Delirium Across the Lifespan: From Neural Basis to Social Impact

Delirium is a severe concern in hospitalized older people. Recently, it has been also observed in the pediatric and young population, in particular during the Covid-19 pandemic. Delirium is a marker for vulnerability and is associated with adverse outcomes. Despite intensive research about this syndrome, several issues are still under debate. Biological markers for early detection are still missing. The pathogenesis of delirium (i.e. which precipitating factors lead to delirium) is mostly obscure. Current research identified the etiology principally in direct brain insults and aberrant stress responses. Aberrant stress responses switch from what, in health, is adaptive to stress-response pathways' adverse effects. Dysfunctional healthcare systems could contribute to precipitate the onset of delirium. However, the delirium burden in terms of functioning and healthcare costs is not well characterized worldwide. Furthermore pediatric delirium remains vastly underdiagnosed both by pediatric and psychiatric teams.

In adults, delirium incidence can be reduced both by multi-component non-pharmacologic approaches and antipsychotic use. In contrast, little has been published on delirium prevention strategies in children.

 It is urgent to focus the research attention both on the neuronal basis and clinical-social impact.

This Research Topic's primary goal is to increase the knowledge in the pathophysiology of delirium by exploring underpinning mechanisms to characterize people at high risk to develop delirium and its dreadful consequences better. Furthermore, we want to give space to innovative research in the diagnosis and therapeutic field, and non-pharmacological approach (such as artificial intelligence, IoT, occupational therapy, Snoezelen room).

 Finally, because delirium could last for several months after discharge, we encourage authors to describe the impact of this syndrome in terms of social consequences by the contributions of diverse disciplines. Our overarching aim is to build a comprehensive framework where theory, diverse methodological analyses, perspective and new technological advance could converge.

This Research Topic aims at stimulating research and give a multi-layered pyramidal perspective on delirium hitting various critical points.

We welcome Review (systematic and narrative)and Mini Review, Original Research (in vitro and in vivo), Perspective, Hypothesis & Theory, Methods and Case Reports on delirium across lifespan:

1) Neurobiological pathways (to stimulate future research on biomarkers of delirium);

2) Clinical detections tools (in order to identify new useful and more sensitive diagnostic tool in clinical practice);

3) Differential diagnosis that discriminate delirium, subsyndromal delirium and other neurological diagnosis or diseases;

3) Pharmacological (i.e. safe and efficient drugs) and non –pharmacological treatments for a more codified intervention;

4) The estimate of social and economic impact of delirium.