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Published online by Cambridge University Press: 05 December 2011
Questions with no answers
This chapter is a summary of what is known or suspected about the pathophysiology of delirium. What actually goes on in the brain? How does this explain the symptoms of delirium? And, importantly, how does the mechanism of delirium account for the adverse outcomes?
All good questions. Unfortunately we still do not have the answers.
The pathophysiology of delirium continues to be poorly understood. Reading about delirium pathophysiology leaves the reader frustrated, not knowing what is real, or important or the result of another process.
A number of theories have emerged, including cell membrane stability; oxygen supply and utilization; imbalance of one, two or many neurotransmitters; false transmitters; stress hormones; cytokines; inflammation; blood supply; functional connection disruption; thalamic dysfunction and quite a few more…
Some or all might be true, or linked to the truth. Given the nature of delirium it is likely that several mechanisms contribute to its development in patients.
Start at the end, final common pathway?
Delirium is thought to represent a generalized dysfunction of higher cerebral cortical processes. Not all areas of the brain, however, are equally impaired. Because of its multifactorial nature, it is thought that delirium from different causes may have different mechanisms and/or involve different parts of the brain. A final common neural pathway is likely involved in the core symptoms.
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