The neuroinflammatory hypothesis of delirium

Cerejeira, Joaquim; Firmino, Horácio; Vaz‐Serra, Adriano; Mukaetova‐Ladinska, Elizabeta B.

doi:10.1007/s00401-010-0674-1

Cited by 346 publications

(262 citation statements)

References 144 publications

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“…Proinflammatory cytokines have been shown to lead to synaptic and neuronal dysfunction and to subsequent neurobehavioural and cognitive symptoms that are characteristic of delirium. 31 Although the incidence of embolic events was low, it is possible that emboli contributed to the postoperative delirium given that the theories regarding the pathogenesis of deliriumneuronal aging, oxidative stress, neurotransmitter and New ischemic lesion in MRI 7 (8%) ICA = internal carotid artery; M1 = M1 segment of middle cerebral artery; A1 = A1 segment of anterior cerebral artery; PVH = periventricular hyper intensities; DSWMH = deep subcortical white matter hyper intensities; T2* = T2 star weighted image MRI = magnetic resonance imaging Delirium after off-pump CABG 599 neuroendocrine dysfunction, network disconnectivity -are complementary rather than competing. 32 The presence of carotid artery stenosis[50% implies the presence of chronic cerebral hypoperfusion and systemic arteriosclerosis.…”

Section: Consent Withdrawn N=1 (New Onset Claustrophobia In Mri)mentioning

confidence: 99%

Imagerie préopératoire par résonance magnétique du cerveau et délirium postopératoire après pontage coronarien à cœur battant: une étude prospective de cohorte

Omiya

Yoshitani

Yamada

et al. 2015

Can J Anesth/J Can Anesth

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Background Delirium after cardiac surgery is a serious complication, increasing morbidity and mortality. Despite its high expectations, off-pump coronary artery bypass grafting (OPCAB) has largely failed to reduce the incidence of postoperative neurological complications. To further investigate the reasons for this failure, we used perioperative brain magnetic resonance imaging (MRI) to determine the relation between MRI findings and postoperative delirium. Methods Altogether, 98 patients undergoing elective OPCAB were enrolled in this prospective observational study. Patients underwent brain MRI and magnetic resonance angiography (MRA) before and after surgery to identify cerebral infarction, white matter lesions, and intracranial artery stenosis. Postoperative delirium in the intensive care unit was measured using the delirium rating scale. The relation between postoperative delirium and MRI findings was examined using logistic regression. Results Magnetic resonance imaging and MRA was completed in 88 (90%) of the patients. New ischemic lesions were present in seven (7.9%) patients. Delirium rating scale scores of 0, 1-7, and C 8 were found in 25 (31%), 48 (60%), and seven (9%) patients, respectively. Multivariate logistic regression analysis revealed that new ischemic lesions (odds ratio [OR] 11.07, 95% confidence interval [CI]: 1.53 to 80.03; P = 0.017), carotid artery stenosis (OR 7.06, 95% CI: 1.59 to 31.13; P = 0.010), history of myocardial infarction (OR 3.78, 95% CI: 1.05 to 13.65; P = 0.043), and deep subcortical white matter hyperintensity (OR 3.04, 95% CI: 1.14 to 8.12; P = 0.027) were significantly associated with postoperative delirium. Conclusions Magnetic resonance imaging findings of new cerebral ischemic lesions, carotid stenosis, and deep subcortical white matter hyperintensity correlated significantly with postoperative delirium in patients who had undergone OPCAB surgery.Author contributions Hiroki Omiya was involved in patient recruitment and writing the manuscript. Kenji Yoshitani was involved in patient recruitment and data collection. Naoki Yamada was involved in review of the brain magnetic resonance images. Yosuke Kubota was involved in patient recruitment and data collection. Kanae Takahashi was involved in study design and data analysis. Junjiro Kobayashi assisted with editing of the manuscript, particularly for the surgical procedure. Yoshihiko Ohnishi was involved in overall supervision and management of the study. 123Can J Anesth/J Can Anesth (2015) 62:595-602 DOI 10.1007/s12630-015-0327-x Résumé Contexte La survenue d'un délirium après chirurgie cardiaque est une complication grave, augmentant la morbidité et la mortalité. En dépit des fortes attentes, le pontage coronarien à coeur battant (OPCAB) a largement échoué à démontrer qu'il pouvait réduire l'incidence des complications neurologiques postopératoires. Pour approfondir l'étude des raisons de cet échec, nous avons utilisé une imagerie par résonance magnétique (IRM) périopératoire du cerveau pour déterminer la rela...

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Section: Consent Withdrawn N=1 (New Onset Claustrophobia In Mri)mentioning

confidence: 99%

Imagerie préopératoire par résonance magnétique du cerveau et délirium postopératoire après pontage coronarien à cœur battant: une étude prospective de cohorte

Omiya

Yoshitani

Yamada

et al. 2015

Can J Anesth/J Can Anesth

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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%

“…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 Med Fac Univ Palacky Olomouc Czech Repub

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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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“…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 neuroinflammatory hypothesis of delirium

Cited by 346 publications

References 144 publications

Imagerie préopératoire par résonance magnétique du cerveau et délirium postopératoire après pontage coronarien à cœur battant: une étude prospective de cohorte

Imagerie préopératoire par résonance magnétique du cerveau et délirium postopératoire après pontage coronarien à cœur battant: une étude prospective de cohorte

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

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

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