Journal Year: 2025, Volume and Issue: 11

Published: Jan. 6, 2025

Delirium is a severe neuropsychiatric symptom following acute ischemic stroke (IS) and associated with poor outcomes. Systemic inflammation immune dysregulation are believed to contribute the pathophysiology of delirium. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte (PLR), lymphocyte-to-monocyte (LMR) widely recognized as convenient reliable biomarkers systemic inflammation. However, their association delirium after IS remains unclear. In this study, we identified patients requiring ICU admission from Medical Information Mart for Intensive Care (MIMIC)-IV database. We employed multivariable logistic regression restricted cubic splines (RCS) assess between NLR, PLR, LMR Two-sample Mendelian randomization (MR) analysis was performed further explore causal relationship at genetic level. A total 1,436 were included in whom 214 (14.9%) had multivariate analysis, adjustment confounders, highest quartile NLR (odds [OR] 2.080, 95% confidence interval [CI], 1.282-3.375) (OR 0.503, CI 0.317-0.798) second PLR 1.574, 1.019-2.431) significantly RCS function showed progressive increase risk higher lower LMR. MR only negatively observational studies found significant associations demonstrated potential protective Further prospective needed validate elucidate underlying mechanisms.

Language: Английский

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A Critical Reappraisal of Haloperidol for Delirium Management in the Intensive Care Unit: Perspective from Psychiatry

Journal of Clinical Medicine, Journal Year: 2025, Volume and Issue: 14(2), P. 438 - 438

Published: Jan. 11, 2025

Delirium is a complex neuropsychiatric syndrome with multifactorial pathophysiology, encompassing wide range of symptoms, and its management remains significant challenge in critical care. Although often managed antipsychotics, like haloperidol, current research has predominantly focused on dopamine dysregulation as the primary driver delirium, overlooking broader neuroanatomical neurochemical underpinnings. This led to majority focusing haloperidol treatment for intensive care unit (ICU) delirium. Our review critically evaluates role ICU delirium management, particularly light recent large-scale randomized controlled trials (RCTs) that have primarily delirium-free days mortality endpoints. These studies highlight an limited understanding true nature treatment, which requires broader, approach. We argue future should shift focus symptoms such agitation psychosis explore clinical functional benefits reducing these distressing symptoms. Additionally, stratification by subtypes etiology, enhancement detection tools, adoption multi-intervention multi-disciplinary approaches be prioritized. Despite methodological flaws studies, findings support safety setting, minimal risk adverse events, cardiac neuropsychiatric. Moving forward, must integrate modern neuroscientific adopt more input nuanced, patient-centered truly advance outcomes.

Language: Английский

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