Bellelli Giuseppe, Moresco Rosamaria, Panina-Bordignon Paola, Arosio Beatrice, Gelfi Cecilia, Morandi Alessandro, Cesari Matteo
Geriatric Unit, San Gerardo Hospital, Monza, Italy.
School of Medicine and Surgery, University Milano-Bicocca, Milan, Italy.
Front Med (Lausanne). 2017 Nov 8;4:188. doi: 10.3389/fmed.2017.00188. eCollection 2017.
Frailty is a clinical syndrome defined by the age-related depletion of the individual's homeostatic reserves, determining an increased susceptibility to stressors and disproportionate exposure to negative health changes. The physiological systems that are involved in the determination of frailty are mutually interrelated, so that when decline starts in a given system, implications may also regard the other systems. Indeed, it has been shown that the number of abnormal systems is more predictive of frailty than those of the abnormalities in any particular system. Delirium is a transient neurocognitive disorder, characterized by an acute onset and fluctuating course, inattention, cognitive dysfunction, and behavioral abnormalities, that complicates one out of five hospital admissions. Delirium is independently associated with the same negative outcomes of frailty and, like frailty, its pathogenesis is usually multifactorial, depending on complex inter-relationships between predisposing and precipitating factors. By definition, a somatic cause should be identified, or at least suspected, to diagnose delirium. Delirium and frailty potentially share multiple pathophysiologic mechanisms and pathways, meaning that they could be thought of as the two sides to the same coin. This review aims at summarizing the existing evidence, referring both to human and animal models, to postulate that delirium may represent the cognitive harbinger of a state of frailty in older persons experiencing an acute clinical event.
衰弱是一种临床综合征，其定义为个体与年龄相关的体内稳态储备耗竭，这决定了个体对应激源的易感性增加以及对负面健康变化的过度暴露。参与确定衰弱的生理系统相互关联，因此当特定系统开始衰退时，也可能影响其他系统。事实上，已表明异常系统的数量比任何特定系统中的异常更能预测衰弱。谵妄是一种短暂性神经认知障碍，其特征为急性起病、病程波动、注意力不集中、认知功能障碍和行为异常，在五分之一的住院患者中出现。谵妄与衰弱的负面后果独立相关，并且与衰弱一样，其发病机制通常是多因素的，取决于易感因素和促发因素之间的复杂相互关系。根据定义，诊断谵妄时应识别或至少怀疑存在躯体原因。谵妄和衰弱可能共享多种病理生理机制和途径，这意味着它们可被视为同一枚硬币的两面。本综述旨在总结现有证据，涉及人类和动物模型，以推测谵妄可能代表经历急性临床事件的老年人衰弱状态的认知先兆。
