Young James W S
Department of Medicine, University of Toronto, Toronto, ON, Canada.
Med Hypotheses. 2017 Jul;104:80-85. doi: 10.1016/j.mehy.2017.05.027. Epub 2017 May 26.
The coordinated function of brain networks underlies consciousness, attention and reality testing, all of which are impaired in delirium. The default-mode network, salience network, frontoparietal control network and dorsal attention network are brain networks with integral roles in the maintenance and modulation of the aforementioned functions. Multiple lines of evidence point to their dysfunction in delirium. The convergence of neurotransmitter changes, neuroendocrine and inflammatory stressors on brain networks disrupts bottom-up and top-down attentional control. Neuroimaging and neuroanatomy correlates are potentially consistent with this hypothesis. Overall, this model appears to have significant utility in connecting the seemingly disparate precipitants of delirium while accounting for the clinical manifestations of the syndrome.
脑网络的协同功能是意识、注意力和现实检验的基础,而在谵妄中所有这些功能都会受损。默认模式网络、突显网络、额顶叶控制网络和背侧注意网络是在维持和调节上述功能中起重要作用的脑网络。多条证据表明它们在谵妄中功能失调。神经递质变化、神经内分泌和炎症应激源在脑网络上的汇聚破坏了自下而上和自上而下的注意力控制。神经影像学和神经解剖学相关性可能与这一假设一致。总体而言,该模型在连接看似不同的谵妄诱发因素并解释该综合征的临床表现方面似乎具有重要作用。