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Delirium: a subcortical phenomenon?

P T Trzepacz1, R J Sclabassi, D H Van Thiel

  • 1University of Pittsburgh School of Medicine, Pennsylvania.

The Journal of Neuropsychiatry and Clinical Neurosciences
|January 1, 1989
PubMed
Summary
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Patients with chronic liver disease and delirium exhibit altered brain activity, specifically lower electroencephalogram (EEG) peak activity and abnormal evoked potentials, suggesting subcortical involvement in delirium.

Area of Science:

  • Neuroscience
  • Clinical Neurology
  • Hepatology

Background:

  • Delirium is a common complication in patients with chronic liver disease.
  • The neurophysiological underpinnings of delirium in this population are not fully understood.
  • Evoked potentials offer a method to assess subcortical and cortical brain function.

Purpose of the Study:

  • To investigate differences in evoked potentials between patients with chronic liver disease and delirium and matched controls.
  • To explore the relationship between cognitive deficits and neurophysiological abnormalities in delirious patients.
  • To determine if evoked potential abnormalities suggest specific levels of brain dysfunction in delirium.

Main Methods:

  • Comparison of auditory brainstem evoked potentials (ABEPs) and somatosensory evoked potentials (SEPs) between delirious patients and non-delirious controls.

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  • Utilized computerized spectral analysis of electroencephalogram (EEG) for peak activity assessment.
  • Cognitive function assessed using the Mini-Mental State Exam (MMSE) and Trail Making Tests (TMT).

    • Main Results:

    • Delirious patients demonstrated significantly poorer performance on cognitive tests (MMSE, TMT).
    • Lower mean peak EEG activity was observed in delirious subjects (7.5 cps) compared to controls (9.5 cps).
    • ABEPs were abnormal in both groups, with a higher proportion of abnormalities and bimodal latency in delirious patients. SEPs were significantly abnormal in delirious patients but normal in controls.

    Conclusions:

    • Evoked potential abnormalities, particularly in somatosensory pathways, are significantly associated with delirium in chronic liver disease patients.
    • Reduced EEG peak activity and altered evoked potentials suggest impaired subcortical and potentially cortical function in delirium.
    • These findings indicate that subcortical dysfunction may play a crucial role in the pathophysiology of delirium in this clinical setting.