Journal Mobile Options
Table of Contents
Vol. 10, No. 5, 1999
Issue release date: September–October 1999
Dement Geriatr Cogn Disord 1999;10:330–334
(DOI:10.1159/000017164)

Update on the Neuropathogenesis of Delirium

Trzepacz P.T.
Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Miss., USA

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

Delirium has been considered a syndrome of generalized dysfunction of higher cortical functions due to its breadth of symptoms and associated diffuse slowing on electroencephalogram. Advances in neuropsychiatry have revealed differences between brain regions, including the hemispheres, which may underlie the constellation of symptoms among different psychiatric disorders. For example, different neural pathways are involved in major depression and obsessive-compulsive disorder, including lateralization to one or the other hemisphere. In this article the author proposes that delirium, too, involves particular neural pathways and that lateralization to the right may be relevant. Structural and functional neuroimaging reports and recent neuropsychological studies support this lateralization. Prefrontal cortices, anterior and right thalamus, and right basilar mesial temporoparietal cortex may play a significant role in subserving delirium symptoms and may be the ‘final common pathway’ for delirium from a variety of etiologies. The final common pathway may be responsible for certain ‘core symptoms’ (disorientation, cognitive deficits, sleep-wake cycle disturbance, disorganized thinking, and language abnormalities), while other symptoms (delusions, hallucinations, illusions, and affective lability) may occur depending on the etiology causing delirium. An imbalance in the cholinergic and dopaminergic neurotransmitter systems is most commonly implicated in causing delirium, and could both account for delirium symptoms and be consistent with the neuroanatomical pathways being implicated.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Trzepacz PT: Neuropathogenesis of delirium: A need to focus our research. Psychosomatics 1994;35:375–391.
  2. Trzepacz PT, Mulsant BH, Dew MA, Pasternak R, Sweet RA, Zubenko GS: Is delirium different when it occurs in dementia: A study using the Delirium Rating Scale. J Neuropsychiatry Clin Neurosci 1998;10:199–204.
  3. Trzepacz PT, Wise M: Neuropsychiatric aspects of delirium; in Hales RM, Yudofsky SC (eds): Textbook of Neuropsychiatry, ed 3. Washington, American Psychiatric Press, 1997, chap 15, pp 447–470.
  4. Meagher DJ, Trzepacz PT: Delirium phenomenology illuminates pathophysiology, management and course. J Geriatr Psychiatry Neurol 1998;11:150–156.
  5. Cummings JL, Gorman DG, Shapira J: Physostigmine ameliorates the delusions of Alzheimer’s disease. Biol Psychiatry 1993;33:536–541.
  6. Vaphiades MS, Celesia GC, Brigell MG: Positive spontaneous visual phenomena limited to the hemianopic field in lesions of central visual pathways. Neurology 1996;47:408–417.
  7. Schnider A, van Daniken C, Gutbrod K: Disorientation in amnesia: A confusion of memory traces. Brain 1996;119:1627–1632.

    External Resources

  8. Bogousslavsky J, Ferranzzini M, Regli E, et al: Manic delirium and frontal-like syndrome with paramedian infarction of right thalamus. J Neurol Neurosurg Psychiatry 1988;51:116–119.

    External Resources

  9. Doyle M, Warden D: Use of SPECT to evaluate postcardiotomy delirium. Am J Psychiatry 1996;153:838–839.
  10. Hart RP, Best AM, Sessler CN, Levenson JL: Abbreviated cognitive test for delirium. J Psychosom Res 1997;43:417–423.
  11. Mach JR Jr, Kabat V, Olson D, Kuskowski M: Delirium and right hemisphere dysfunction in cognitively impaired older persons. Int Psychogeriatr 1996;8:378–381.
  12. Ritchie J, Steiner W, Abrahamowicz M: Incidence of and risk factors for delirium among psychiatric inpatients. Psychiatr Serv 1996;47:727–730.

    External Resources

  13. Goldberg E: Lateralization of frontal lobe functions and cognitive novelty. J Neuropsychiatry Clin Neurosci 1998;6:371–378.
  14. Trzepacz PT: Anticholinergic model for delirium. Semin Clin Neuropsychiatry 1996;1:294–303.

    External Resources

  15. Nymeyer L, Grossberg GT: Delirium in a 75 year old woman receiving ECT and levodopa. Convuls Ther 1997;13:114–116.

    External Resources

  16. Mrzljak L, Goldman-Rakic P: Acetylcholinesterase reactivity in the frontal cortex of human and monkey: Contribution of AChE-rich pyramidal neurons. J Comp Neurol 1992;324:261–281.

    External Resources

  17. Goldman-Rakic PS, Lidow MS, Smiley JF, Williams MS: The anatomy of dopamine in monkey and human prefrontal cortex. J Neural Transm 1992;36:163–177.
  18. Goldman-Rakic PS, Lidow MS, Gallagher DW: Overlap of dopaminergic, adrenergic, and serotonergic receptors and complementarity of their subtypes in primate prefrontal cortex. J Neurosci 1990;10:2125–2138.

    External Resources



Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50