Aug 2026· The Egyptian Journal of Internal Medicine· Vol 38· 0 citations· 143 references
TL;DR
An updated overview of delirium is provided, emphasizing its complex pathophysiology, clinical characteristics, risk factors, diagnostic challenges, and management strategies, particularly in patients with neurological disorders.
Abstract
A narrative review was presented, synthesizing existing literature on the historical understanding, neurobiological mechanisms, diagnostic approaches, and treatment modalities related to delirium. The purpose of this narrative review is to provide an updated overview of delirium, emphasizing its complex pathophysiology, clinical characteristics, risk factors, diagnostic challenges, and management strategies, particularly in patients with neurological disorders. Delirium predominantly occurs in hospitalized patients, especially those with pre-existing neurological conditions. Its pathogenesis is multifactorial, involving neuroinflammatory processes, neurotransmitter imbalances, and disruptions in neural connectivity. Clinically, it presents with acute onset of altered mental status, inattention, disorganized thinking, and fluctuating consciousness. Crucial risk factors include advanced age, cognitive impairment, polypharmacy, metabolic disturbances, and critical illness. Diagnosis remains challenging due to heterogeneous manifestations and symptom overlap with other disorders. Current diagnostic strategies integrate standardized screening tools, clinical assessment, and biomarker research. Management primarily targets underlying causes, supportive care optimization, and cautious pharmacological use. Delirium represents a multifaceted neuropsychiatric syndrome closely linked to neurological diseases and adverse patient outcomes. Persistent challenges in its prevention, diagnosis, and management highlight the need for a deeper understanding of its mechanistic pathways and risk factors to inform targeted therapeutic interventions and improve clinical outcomes.
Background: Long COVID is a heterogeneous multisystem condition associated with fatigue, cognitive difficulties, sleep disturbance, depression, anxiety, and post-traumatic symptoms.
Methods: This narrative review examined PubMed/MEDLINE literature published between January 2020 and July 2026, supplemented by major reviews and guidance from WHO, NICE, and CDC.
Results: Neuropsychiatric symptoms likely result from interacting mechanisms, including persistent immune activation, autoimmunity, endothelial dysfunction, blood–brain barrier disruption, dysautonomia, altered neurotransmitter metabolism, microbiome changes, and impaired cellular energy production. Routine investigations may be normal, and no diagnostic biomarker has been validated. Treatment remains multidisciplinary, symptom-based, and tailored to clinical phenotype, with rehabilitation adapted for post-exertional malaise.
Conclusion: Long COVID requires integrated medical, neurological, and psychiatric assessment. Further biomarker-based research and well-designed clinical trials are needed.
Sandra Kołodziejczyk, Bartłomiej Wiak, Monika Łapot et al.· African Journal of Biomedica...· 0 citations
Delirium is one of the most common and clinically significant neuropsychiatric syndromes encountered in hospitalized adults, particularly among older patients, critically ill individuals, and those undergoing major surgery. Characterized by an acute disturbance in attention, awareness, and cognition, delirium is associated with increased mortality, prolonged hospitalization, functional decline, institutionalization, long-term cognitive impairment, and substantial healthcare costs. Despite its prevalence, delirium remains underrecognized, especially in patients presenting with hypoactive symptoms.Advances in recent years have improved understanding of the complex pathophysiological mechanisms underlying delirium, highlighting the interplay between neuroinflammation, neurotransmitter imbalance, oxidative stress, blood-brain barrier dysfunction, and impaired cerebral network connectivity. Prevention through multicomponent, non-pharmacological interventions remains the most effective strategy for reducing delirium incidence, while pharmacological therapy continues to have a limited role and should be reserved for carefully selected patients with severe distress or behaviours that threaten patient or staff safety.Emerging research has focused on artificial intelligence (AI)-based prediction models, blood-based biomarkers, electroencephalography, and precision medicine approaches that may improve early identification of high-risk patients and facilitate individualized prevention strategies. However, important challenges remain, including the underrecognition of hypoactive delirium, limited evidence supporting pharmacological interventions, and the need for prospective validation of emerging diagnostic technologies.This narrative review summarizes the contemporary evidence regarding the epidemiology, pathophysiology, risk factors, diagnosis, prevention, and management of delirium in hospitalized adults while highlighting current controversies, recent advances, and future directions that may shape clinical practice.
