ArticleNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology2021
Why is delirium more frequent in the elderly?
Article in Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 4 of them syntheses that pooled it.
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Who cites it
31 citing papers in PubMed, 4 syntheses or guidelines pooled it, 50 citations in OpenAlex.
- Machine learning models for predicting postoperative delirium in non-cardiac surgery patients - systematic review and meta-analysis.GeroScience · 2026Pooled it
- Long-term clinical outcomes of delirium after hospital discharge: a systematic review and meta-analysis.Age and ageing · 2025Pooled it
- Risk factors of delirium after cardiac surgery: a systematic review and meta-analysis.Journal of cardiothoracic surgery · 2024Pooled it
- Melatonin and Its Analogs for Prevention of Post-cardiac Surgery Delirium: A Systematic Review and Meta-Analysis.Frontiers in cardiovascular medicine · 2022Pooled it
- Efficacy of Repetitive Transcranial Magnetic Stimulation on Postoperative Delirium in Elderly Patients Undergoing Non-Cardiac Major Surgery: A Randomized Controlled Trial.Brain and behavior · 2026Trial
- Comparison of Remimazolam and Propofol on Postoperative Delirium in Elderly Patients Undergoing Radical Resection of Colon Cancer: A Single-Center Prospective Randomized Controlled Study.Medical science monitor : international medical journal of experimental and clinical research · 2024Trial
- Article
- Companionship at hospital discharge and its association with subsequent delirium onset in older adults - the TRADE observational study.BMC geriatrics · 2026Observational
- Mitochondrial transplantation for delirium superimposed on dementia: from pathogenic mechanisms to clinical translation challenges.Frontiers in aging neuroscience · 2026Review
- Progress of nursing management for delirium in critically ill geriatric patients: a narrative review.Frontiers in human neuroscience · 2026Review
- Association between post-intravenous thrombolysis delirium and 90-day functional outcomes in patients with acute ischemic stroke.Frontiers in psychiatry · 2026Article
- Preoperative electroacupuncture for prevention of postoperative delirium in older adults undergoing total knee arthroplasty: protocol for a multicenter randomized controlled trial.Annals of medicine · 2025Article
- Lessons on catatonia with or without delirium on the consultation-liaison psychiatry service in a Lebanese tertiary care center: a retrospective chart review of 36 cases of catatonia.BMC psychiatry · 2025Article
- Brain Microstructural Alteration and Its Implications for Postoperative Delirium in Elderly Surgical Patients: A Narrative Review.Brain and behavior · 2025Review
- Negative Impact of Olanzapine on ICU Delirium Resolution: An Emulated Clinical Trial.Pharmaceuticals (Basel, Switzerland) · 2025Article
- Evaluation of postoperative delirium in cardiac surgery patients with the SDACS screening tool: a multicenter-multiphase study.Perioperative medicine (London, England) · 2025Article
- Practical prognostic tools to predict the risk of postoperative delirium in older patients undergoing cardiac surgery: visual and dynamic nomograms.Journal of clinical monitoring and computing · 2025Article
- Article
- Incidence of Delirium in ICU Patients With and Without COVID-19 in a Costa Rican Hospital.Cureus · 2024Article
- Thoracic delirium index for predicting postoperative delirium in elderly patients following thoracic surgery: A retrospective case-control study.Brain and behavior · 2024Observational
Corrections and comments
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Authors and funding
1 author at 1 institution in 1 country.
Funding
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Abstract
An aging-related reduction in the brain's functional reserve may explain why delirium is more frequent in the elderly than in younger people insofar as the reserve becomes inadequate to cover the metabolic requirements that are critically increased by stressors. The aim of this paper is to review the normal aging-related changes that theoretically compromise complex mental activities, neuronal and synaptic densities, and the neurocomputational flexibility of the functional reserve. A pivotal factor is diminished connectivity, which is substantially due to the loss of synapses and should specifically affect association systems and cholinergic fibres in delirious patients. However, micro-angiopathy with impaired blood flow autoregulation, increased blood/brain barrier permeability, changes in cerebrospinal fluid dynamics, weakened mitochondrial performance, and a pro-inflammatory involution of the immune system may also jointly affect neurons and their synaptic assets, and even cause the progression of delirium to dementia regardless of the presence of co-existing plaques, tangles, or other pathological markers. On the other hand, the developmental growth in functional reserve during childhood and adolescence makes the brain increasingly resistant to delirium, and residual reserve can allow the elderly to recover. These data support the view that functional reserve is the variable that confronts stressors and governs the risk and intensity of and recovery from delirium. Although people of any age are at risk of delirium, the elderly are at greater risk because aging and age-dependent structural changes inevitably affect the brain's functional reserve.
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