Elucidating the pathophysiology of delirium

The capabilities of these diverse factors for inducing delirium must be mediated by a pathway into the brain, such as the blood–brain barrier, requiring either high permeability of the inciting factors or a compromised blood–brain barrier (2).Thus, the second target question is: Considerable progress has been made at defining risk factors for delirium, including both vulnerability and precipitating factors identified in epidemiologic studies (1).

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Similar lesions, and delirium-related symptoms, have been observed in high altitude cerebral edema and acute mountain sickness, where they are believed to represent vasogenic edema induced by hypoxia-associated leakage of the blood–brain barrier (15).

The reason for the preferential occurrence in the corpus callosum remains unclear but may relate to unique characteristics of its vasculature.

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.

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.This article may provide a useful framework to guide future neuroimaging studies investigating the pathophysiology of delirium.Delirium is an acute confusional state characterized by decline in attention and cognition.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.Several studies have used x-ray computed tomography (CT) or magnetic resonance imaging (MRI) scanning to search for lesions or other indicators of structural abnormality in the brains of patients with delirium.

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