谵妄
神经炎症
小胶质细胞
胆碱能的
医学
痴呆
抗胆碱能
抗胆碱药
神经科学
免疫学
重症监护医学
乙酰胆碱
心理学
炎症
药理学
内科学
疾病
作者
Willem A. van Gool,Diederik van de Beek,Piet Eikelenboom
出处
期刊:The Lancet
[Elsevier]
日期:2010-02-01
卷期号:375 (9716): 773-775
被引量:524
标识
DOI:10.1016/s0140-6736(09)61158-2
摘要
Systemic infection and drugs with anticholinergic effects are well-recognised and prevalent risk factors for delirium in elderly people. Experimental findings and neuropathological observations suggest that activation of microglia is pivotal for mediation of the behavioural effects of systemic infections. The microglial response is usually regulated tightly, but defensive features could turn neurotoxic once microglial cells escape from cholinergic inhibition. A self-propelling neuroinflammatory reaction might follow, and this cascade could account for the strong association between delirium and long-term cognitive impairment and even dementia. Here, we propose a hypothetical model, suggesting that poor outcome after delirium can be averted in vulnerable elderly people by use of readily available drugs. Agents that either restore cholinergic control of microglia or directly inhibit neuroinflammation warrant testing in clinical trials.
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