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Advancing the Neurophysiological Understanding of Delirium
Author(s) -
Shafi Mouhsin M.,
Santarnecchi Emiliano,
Fong Tamara G.,
Jones Richard N.,
Marcantonio Edward R.,
PascualLeone Alvaro,
Inouye Sharon K.
Publication year - 2017
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.14748
Subject(s) - delirium , medicine , stressor , transcranial magnetic stimulation , emergence delirium , neuroplasticity , cognition , intensive care medicine , electroencephalography , psychological intervention , neuroscience , psychiatry , psychology , stimulation
Delirium is a common problem associated with substantial morbidity and increased mortality. However, the brain dysfunction that leads some individuals to develop delirium in response to stressors is unclear. In this article, we briefly review the neurophysiologic literature characterizing the changes in brain function that occur in delirium, and in other cognitive disorders such as Alzheimer's disease. Based on this literature, we propose a conceptual model for delirium. We propose that delirium results from a breakdown of brain function in individuals with impairments in brain connectivity and brain plasticity exposed to a stressor. The validity of this conceptual model can be tested using Transcranial Magnetic Stimulation in combination with Electroencephalography, and, if accurate, could lead to the development of biomarkers for delirium risk in individual patients. This model could also be used to guide interventions to decrease the risk of cerebral dysfunction in patients preoperatively, and facilitate recovery in patients during or after an episode of delirium.