Review article
PATHOPHYSIOLOGY OF DELIRIUM
TAJANA ZAH BOGOVIĆ
; University of Zagreb School of Medicine, Department of Anesthesiology, Resuscitation and Intensive Care, Zagreb University Hospital Center, Zagreb, Croatia
DINKO TONKOVIĆ
; University of Zagreb, Department of Anesthesiology, Resuscitation and Intensive Care, Sveti Duh University Hospital, Zagreb, Croatia
ANTE SEKULIĆ
; University of Zagreb School of Medicine, Department of Anesthesiology, Resuscitation and Intensive Care, Zagreb University Hospital Center, Zagreb, Croatia
DANIELA BANDIĆ-PAVLOVIĆ
; University of Zagreb School of Medicine, Department of Anesthesiology, Resuscitation and Intensive Care, Zagreb University Hospital Center, Zagreb, Croatia
ROBERT BARONICA
; University of Zagreb School of Medicine, Department of Anesthesiology, Resuscitation and Intensive Care, Zagreb University Hospital Center, Zagreb, Croatia
MARKO BOGOVIĆ
; University of Zagreb School of Medicine,University Department of Surgery, Zagreb, Croatia
SANJA SAKAN
; University of Zagreb School of Medicine, Department of Anesthesiology, Resuscitation and Intensive Care, Zagreb University Hospital Center, Zagreb, Croatia
INA FILIPOVIĆ GRČIĆ
; University of Zagreb School of Medicine, Department of Anesthesiology, Resuscitation and Intensive Care, Zagreb University Hospital Center, Zagreb, Croatia
BORIS TOMAŠEVIĆ TOMAŠEVIĆ
; University of Zagreb School of Medicine, Department of Anesthesiology, Resuscitation and Intensive Care, Zagreb University Hospital Center, Zagreb, Croatia
Abstract
Today’s understanding of the pathophysiological mechanisms of delirium is still limited, but there are several promising hypotheses. It is believed that biomarkers sensitive to death of neurons or glial cells indicate delirium. Several neurotransmitters are considered to be involved in the state of delirium, with greatest emphasis on acetylcholine and dopamine acting in opposite ways; acetylcholine reduces, while dopamine increases neuron excitability. Other neurotransmitters that probably play a role in the pathogenesis of delirium are GABA, glutamate and monoamines. Sepsis leading to systemic inflammatory response syndrome often presents with delirium and perhaps is the most common causal factor for delirium in intensive care unit; sedatives and analgesics are also common iatrogenic risk factors. Patients receiving benzodiazepines are more likely to have postoperative delirium than those who do not. Postoperative cognitive changes are more common in older than in younger patients, and they can be categorized as postoperative delirium, postoperative cognitive dysfunction and dementia. The mechanisms responsible for postoperative cognitive changes are not fully understood, but it is certain that they are multifactorial. Risk factors may be associated with patient characteristics, type of surgery and type of anesthesia.
Keywords
delirium; intensive care unit; postoperative cognitive dysfunction; anesthesia; surgery; risk factors
Hrčak ID:
93245
URI
Publication date:
30.10.2012.
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