Department of Intensive Care Medicine and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
Department of Psychiatry and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; Melbourne Neuropsychiatry Center, Department of Psychiatry, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton South, 3053 Victoria, University of Melbourne and Melbourne Health, Australia.
Neuroimage Clin. 2019;23:101809. doi: 10.1016/j.nicl.2019.101809. Epub 2019 Apr 3.
Delirium is an acute neuropsychiatric syndrome characterized by altered levels of attention and awareness with cognitive deficits. It is most prevalent in elderly hospitalized patients and related to poor outcomes. Predisposing risk factors, such as older age, determine the baseline vulnerability for delirium, while precipitating factors, such as use of sedatives, trigger the syndrome. Risk factors are heterogeneous and the underlying biological mechanisms leading to vulnerability for delirium are poorly understood. We tested the hypothesis that delirium and its risk factors are associated with consistent brain network changes. We performed a systematic review and qualitative meta-analysis and included 126 brain network publications on delirium and its risk factors. Findings were evaluated after an assessment of methodological quality, providing N=99 studies of good or excellent quality on predisposing risk factors, N=10 on precipitation risk factors and N=7 on delirium. Delirium was consistently associated with functional network disruptions, including lower EEG connectivity strength and decreased fMRI network integration. Risk factors for delirium were associated with lower structural connectivity strength and less efficient structural network organization. Decreased connectivity strength and efficiency appear to characterize structural brain networks of patients at risk for delirium, possibly impairing the functional network, while functional network disintegration seems to be a final common pathway for the syndrome.
谵妄是一种以注意力和意识水平改变为特征的急性神经精神综合征，伴有认知缺陷。它在老年住院患者中最为常见，与不良预后相关。易患风险因素，如年龄较大，决定了谵妄的基线脆弱性，而诱发因素，如使用镇静剂，触发了综合征。风险因素具有异质性，导致谵妄易感性的潜在生物学机制尚不清楚。我们检验了这样一个假设，即谵妄及其风险因素与一致的大脑网络变化有关。我们进行了系统的回顾和定性的荟萃分析，并纳入了 126 篇关于谵妄及其风险因素的大脑网络研究。在对方法学质量进行评估后，对研究结果进行了评估，其中包括 99 项关于易患风险因素的研究（良好或优秀），10 项关于诱发风险因素的研究和 7 项关于谵妄的研究。谵妄与功能网络中断一致相关，包括 EEG 连接强度降低和 fMRI 网络整合减少。谵妄的风险因素与结构连接强度降低和结构网络组织效率降低有关。连接强度和效率的降低似乎是谵妄风险患者的结构脑网络的特征，可能损害功能网络，而功能网络解体似乎是该综合征的最终共同途径。
