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Review Article

The Role of Neuroimaging in Elucidating Delirium Pathophysiology

¹ Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
² Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System and Harvard Medical School, Boston, Massachusetts.
³ Departments of Radiology and Neurology, Massachusetts General Hospital, Boston.
⁴ Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts.
⁵ Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
⁶ Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, and Aging Brain Center, Hebrew SeniorLife, Boston, Massachusetts.

Address correspondence to David Alsop, PhD, Department of Radiology, Ansin 226, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215. E-mail: dalsop{at}bidmc.harvard.edu

Understanding of delirium pathogenesis remains limited despite improved diagnosis, and elucidation of risk factors and prognosis. Major advances in neuroimaging offer the possibility of probing the mechanisms and networks involved in delirium and hence improving understanding of this often devastating syndrome. This review describes the current literature of imaging studies in delirium and related conditions, introduces some of the newer capabilities of neuroimaging with magnetic resonance imaging, positron emission tomography, and single photon emission computed tomography, and discusses how these techniques may be applied to the study of delirium. Despite considerable challenges in patient recruitment, study design, intersubject variability, and scanner and contrast agent availability, imaging offers great potential for the identification and clarification of pathogenic mechanisms of delirium and its long-term sequelae.

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