Systemic inflammation and delirium: important co-factors in the progression of dementia.
Systemic inflammation and delirium: important co-factors in the progression of dementia.
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DOI：
10.1042/bst0390945
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发表时间：
2011-08
影响因子：
3.9
通讯作者：
Cunningham C
中科院分区：
文献类型：
--
作者：
Cunningham C
人们普遍认为炎症在慢性神经退行性疾病如阿尔茨海默病的进展中起一定作用，但其确切作用仍然难以捉摸。多年来已经知道，全身性炎症损伤可以向大脑发出信号，诱导CNS功能的变化，通常归类为疾病行为综合征。这些变化通过全身和CNS细胞因子和前列腺素合成介导。当痴呆患者遭受类似的全身炎症损伤时，谵妄是一种常见的后果。这种认知功能障碍的严重急性加重与预后不良有关：加速认知能力下降，缩短永久性机构化和死亡的时间。因此，更好地了解痴呆症期间谵妄如何发生以及这些事件如何影响现有的神经退行性变现在是重要的优先事项。目前的审查总结了痴呆症，全身性炎症和谵妄发作之间的关系，并解决了目前正在追求的基本科学方法，以了解急性认知功能障碍在衰老和痴呆症。此外，尽管关于这一主题的研究有限，但越来越清楚的是，感染和其他全身性炎症确实会增加阿尔茨海默病的风险，并加速已建立的痴呆症的进展。这些数据表明，全身性炎症是痴呆进展的主要因素，并构成重要的临床靶点。
It is widely accepted that inflammation plays some role in the progression of chronic neurodegenerative diseases such as Alzheimer’s disease but its precise role remains elusive. It has been known for many years that systemic inflammatory insults can signal to the brain to induce changes in CNS function, typically grouped under the syndrome of sickness behaviour. These changes are mediated via systemic and CNS cytokine and prostaglandin synthesis. When patients with dementia suffer similar systemic inflammatory insults, delirium is a frequent consequence. This profound and acute exacerbation of cognitive dysfunction is associated with poor prognosis: accelerating cognitive decline and shortening time to permanent institutionalization and death. Therefore a better understanding of how delirium occurs during dementia and how these episodes impact on existing neurodegeneration are now important priorities. The current review summarises the relationship between dementia, systemic inflammation and episodes of delirium and addresses the basic scientific approaches currently being pursued with respect to understanding acute cognitive dysfunction during aging and dementia. In addition, though there are limited studies on this subject, it is becoming increasingly clear that infections and other systemic inflammatory conditions do increase the risk of Alzheimer’s disease and accelerate the progression of established dementia. These data suggest that systemic inflammation is a major contributor to the progression of dementia and constitutes an important clinical target.