Soiza Roy L, Sharma Vijay, Ferguson Karen, Shenkin Susan D, Seymour David Gwyn, Maclullich Alasdair M J
Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen, Scotland, UK.
J Psychosom Res. 2008 Sep;65(3):239-48. doi: 10.1016/j.jpsychores.2008.05.021.
Neuroimaging offers clear potential in developing a better understanding of the pathophysiology of delirium. We performed a systematic review of structural and functional neuroimaging findings in delirium. The aims were to categorize and summarize the existing literature, and to determine whether this literature provides conclusive information on structural or functional brain predictors, correlates, or consequences of delirium.
Studies were identified by comprehensive textword and MeSH-based electronic searches of MEDLINE, EMBASE, and Evidence-Based Medicine reviews, combining multiple terms for neuroimaging, brain structure, and delirium.
Twelve studies met the inclusion criteria. There were a total of 194 patients with delirium and 570 controls. Patient age, population, comorbidities, and identified precipitating factors were heterogeneous. Of the 10 structural studies, 3 studies used computed tomography (CT), 3 studies used magnetic resonance imaging (MRI), and 4 studies used a mixture of CT and MRI. One functional study used xenon CT, and the other used single photon emission computed tomography. There was a wide range of measurement techniques and timing of scans. Some studies found associations between delirium and cortical atrophy, and between ventricular enlargement and white matter lesion burden, but many studies did not control for potential confounders. Only two small studies of cerebral blood flow were identified, with both suggesting that there may be reduced regional cerebral blood flow, but the data were limited and somewhat inconsistent.
The small sample sizes and other limitations of the studies identified in this review preclude drawing any clear conclusions regarding neuroimaging findings in delirium, but these studies suggest multiple avenues for future research.
神经影像学在深入理解谵妄的病理生理学方面具有明显潜力。我们对谵妄的结构和功能神经影像学研究结果进行了系统综述。目的是对现有文献进行分类和总结，并确定该文献是否提供了关于谵妄的结构或功能脑预测因素、相关因素或后果的确凿信息。
通过对MEDLINE、EMBASE和循证医学综述进行基于文本词和医学主题词的全面电子检索来识别研究，结合神经影像学（neuroimaging）、脑结构和谵妄的多个术语。
12项研究符合纳入标准。共有194例谵妄患者和570例对照。患者年龄、人群、合并症和确定的诱发因素各不相同。在10项结构研究中，3项研究使用计算机断层扫描（CT），3项研究使用磁共振成像（MRI），4项研究使用CT和MRI的混合方法。1项功能研究使用氙CT，另1项使用单光子发射计算机断层扫描。扫描的测量技术和时间差异很大。一些研究发现谵妄与皮质萎缩之间以及脑室扩大与白质病变负担之间存在关联，但许多研究没有控制潜在的混杂因素。仅确定了两项关于脑血流量的小型研究，两者均表明可能存在局部脑血流量减少，但数据有限且有些不一致。
本综述中确定的研究样本量小及其他局限性妨碍就谵妄的神经影像学研究结果得出任何明确结论，但这些研究为未来研究提出了多种途径。
