HOSPITAL-ACQUIRED DELIRIUM: NEUROINFLAMMATORY MECHANISMS, METABOLIC DISTURBANCES, AND EVIDENCE-BASED PREVENTION STRATEGIES
Keywords:
Delirium, Inpatients, Inflammation, Microglia, Primary PreventionAbstract
DOI: https://doi.org/10.46296/yc.v10i18.0869
Abstract
Introduction: delirium is an acute and fluctuating neuropsychiatric syndrome associated with higher mortality, prolonged hospitalization, institutionalization, and subsequent cognitive decline. Delayed recognition remains a major clinical limitation in medical wards. Objective: to critically synthesize recent evidence on neuroinflammatory mechanisms, metabolic precipitants, and evidence-based strategies for prevention and management of delirium in hospitalized patients. Methodology: a critical literature review was conducted using publications from 2016 to 2026 retrieved from PubMed/MEDLINE, Embase, Scopus, and ScienceDirect. Systematic reviews, meta-analyses, cohort studies, and clinical guidelines relevant to internal medicine, psychiatry, neurology, and critical care were prioritized. Results: current evidence supports a multifactorial model involving systemic inflammation, neurovascular dysfunction, neuroendocrine stress, and preexisting brain vulnerability. Modifiable precipitants include hypoxemia, electrolyte disturbances, dysglycemia, elevated blood urea nitrogen, and exposure to deliriogenic drugs. No single biomarker is suitable for routine diagnosis, although C-reactive protein, interleukin-6, cortisol, neutrophil-to-lymphocyte ratio, and cerebrospinal fluid sTREM2 provide physiopathological and stratification insights. Multicomponent nonpharmacological interventions remain the most strongly supported preventive strategy. By contrast, antipsychotics do not show consistent preventive benefit, and therapeutic use should be reserved for severe agitation or safety-threatening situations. Conclusions: hospital delirium requires a systematic and multidimensional approach focused on prompt correction of precipitants, structured screening, and nonpharmacological prevention bundles. Pharmacologic therapy should remain selective and adjunctive.
Keywords: Delirium, Inpatients, Inflammation, Microglia, Primary Prevention.
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