Pathophysiology and biomarkers of delirium in older adults-Narrative review.

Authors

Fatima Irfan, Janine Jorke, Niels Hansen, Christine A F von Arnim

Published in

Zeitschrift fur Gerontologie und Geriatrie. Sep 04, 2026. Epub Sep 04, 2026.

Abstract

Delirium is a frequent acute neurocognitive syndrome in older adults, associated with morbidity, mortality, and long-term cognitive decline. Its pathophysiology is multifactorial and not yet fully understood.
To summarize clinically relevant concepts of delirium pathophysiology and emerging biomarkers.
Narrative review of literature from 2010-2026, prioritizing human studies, reviews, meta-analyses, and clinically relevant pathophysiological literature relevant to older hospitalized or perioperative patients.
Delirium arises from the interaction of predisposing vulnerability and acute triggers. Relevant mechanisms include neuroinflammation, neurotransmitter imbalance, neurodegeneration, metabolic dysfunction and blood-brain barrier impairment. Biomarker research has identified promising candidates, including inflammatory, neurodegenerative, metabolic and stress-related markers but none is currently established for routine clinical use.
Delirium prevention remains clinically driven. Multimodal biomarkers may support future risk stratification but require prospective validation.

PMID:
42698026
Bibliographic data and abstract were imported from PubMed on 05 Sep 2026.

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