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Infección sistémica y delirio: cuando las citoquinas y la acetilcolina chocan
Willem A van Gool1, Diederik van de Beek, Piet Eikelenboom
1Department of Neurology, Academic Medical Center, Amsterdam, Netherlands. w.a.vangool@amc.uva.nl
Lancet (London, England)
|March 2, 2010
Resumen
Las infecciones sistémicas y los medicamentos anticolinérgicos pueden causar delirio en adultos mayores. Dirigir la activación microglial puede prevenir el deterioro cognitivo a largo plazo asociado con el delirio.
Área de la Ciencia:
- La neurociencia es la neurociencia.
- Gerontología Gerontología.
- Farmacología Farmacología.
Sus antecedentes:
- Las infecciones sistémicas y los medicamentos anticolinérgicos son factores de riesgo significativos para el delirio en los ancianos.
- La activación microglial está implicada en los efectos conductuales de las infecciones, convirtiéndose potencialmente en neurotóxica si se pierde la inhibición colinérgica.
Objetivo del estudio:
- Proponer un modelo hipotético que explique el vínculo entre el delirio y el deterioro cognitivo a largo plazo.
- Sugerir posibles estrategias terapéuticas para prevenir malos resultados después del delirio en personas mayores vulnerables.
Principales métodos:
- Revisión de hallazgos experimentales y observaciones neuropatológicas.
- Formulación de un modelo hipotético basado en el papel de la microglia y la inhibición colinérgica.
Principales resultados:
- Las células microgliales que escapan de la inhibición colinérgica pueden iniciar una cascada neuroinflamatoria autopropulsada.
- Esta cascada podría explicar la asociación entre el delirio y el posterior deterioro cognitivo o demencia.
Conclusiones:
- Las personas mayores vulnerables pueden beneficiarse de intervenciones que restauran el control colinérgico de la microglia o inhiben la neuroinflamación.
- Los medicamentos fácilmente disponibles dirigidos a estas vías justifican ensayos clínicos para prevenir resultados adversos después del delirio.
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