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The dopamine pathogenesis of delirium: A review of dopaminergic therapeutic approaches in the treatment and prevention of delirium
1
Students’ Scientific Club, Department of Pharmacology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
2
Department of Pharmacology, Faculty of Medical Sciences in Katowice, Medical University of Silesia
Corresponding author
Nikodem Świderski
Studenckie Koło Naukowe, Zakład Farmakologii, ul. Medyków 18, 40-752 Katowice, tel. +48 32 208 85 10
Studenckie Koło Naukowe, Zakład Farmakologii, ul. Medyków 18, 40-752 Katowice, tel. +48 32 208 85 10
Ann. Acad. Med. Siles. 2026;80:113-123
KEYWORDS
TOPICS
ABSTRACT
Delirium is a neuropsychiatric disorder whose multivector pathogenesis is not clear. The current state of knowledge favors the system integration failure hypothesis (SIFH), in which crucial roles are played by central nervous system structures involved in dopaminergic transmission. The aim of the search is to find therapeutic approaches that target alterations of dopaminergic transmission. Methylphenidate was shown to improve cognitive function in advanced cancer patients with hypoactive delirium, as demonstrated by an increase in mean scores on the Mini-Mental State Examination (MMSE) from 20.9 to 27.8. Yokukansan did not significantly affect the overall risk of postoperative delirium following oncologic surgery; however, in patients aged 75 years or older, it reduced the incidence of delirium with agitation (21.4% vs. 71%). Aripiprazole showed no difference compared to other antipsychotics in delirium resolution efficacy without distinguishing into subtypes, but had fewer side effects. In hypoactive delirium, it showed both a higher rate of resolution and improvement in the Memorial Delirium Assessment Scale (MDAS) score compared to haloperidol. Intervention with dopaminergic drugs has shown a superior effect in treating the hypoactive subtype with coexisting terminal cancer, while all therapeutic approaches have shown efficacy compared to a placebo in treating and preventing delirium episodes.
FUNDING
Not applicable
CONFLICT OF INTEREST
The authors declare no conflict of interest.
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