Occurrence of Delirium in Different Regional Brain Syndromes

Robertsson, Barbro; Olsson, Lis; Wallin, Anders

doi:10.1159/000017132

Cited by 17 publications

(6 citation statements)

References 24 publications

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“…Delirium research has only recently begun to employ neuroimaging. The studies described herein are beginning to provide evidence that delirium may be caused by widespread brain dysfunction rather than localized disruption [17,18]. Further evidence suggests that this may lead to cell death in the central nervous system (CNS).…”

Section: Neuroimaging and Neuroanatomic Correlates Of Deliriummentioning

confidence: 97%

“…Furthermore, there were even greater CBF decreases in subcortical and occipital regions [19]. This overall decrease in CBF suggests that delirium may, indeed, manifest via widespread brain dysfunction rather than localized disruption [17,18]. Additionally, global hypoperfusion would have the potential to cause several of the long-term changes associated with prolonged delirious states, including autophagy [36,37] and long-term cognitive impairment (LTCI) [38,39].…”

Section: Functional Neuroimaging During Acute Deliriummentioning

confidence: 99%

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Pathophysiology of Delirium in the Intensive Care Unit

Gunther

Morandi

Ely

2008

Critical Care Clinics

153

101

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Section: Neuroimaging and Neuroanatomic Correlates Of Deliriummentioning

confidence: 97%

Section: Functional Neuroimaging During Acute Deliriummentioning

confidence: 99%

Pathophysiology of Delirium in the Intensive Care Unit

Gunther

Morandi

Ely

2008

Critical Care Clinics

153

101

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“…Delirium is associated more with late onset Alzheimer’s disease and vascular dementia than with early onset Alzheimer’s disease or frontotemporal dementia 67. Even so, while seen with posterior hemispherical strokes,68 there is no association with regional brain syndromes 69. This conceptualisation would also suggest that impairments may range from peripheral (for example musculature) (through the brainstem) to central (frontoparietal cortex).…”

Section: Synthesismentioning

confidence: 99%

Delirium as a disorder of consciousness

Bhat

Rockwood²

2007

Journal of Neurology, Neurosurgery & Psychiatry

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Delirium is a common clinical phenomenon, often described as a disorder of consciousness. Delirium is commonly under recognised. The usual response to under recognition is to exhort practitioners to do a better job, but perhaps under recognition should instead be seen as a daily pragmatic challenge to how delirium is conceptualised. Here we retain the view that delirium is a disorder of consciousness, but propose a more multidimensional approach to this key feature. We argue that delirium can be recognised through evaluating arousal, attention and temporal orientation. We suggest that this approach can be validated by testing whether it leads to better delirium identification, accounts for the characteristic clinical disturbances, explains why delirium is common in the extreme age groups and why in later life its boundaries often blend with dementia.

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“…One study performed with Xenon-enhanced CT for blood flow measurement in 10 patients during and after delirium (16) demonstrated a 42% globally decreased flow during delirium with possibly greater decreases in subcortical structures and occipital cortex compared to other brain regions. Such changes would be largely missed in relative flow studies and are consistent with delirium being, at least in part, a global brain dysfunction (17). Globally reduced blood flow could represent a causal mechanism in some cases of delirium or a marker for some of the conditions that can precipitate delirium (e.g., toxic-metabolic derangements).…”

Section: Cerebral Blood Flow Studiesmentioning

confidence: 99%

Good News for Elderly Persons: Olfactory Pleasure Increases at Later Stages of the Life Span

Markovic¹,

Reulbach²,

Vassiliadu³

et al. 2007

The Journals of Gerontology Series A: Biological Sciences and M

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Understanding of delirium pathogenesis remains limited despite improved diagnosis, and elucidation of risk factors and prognosis. Major advances in neuroimaging offer the possibility of probing the mechanisms and networks involved in delirium and hence improving understanding of this often devastating syndrome. This review describes the current literature of imaging studies in delirium and related conditions, introduces some of the newer capabilities of neuroimaging with magnetic resonance imaging, positron emission tomography, and single photon emission computed tomography, and discusses how these techniques may be applied to the study of delirium. Despite considerable challenges in patient recruitment, study design, intersubject variability, and scanner and contrast agent availability, imaging offers great potential for the identification and clarification of pathogenic mechanisms of delirium and its long-term sequelae.T HE rapid advancement of neuroimaging methods over the last few decades has made available a wide array of tools for research and clinical management of brain disorders. Imaging can be used to quantify normal or pathologic physiology and to localize abnormalities to specific regions of the brain. In clinical studies, imaging results can also help to control for intersubject variation due to varying severity of related or comorbid pathologies. These capabilities of imaging could prove highly valuable in the study of delirium, an important and highly prevalent syndrome in elderly people, but one for which understanding of pathophysiology remains limited.In this review article, we discuss the shortcomings of our current understanding of delirium and distill from this a series of target questions about the pathophysiology of delirium that might be addressable by neuroimaging studies and whose answers would provide a major advance in the understanding of delirium. We survey the existing literature on imaging studies in delirium and highlight the gaps that remain. Subsequently, we introduce a number of newer neuroimaging techniques and describe how some of these methods might be used to answer our target questions about delirium. Finally, we consider the obstacles to performing such neuroimaging studies and discuss potential solutions. This article may provide a useful framework to guide future neuroimaging studies investigating the pathophysiology of delirium.

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Occurrence of Delirium in Different Regional Brain Syndromes

Cited by 17 publications

References 24 publications

Pathophysiology of Delirium in the Intensive Care Unit

Pathophysiology of Delirium in the Intensive Care Unit

Delirium as a disorder of consciousness

Good News for Elderly Persons: Olfactory Pleasure Increases at Later Stages of the Life Span

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