Advancing the Neurophysiological Understanding of Delirium.
Delirium is a common problem associated with substantial morbidity and increased mortality. However, the brain dysfunction that leads some individuals to develop delirium in response to stressors is unclear. In this article, we briefly review the neurophysiologic literature characterizing the changes in brain function that occur in delirium, and in other cognitive disorders such as Alzheimer's disease. Based on this literature, we propose a conceptual model for delirium. We propose that delirium results from a breakdown of brain function in individuals with impairments in brain connectivity and brain plasticity exposed to a stressor. The validity of this conceptual model can be tested using Transcranial Magnetic Stimulation in combination with Electroencephalography, and, if accurate, could lead to the development of biomarkers for delirium risk in individual patients. This model could also be used to guide interventions to decrease the risk of cerebral dysfunction in patients preoperatively, and facilitate recovery in patients during or after an episode of delirium.
Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.|Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Mouhsin M
MM
Shafi
Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Emiliano
E
Santarnecchi
Harvard Medical School, Boston, Massachusetts.|Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.|Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.
Tamara G
TG
Fong
Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, Rhode Island.|Department of Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island.
Richard N
RN
Jones
Harvard Medical School, Boston, Massachusetts.|Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Edward R
ER
Marcantonio
Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.|Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Alvaro
A
Pascual-Leone
Harvard Medical School, Boston, Massachusetts.|Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.|Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Sharon K
SK
Inouye
D000544:Alzheimer Disease / Q000503:physiopathology; D001921:Brain / Q000503:physiopathology; D003693:Delirium / Q000503:physiopathology*; D004569:Electroencephalography / Q000379:methods*; D006801:Humans; D008962:Models, Theoretical; D009473:Neuronal Plasticity; D050781:Transcranial Magnetic Stimulation / Q000379:methods
connectivity; delirium; electroencephalography; plasticity; transcranial magnetic stimulation