The Cholinergic System and Inflammation: Common Pathways in Delirium Pathophysiology

Cerejeira, Joaquim; Nogueira, V.; Luis., Pedro; Vaz‐Serra, Adriano; Mukaetova‐Ladinska, Elizabeta B.

doi:10.1111/j.1532-5415.2011.03883.x

Cited by 169 publications

(156 citation statements)

References 39 publications

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“…One of the earliest changes during sepsis, due to pro-inflammatory cytokines, is microglial activation which in turn leads to neuronal loss. Oxidative stress, mitochondrial dysfunction with mitochondrial-mediated apoptosis, impaired cerebral perfusion and persistent hyperglycaemia are other important mechanisms that may induce brain dysfunction [12][13][14][15][16][17][18][19] . Neurotransmitter imbalance, especially between dopaminergic and cholinergic neurotransmission, seems to play a significant role and there are other significant neurotransmitters (beta-adrenergic substances, gamma-aminobutyric acid, serotonergic agents) whose alterations affect the development of delirium 1,11 .…”

Section: Sepsismentioning

confidence: 99%

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Incidence and risk factors for delirium development in ICU patients - a prospective observational study

Káňová¹,

Sklienka²,

Kula³

et al. 2017

BIOMED PAP

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a Background and Aims. Delirium is an acute brain dysfunction and a frequent complication in critically ill patients. When present it significantly worsens the prognosis of patients. The aim of this study was to evaluate the incidence of delirium and risk factors for delirium in a mixed group of trauma, medical and surgical ICU patients. Methods. A prospective observational study was conducted in one of the six-bed Intensive Care Units of the University Hospital Ostrava in the Czech Republic during a 12-month period. We evaluated the incidence of delirium and its predisposing and precipitating risk factors. All patients were assessed daily using the Confusion Assessment Method for the ICU (CAM-ICU). Results and Conclusions. Of the total of 332 patients with a median APACHE II (the Acute Physiology and Chronic Health Evaluation) score of 12, who were evaluated for delirium, 48 could not be assessed using CAM-ICU (47 due to prolonged coma, 1 due to language barriers). The incidence of delirium was 26.1%, with trauma and medical patients being more likely to develop delirium than surgical patients. Risk of delirium was significantly associated with age ≥ 65 years, and alcohol abuse in their anamnesis, with APACHE II score on admission, and with the use of sedatives and/or vasopressors. Delirious patients who remained in the ICU for a prolonged period showed a greater need for ventilator support and had a greater ICU-mortality.

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Section: Sepsismentioning

confidence: 99%

“…Delirium indicates an acute cerebral failure. Its pathophysiology is highly complex, resulting from both inflammatory and non-inflammatory processes 1,[11][12][13][14][15][16][17][18][19] . Delirium is never caused by a single factor.…”

Section: Introductionmentioning

confidence: 99%

Incidence and risk factors for delirium development in ICU patients - a prospective observational study

Káňová¹,

Sklienka²,

Kula³

et al. 2017

BIOMED PAP

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“…Delirium is the end product of a sequence of local and systemic insults and injury that lead to a common measurable manifestation of endorgan brain injury. Implicit in the syndromal characterization is the underlying notion that delirium does not have a single etiology but rather has multiple different and potentially interacting etiologies [5].…”

Section: Discussionmentioning

confidence: 99%

Study of Delirium on Psychiatric Referrals at Helping Hands Community Hospital, Kathmandu, Nepal

Bhattarai

Joshi²

2018

Janaki Med. Coll. J. Med. Sci.

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Background and Objectives: Delirium is one of the most important neuro-psychiatric disorders in Consultation liaison psychiatry. There is a dearth of studies in this subject in Nepalese context. The objective of this study was to find out the demographic profile, source of referral, reason for referral and possible risk factors for delirium and association between risk factors and subtypes of delirium.Material and Methods: This is a descriptive cross-sectional study carried out in a tertiary care center over a period of six months. Delirium was diagnosed by psychiatrist based on International Classification of Disease, 10th revision, Diagnostic Criteria for Research (ICD-10 DCR) and was classified into subtypes using the Liptzin and Levkoff criteria. Data analysis was done using SPSS version 16 and chi- square test was applied to find the association between risk factors and subtypes of delirium.Results: A total of 52 cases of delirium were included in the study. Majority of cases were aged 65 years and above with male preponderance. The most common cause for referral was disturbed behavior and disorientation. Hyperactive delirium was the most common subtype of delirium. Most of the referred cases of delirium were from Medical ward and Intensive Care Unit/Critical Care Unit (ICU/CCU). Infection / Inflammation, Drug/alcohol intoxication or withdrawal and those with multiple etiologies were the most common possible causes of delirium. There was no significant difference in terms of associated risk factors between the clinical subtype (p = 0.8023).Conclusion: The presence of delirium warrants prompt intervention to identify and treat the underlying causes and consultation liaison psychiatric services should be enhanced to achieve this goal.Janaki Medical College Journal of Medical Sciences (2017) Vol. 5(2): 19-26

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“…In this study, incidence of delirium within 7 days after ICU entry was 20.6% among postpartum women. Although the mechanisms underlying delirium were unknown, the accumulating evidence indicates that brain injury (Hall et al, 2013;van Munster, Bisschop, et al, 2010;van Munster et al, 2009) and inflammation (Cerejeira et al, 2010(Cerejeira et al, , 2012Dillon et al, 2017) might be involved in this process. Consistent with this statement, we also found that serum S100B and C-reactive protein levels were obviously elevated in postpartum ICU women, especially in delirium women.…”

Section: Discussionmentioning

confidence: 99%

Serum galectin‐3 levels and delirium among postpartum intensive care unit women

Zhu

et al. 2017

Brain and Behavior

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Objective: Inflammation correlates with delirium. Galectin-3 is a proinflammatory protein. This study aimed to determine relation of serum galectin-3 levels to delirium of postpartum intensive care unit (ICU) women. Materials and Methods:In this prospective observational study, serum galectin-3, S100B, and C-reactive protein levels of 412 postpartum ICU women and 412 healthy women were measured. Delirium and Acute Physiology and Chronic Health Care Evaluation II (APCHCE II) scores were recorded.Results: Serum levels of galectin-3, S100B, and C-reactive protein were significantly elevated in the postpartum women than in the healthy women. Galectin-3 levels were highly associated with APCHCE II scores and S100B and C-reactive protein levels.Galectin-3, C-reactive protein, and S100B levels and APCHCE II scores were identified as independent predictors for delirium. Area under the curve (AUC) of serum galectin-3 levels was similar to that of S100B levels, and significantly exceeded those of Creactive protein levels and APCHCE II scores. Moreover, galectin-3 significantly improved the AUCs of APCHCE II scores, S100B levels, and C-reactive protein levels. Conclusions:Galectin-3, involved in inflammatory process underlying delirium-related brain injury, might be a potential biomarker to predict delirium of postpartum ICU women. K E Y W O R D Sdelirium, galectin-3, intensive care unit, postpartum, women

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The Cholinergic System and Inflammation: Common Pathways in Delirium Pathophysiology

Cited by 169 publications

References 39 publications

Incidence and risk factors for delirium development in ICU patients - a prospective observational study

Incidence and risk factors for delirium development in ICU patients - a prospective observational study

Study of Delirium on Psychiatric Referrals at Helping Hands Community Hospital, Kathmandu, Nepal

Serum galectin‐3 levels and delirium among postpartum intensive care unit women

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