%0 Journal Article
%T Insulin-Like Growth Factor I and the Pathogenesis of Delirium: A Review of Current Evidence
%A Dimitrios Adamis
%A David Meagher
%J Journal of Aging Research
%D 2011
%I Hindawi Publishing Corporation
%R 10.4061/2011/951403
%X Delirium is a frequent complication in medically ill elderly patients that is associated with serious adverse outcomes including increased mortality. Delirium risk is linked to older age, dementia, and illness that involves activation of inflammatory responses. IGF-I is increasingly postulated as a key link between environmental influences on body metabolism with a range of neuronal activities and has been described as the master regulator of the connection between brain and bodily well-being. The relationships between IGF-I and ageing, cognitive impairment and inflammatory illness further support a possible role in delirium pathogenesis. Five studies of IGF-I in delirium were identified by a systematic review. These conflicting findings, with three of the five studies indicating an association between IGF-1 and delirium occurrence, may relate to the considerable methodological differences in these studies. The relevance of IGF-I and related factors to delirium pathogenesis can be clarified by future studies which account for these issues and other confounding factors. Such work can inform therapeutic trials of IGF-I and/or growth hormone administration. 1. Introduction Delirium is an etiologically diverse organic cerebral syndrome of acute onset (over hours to days) characterized by a fluctuating course that includes alterations in level of consciousness, psychomotor behavior, attention and cognition, as well as variable expression of various neuropsychiatric disturbances [1]. It is a frequent complication in elderly hospitalized patients, affecting around 30% [2]. Despite this frequency, delirium is frequently misdiagnosed or missed, and considerable uncertainty remains regarding optimal management [3¨C5]. Delirium is associated with a range of adverse outcomes, including, longer hospital stays, greater healthcare costs, reduced subsequent functional independence, and increased mortality [6]. The pathophysiology of delirium has been understudied [5], and, in particular, it remains uncertain how such a wide range of potential etiologies, many of which involve pathology at peripheral body locations and without clear links to CNS function, can produce such a consistent complex neuropsychiatric picture that reflects generalized brain dysfunction. Central to understanding delirium is understanding mechanisms by which body and brain well-being are linked and, in particular, how brain responses to bodily homeostatic stress is mediated. 2. Delirium and the Aging Process Advanced age is an independent risk factor for developing delirium with increasing risk
%U http://www.hindawi.com/journals/jar/2011/951403/