Devina Wadhwa· Journal of Biomedical Resear...· 0 citations
Background: Dementia is a heterogeneous clinical
syndrome characterized by progressive cognitive
decline that interferes with independent functioning.
Although advances in neuroimaging, fluid biomarkers, molecular diagnostics, and genetic testing have
improved etiological classification, dementia remains
fundamentally a clinical diagnosis. Biomarker findings
must therefore be interpreted within the context of the
patient’s cognitive, functional, behavioural, neurological, medical, and psychosocial presentation.
Objective: This narrative review provides a practical,
evidence-based framework for the comprehensive
clinical assessment of adults presenting with suspected dementia, with emphasis on translating contemporary diagnostic principles into routine clinical
practice across primary care, geriatrics, neurology,
psychiatry, and memory-clinic settings.
Methods: Current clinical guidelines, consensus criteria, validated assessment instruments, and contemporary evidence concerning dementia diagnosis
were narratively synthesized. The review examines
history taking and collateral information, characterization of cognitive symptom profiles, functional assessment, neurological examination, early warning
signs, longitudinal progression, behavioural and psychological symptoms, differential diagnosis, cognitive
screening, laboratory and neuroimaging evaluation,
biomarkers, and emerging digital and artificial-intelligence technologies.
Results: Accurate assessment requires integration of
multiple complementary sources of information rather than reliance on any single test. A detailed history
from both the patient and a knowledgeable informant
establishes symptom onset, tempo, affected cognitive
domains, and change from premorbid functioning.
Functional assessment is essential for distinguishing
dementia from mild cognitive impairment, while neurological and behavioural findings assist with syndrome
differentiation, severity determination, safety evaluation, and identification of reversible or contributing
conditions. Serial assessment is particularly valuable
because longitudinal changes in cognition, function,
and behaviour may be more diagnostically informative than a single evaluation. Biomarkers and artificial
intelligence can improve diagnostic confidence, subtype classification, and monitoring but should complement rather than replace clinical reasoning and
patient-centered judgment.
Conclusion: Comprehensive clinical assessment
remains the cornerstone of timely and accurate dementia diagnosis. A systematic, multidisciplinary, and
patient-centered approach integrating history, cognition, function, behaviour, neurological examination,
and appropriately selected investigations provides
the strongest basis for etiological diagnosis, individualized management, caregiver support, safety planning, and longitudinal care.
Keywords: dementia; cognitive impairment; clinical
assessment; diagnosis; functional assessment; neurological examination; neuropsychiatric symptoms;
biomarkers; artificial intelligence; patient-centered
care.
A. Abyad· World Family Medicine Journa...· 0 citations
INTRODUCTION
Late-onset bipolar disorder (LOBD) represents a clinically relevant but understudied subtype of bipolar. Compared with early-onset bipolar disorder, LOBD may present with distinct clinical features, increased somatic comorbidity, and potential associations with neurodegenerative and vascular processes. Specific diagnostic and therapeutic recommendations for LOBD are currently limited.
AREAS COVERED
This narrative review examines the current evidence regarding epidemiology, pathophysiology, diagnostic workup, and management of LOBD. Literature was identified using PubMed to conduct a structured literature search of the MEDLINE database for articles between 2015 and 2025, and review of relevant articles. Particular attention is given to differential diagnosis with secondary mania and neurodegenerative disorders, the role of medical and neurological evaluation, and treatment considerations including pharmacological strategies, neuromodulation, psychosocial interventions, and longitudinal follow-up.
EXPERT OPINION
Current evidence suggests that LOBD likely represents a heterogeneous condition with multiple underlying mechanisms, including vascular burden, neurodegenerative processes, and age-related biological vulnerability. Comprehensive somatic and cognitive assessment is essential. While treatment generally follows established bipolar disorder guidelines, careful adaptation is required due to comorbidity, polypharmacy, and age-related pharmacodynamic changes. Lithium, with its potential neuroprotective properties, may be the first-choice medication. Future research should focus on clarifying pathophysiological mechanisms and developing tailored management strategies.
