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Cerebral metabolic covariance in delirium: pattern response to symptomatic changes
Sean J. Colloby, Anita Nitchingham, Sarah Joanna Richardson, Rachael Ashleigh Lawson, John Tiernan O'Brien, Eva Alina Wegner, Robert Welschinger, Gideon A. Caplan et al.. Alzheimer s & Dementia, 2025-12-01
Topic: Risk, prevention and care in population studies
Abstract BACKGROUND Delirium is an acute neuropsychiatric condition linked to increased dementia risk, yet its mechanisms remain unclear. Previous studies reported cerebral hypometabolism. Spatial covariance of 18 F‐fluorodeoxyglucose (FDG) positron emission tomography (PET) was applied to acutely unwell inpatients with and without delirium (Delirium, Con unwell ) to derive a delirium‐specific metabolic pattern (DP). DP expression was evaluated in healthy older adults (Con healthy ) and patients with delirium superimposed on dementia (DSD) and tracked longitudinally with symptom resolution. METHODS Seventy participants were included (30 Con healthy , 10 Con unwell, 13 Delirium, 17 DSD). Voxel principal components (PCs) identified intercorrelated metabolic patterns. RESULTS The DP distinguished Con unwell from Delirium, with relative hypometabolism in default, frontoparietal, visual, and frontostriatal networks, and relative hypermetabolism in sensorimotor and limbic hubs. Delirium and DSD demonstrated higher DP expression than controls. In participants with follow‐up, recovery was paralleled by reduced DP expression. DISCUSSION Delirium exhibited a metabolic profile of network dysfunction that may be modifiable and clinically responsive. Highlights Derivation of a DP, primarily attributable to delirium itself, rather than acute illness or dementia. The DP revealed metabolic dysfunction spanning large‐scale networks, consistent with the proposed model of delirium as global brain failure. DP expression was elevated in delirium, both with and without dementia, compared to healthy and acutely unwell controls. In participants with follow‐up, clinical recovery was paralleled by a reduction in DP expression. The delirium pattern reflected clinically responsive and modifiable network dysfunction.
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APA 7th
Colloby, S. J., Nitchingham, A., Richardson, S. J., Lawson, R. A., O'Brien, J. T., Wegner, E. A., et al. (2025). Cerebral metabolic covariance in delirium: pattern response to symptomatic changes. Alzheimer s & Dementia. https://doi.org/10.1002/alz.70993
Vancouver
Colloby SJ, Nitchingham A, Richardson SJ, Lawson RA, O'Brien JT, Wegner EA, et al. Cerebral metabolic covariance in delirium: pattern response to symptomatic changes. Alzheimer s & Dementia. 2025. doi:10.1002/alz.70993. PMID: 41399191.
BibTeX
@article{colloby2025-41399191,
author = {Colloby, Sean J. and Nitchingham, Anita and Richardson, Sarah Joanna and Lawson, Rachael Ashleigh and O'Brien, John Tiernan and Wegner, Eva Alina and Welschinger, Robert and Caplan, Gideon A. and others},
title = {{Cerebral metabolic covariance in delirium: pattern response to symptomatic changes}},
journal = {Alzheimer s \& Dementia},
year = {2025},
doi = {10.1002/alz.70993},
pmid = {41399191},
url = {https://doi.org/10.1002/alz.70993}
}
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Key findings
- RESULTS The DP distinguished Con unwell from Delirium, with relative hypometabolism in default, frontoparietal, visual, and frontostriatal networks, and relative hypermetabolism in sensorimotor and limbic hubs.
- Delirium and DSD demonstrated higher DP expression than controls.
- The DP revealed metabolic dysfunction spanning large‐scale networks, consistent with the proposed model of delirium as global brain failure.
- DP expression was elevated in delirium, both with and without dementia, compared to healthy and acutely unwell controls.
Why it matters
This study used FDG PET imaging to derive a delirium-specific metabolic pattern that distinguished acutely unwell patients with delirium from those without. The pattern showed higher expression in delirium and delirium superimposed on dementia, and recovery was paralleled by reduced expression, suggesting the metabolic profile may be modifiable and clinically responsive.
Study details
- Evidence strengthLow
How this study scored 38/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Alzheimer s & Dementia) |
| Journal's citation record | 2 / 4 | Alzheimer s & Dementia: journal h-index 228 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 1 / 7 | Cited 2 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.7 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 2 / 6 | Cited 1.5× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 2 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author John‐Paul Taylor: h-index 67 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of Cambridge: institution h-index 1,973 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 5 institution(s) in 2 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 41399191) |
| Free to read | 2 / 2 | Free to read |
| Total | 38 / 100 | — |
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