New horizons: disrupted brain energy metabolism as a driver of delirium.
Delirium is a highly prevalent neuropsychiatric syndrome characterised by acute inattention, altered arousal and impaired cognition. Cerebral energy insufficiency is hypothesised to drive delirium and both hypoglycaemia and hypoxia can directly precipitate functional deficits and EEG slowing. Here w...
| Publicado en: | Age & Ageing Vol. 55; no. 2; pp. 1 - 16 |
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| Autores principales: | , , |
| Formato: | Artículo |
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Oxford University Press / USA
Feb2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=192513152&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 192513152 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00020729 AGA jtl: Age & Ageing issn: 00020729 maglogo: N pubinfo: dt: Feb2026 vid: 55 iid: 2 pid: 622 pub: Oxford University Press / USA artinfo: ui: 192513152 10.1093/ageing/afag024 ppf: 1 ppct: 15 formats: tig: atl: New horizons: disrupted brain energy metabolism as a driver of delirium. aug: au: Sabharwal, Meher Boyd, Gordon Cunningham, Colm affil: Trinity Biomedical Sciences Institute—School of Biochemistry & Immunology, Trinity College Dublin, Dublin, Ireland Department of Critical Care Medicine, Kingston General Hospital, Kingston, Ontario, Canada Trinity Biomedical Sciences Institute—School of Biochemistry & Immunology and Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland su: Brain metabolism Glucose metabolism Glycolysis Mitochondria Neurophysiology Electroencephalography Neuroglia Oximetry Positron emission tomography Magnetic resonance imaging Energy metabolism Blood sugar Transcranial Doppler ultrasonography Infrared spectroscopy Insulin resistance Delirium Cognition disorders Neuroradiology Hypoglycemia Hypoxemia Biomarkers sug: subj: Diagnostic Imaging Centers Brain metabolism Glucose metabolism Glycolysis Mitochondria Neurophysiology Electroencephalography Neuroglia Oximetry Positron emission tomography Magnetic resonance imaging Energy metabolism Blood sugar Transcranial Doppler ultrasonography Infrared spectroscopy Insulin resistance Delirium Cognition disorders Neuroradiology Hypoglycemia Hypoxemia Biomarkers keyword: brain copyrightHolder:British Geriatrics Society copyrightYear:2026 delirium encephalopathy energy metabolism glucose https://dx.doi.org/10.1093/ageing/afag024 inLanguage:en insulin resistance insulin resistance functional imaging older people oxygen perfusion publisher:Oxford University Press sameAs:https://pubmed.ncbi.nlm.nih.gov/41701637/ brain copyrightHolder:British Geriatrics Society copyrightYear:2026 delirium encephalopathy energy metabolism glucose https://dx.doi.org/10.1093/ageing/afag024 inLanguage:en insulin resistance insulin resistance functional imaging older people oxygen perfusion publisher:Oxford University Press sameAs:https://pubmed.ncbi.nlm.nih.gov/41701637/ ab: Delirium is a highly prevalent neuropsychiatric syndrome characterised by acute inattention, altered arousal and impaired cognition. Cerebral energy insufficiency is hypothesised to drive delirium and both hypoglycaemia and hypoxia can directly precipitate functional deficits and EEG slowing. Here we review the evidence that disrupted energy metabolism may play a causative role in delirium across multiple settings. Neuromonitoring methods including near infrared resonance spectroscopy and Transcranial Doppler suggest an association between altered cerebral perfusion and delirium, albeit with a minority of studies demonstrating associations with hyperoxia or low brain oxygen extraction. Hyperglycaemia, hypoglycaemia, relative hypoglycaemia and large fluctuations in glucose show associations with delirium, dependent on the setting. Functional neuroimaging methodologies such as functional MRI and fluorodeoxyglucose-positron emission tomography, demonstrate regional rather than global changes in functional hyperaemia and hypometabolism and the networks across which these changes occur may be key drivers of the delirium phenotype. Whether those changes reflect regulated changes in activity, the development of insulin resistance or an impairment of neurovascular coupling in those circuits requires further research. Availability of glucose, the ability to take it up and use it are all important in maintaining normal brain function and the disruption of any or all of these could impair energy metabolism in the brain during acute illness and delirium. Optimising brain glucose utilisation is a rational goal towards reducing delirium. Clinical trials with intranasal insulin offer tentative indication that this might be tractable and alternative fuels also might mitigate delirium. Systematic experiments and clinical trials are necessary to assess whether restoring normal metabolism can protect against delirium in different clinical environments. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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