Bruno Lancksweerdt, Anneke Van Duyse, B. Sabbe· Expert Review of Neurotherap...· 0 citations
Background: Neurological and mental health disorders are among the leading causes of disability and reduced quality of life worldwide. Conditions such as stroke, epilepsy, Parkinson's disease, Alzheimer's disease, multiple sclerosis, depression, anxiety disorders, bipolar disorder, and schizophrenia impose substantial clinical, social, and economic burdens. The growing prevalence of these disorders underscores the need for early diagnosis, comprehensive management, and multidisciplinary care.
Objective: This review aims to provide a comprehensive overview of the epidemiology, pathophysiology, clinical manifestations, diagnostic approaches, and evidence-based management of common neurological and mental health disorders, emphasizing recent advances in precision medicine, neuroimaging, and integrated patient care.
Methods: A narrative review of current international clinical guidelines, systematic reviews, randomized controlled trials, and high-quality observational studies was undertaken. Evidence relating to neurological examination, psychiatric assessment, neuroimaging, electrophysiological investigations, laboratory biomarkers, pharmacological therapies, psychological interventions, rehabilitation, and digital health technologies was critically synthesized.
Results: Advances in neuroimaging, molecular diagnostics, electrophysiology, and biomarker research have improved the early detection and classification of neurological diseases. Novel therapeutic strategies, including disease-modifying treatments, monoclonal antibodies, neuromodulation techniques, precision pharmacotherapy, and multidisciplinary rehabilitation, have enhanced outcomes for many neurological conditions. In mental health, integrated approaches combining pharmacotherapy, psychotherapy, cognitive behavioral therapy, community-based care, and digital mental health interventions have demonstrated significant improvements in symptom control, functional recovery, and quality of life. Early intervention and coordinated care remain essential for reducing disability and preventing disease progression.
Conclusion: Neurology and mental health require an integrated, patient-centered approach that combines accurate diagnosis, individualized treatment, rehabilitation, and long-term follow-up. Continued advances in neuroscience, artificial intelligence, genomics, and digital health are expected to transform clinical practice, enabling earlier diagnosis, personalized therapies, and improved neurological and psychological well-being while addressing the increasing global burden of brain and mental health disorders.
OBJECTIVES
Agitation is a common and distressing phenomenon across neurocognitive disorders (NCD). It is linked to decreased quality of life of the person with NCD, cognitive and functional decline, increased health-care utilization and institutionalization rates, and substantial burden for family carers and care professionals. Its management is particularly challenging. The objective of this International Psychogeriatric Association's (IPA) task force was to synthesize recent advances in nomenclature and assessment, epidemiology, progression, etiology, detection, impact, approaches to managing agitation; and to make recommendations to guide IPA's next 10-year strategy.
METHODS
A multidisciplinary expert workgroup met multiple times virtually and during the 2024 IPA Congress in person to discuss the current scientific and clinical practice landscape for agitation in NCD. The group integrated evidence about validated behavioral measures, biomarkers, digital monitoring, psychosocial and environmental interventions, and pharmacological options.
RESULTS
Agitation is attributed to disruptions in fronto-limbic circuitry with contributions from neuroimmune dysregulation, neurotransmitter alterations, and mitochondrial dysfunction, and various psychosocial and environmental factors. Psychosocial and environmental strategies can reduce agitation, though magnitude and durability of responses vary. Pharmacological options can have short-term benefits but carry risks that require strict patient selection, counseling, monitoring and medication stewardship. Approved medications based on controlled clinical trials remain limited.
CONCLUSION
Care and support in agitation in NCD should involve the implementation of person-centered, rights-based psychosocial and environmental approaches, with time-limited pharmacological adjuncts as second-line. Key evidence gaps include head-to-head and longer-term trials, active safety surveillance, validated agitation measures, and equity-focused implementation across settings and cultures.
D. Gerritsen, Maarten Van Den Bossche, A. Atri et al.· International Psychogeriatri...· 0 citations
We use cookies to run the site and, with your consent, for analytics and to show ads.
See our Cookie Policy.
