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Pathophysiology and biomarkers of delirium in older adults-Narrative review
Fatima Irfan1, Janine Jorke1, Niels Hansen2
1Department of Geriatrics, University Medical Center Goettingen, Robert-Koch-Str. 42, 37075, Göttingen, Germany.
Background:
Delirium is a frequent acute neurocognitive syndrome in older adults, associated with morbidity, mortality, and long-term cognitive decline. Its pathophysiology is multifactorial and not yet fully understood.
Objective:
To summarize clinically relevant concepts of delirium pathophysiology and emerging biomarkers.
Methods:
Narrative review of literature from 2010-2026, prioritizing human studies, reviews, meta-analyses, and clinically relevant pathophysiological literature relevant to older hospitalized or perioperative patients.
Results:
Delirium arises from the interaction of predisposing vulnerability and acute triggers. Relevant mechanisms include neuroinflammation, neurotransmitter imbalance, neurodegeneration, metabolic dysfunction and blood-brain barrier impairment. Biomarker research has identified promising candidates, including inflammatory, neurodegenerative, metabolic and stress-related markers but none is currently established for routine clinical use.
Conclusion:
Delirium prevention remains clinically driven. Multimodal biomarkers may support future risk stratification but require prospective validation.
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