Postoperative delirium in the elderly: the potential neuropathogenesis

Area of Science:

• Geriatric Medicine
• Neuroscience
• Anesthesiology

Background:

• Postoperative delirium (POD) is a common yet under-recognized neurobehavioral syndrome in the elderly.
• Its exact pathophysiologic mechanisms remain unidentified, despite proposed multifactorial causes like aging and hypoxia.

Purpose of the Study:

• To summarize the five most prominent theories explaining the neuropathogenesis of postoperative delirium.
• To provide a foundation for future research and the development of prophylactic and treatment strategies for POD.

Main Methods:

• Literature review and synthesis of prominent theories on delirium development.
• Focus on five key areas: neuronal aging, neuroinflammation, neurotransmitter imbalance, neuroendocrine activation, and network connectivity changes.

Main Results:

• Theories discussed include neuronal aging, neuroinflammation, neurotransmitter imbalance, neuroendocrine activation, and altered network connectivity.
• Each theory offers a potential pathway to understanding delirium's complex development.

Conclusions:

• A comprehensive understanding of POD's neuropathogenesis is crucial.
• Identifying specific mechanisms will facilitate the development of targeted prophylactic and treatment interventions for delirium.