[Delirium is a very common and life-threatening condition].
Although a lot is known regarding the epidemiology and aetiology of this condition, the pathophysiology of delirium remains poorly understood. Today, the leading hypothesized mechanism for the pathogenesis of delirium focuses on a central cholinergic deficiency and dopamine excess. Besides, other neurotransmitters, such as dopamine, serotonin, norepinephrine, glutamate and gamma-aminobutyric acid (GABA) may also contribute to delirium. Moreover, cytokines including interleukin-1, interleukin-2, interleukin-6, interferon and tumour necrosis factor alpha (TNF-alpha) can lead to an imbalance among the different neurotransmitters and thereby lead to an activation of the hypothalamic-pituitary-adrenocortical axis (HPA axis). The article reviews the current pathophysiological findings that may underly delirious states.
Singler
Katrin
K
Medizinische Klinik 2, Schwerpunkt Geriatrie, Klinikum Nürnberg, Deutschland, Lehrstuhl für Geriatrie, Friedrich-Alexander-Universität, Erlangen-Nürnberg. katrin.singler@klinikum-nuernberg.de
Hafner
Martina
M
Sieber
Cornel
C
D000109:Acetylcholine / Q000502:physiology; D000368:Aged; D001921:Brain / Q000187:drug effects / Q000503:physiopathology*; D018680:Cholinergic Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D016207:Cytokines / Q000502:physiology; D003693:Delirium / Q000139:chemically induced / Q000503:physiopathology*; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects / Q000503:physiopathology; D018377:Neurotransmitter Agents / Q000502:physiology; D010913:Pituitary-Adrenal System / Q000187:drug effects / Q000503:physiopathology; D011950:Receptors, Cholinergic / Q000187:drug effects / Q000502:physiology
D018680:Cholinergic Antagonists; D016207:Cytokines; D018377:Neurotransmitter Agents; D011950:Receptors, Cholinergic; D000109:Acetylcholine