Lu Zhongyuan, Wang Xiaoling, Wang Jiao, Zhao Liang, Wu Yichen, Sun Mingyang, Zhang Jiaqiang
Department of Anesthesiology and Perioperative Medicine, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, No. 7, Wei-Wu Road, Jinshui District, Zhengzhou, 450000, Henan, China.
Henan Academy of Innovations in Medical Science, Zhengzhou, 450000, Henan, China.
J Neurol. 2025 May 6;272(6):381. doi: 10.1007/s00415-025-13104-1.
Delirium, a neuropsychiatric syndrome characterized by an acute and usually reversible state of confusion, while dementia is a chronic, acquired cognitive impairment that significantly reduces a patient's ability to perform daily tasks, learn, work, and engage in social interactions. Previous studies indicates that individuals with dementia are more susceptible to delirium than the general population, and that delirium serves as an independent risk factor for the subsequent onset of dementia. However, a major controversy in this field concerns whether delirium is merely a marker of vulnerability to dementia, or whether delirium-induced adverse outcomes such as falls and functional decline contribute to dementia, or whether delirium directly causes permanent neuronal damage and lead to dementia. It is possible that all these hypotheses hold some truth. In this review, we examine the shared and distinct mechanisms of delirium and dementia by reviewing their clinical features, epidemiology, clinicopathological, biomarkers, neuroimaging, and recent experimental studies, and we discuss the importance of targeting delirium to explore new preventive and therapeutic strategies for reducing long-term cognitive impairment.
谵妄是一种神经精神综合征，其特征为急性且通常可逆的意识混乱状态，而痴呆是一种慢性获得性认知障碍，会显著降低患者执行日常任务、学习、工作和参与社交互动的能力。先前的研究表明，与普通人群相比，痴呆患者更容易发生谵妄，且谵妄是随后发生痴呆的独立危险因素。然而，该领域的一个主要争议在于，谵妄仅仅是易患痴呆的一个标志，还是谵妄引发的跌倒和功能衰退等不良后果会导致痴呆，亦或是谵妄直接导致永久性神经元损伤并引发痴呆。所有这些假设都有可能有一定道理。在本综述中，我们通过回顾谵妄和痴呆的临床特征、流行病学、临床病理学、生物标志物、神经影像学及近期实验研究，来探讨它们的共同和不同机制，并讨论针对谵妄以探索减少长期认知障碍的新预防和治疗策略的重要性。
