Home › Research › Inflammation and the immune system
Systemic infection and delirium: when cytokines and acetylcholine collide
van Gool WA, van de Beek D, Eikelenboom P.. Lancet (London, England), 2010-02-01
Topic: Brain proteins, microglia and lab models
Systemic infection and drugs with anticholinergic effects are well-recognised and prevalent risk factors for delirium in elderly people. Experimental findings and neuropathological observations suggest that activation of microglia is pivotal for mediation of the behavioural effects of systemic infections. The microglial response is usually regulated tightly, but defensive features could turn neurotoxic once microglial cells escape from cholinergic inhibition.
Key findings
- Experimental findings and neuropathological observations suggest that activation of microglia is pivotal for mediation of the behavioural effects of systemic infections.
- The microglial response is usually regulated tightly, but defensive features could turn neurotoxic once microglial cells escape from cholinergic inhibition.
- A self-propelling neuroinflammatory reaction might follow, and this cascade could account for the strong association between delirium and long-term cognitive impairment and even dementia.
- Here, we propose a hypothetical model, suggesting that poor outcome after delirium can be averted in vulnerable elderly people by use of readily available drugs.
Why it matters
This review proposes that microglial activation mediates behavioural effects of systemic infection and that loss of cholinergic inhibition could make microglia neurotoxic, linking delirium to long-term cognitive impairment. It offers no treatment, cure or prevention for Alzheimer's disease.
Study details
- Evidence strengthLow
How this study scored 54/100
Published in a top-tier 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 | 10 / 10 | Tier 1 — top-tier general journal (Lancet (London, England)) |
| Journal's citation record | 4 / 4 | The Lancet: journal h-index 1,205 (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 | 1 / 5 | 2010 — within 20 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 | 6 / 7 | Cited 565 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 31.4 citations a year over 18 year(s) since 2010 |
| Impact for its field and year | 5 / 6 | Cited 27.1× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 3 / 6 | Cited by 10 other studies in this library |
| Still being cited | 3 / 4 | Cited 94 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Piet Eikelenboom: h-index 71 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Amsterdam UMC Location University of Amsterdam: institution h-index 992 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 2 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 20189029) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 54 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
May need a subscription OpenAlex found no free copy of the full text (checked 6 Feb 1020), so the publisher may charge for it. The PubMed abstract is free.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
van Gool, W. A., van de Beek, D., & Eikelenboom, P. (2010). Systemic infection and delirium: when cytokines and acetylcholine collide. Lancet (London, England). https://doi.org/10.1016/s0140-6736(09)61158-2
Vancouver
van Gool WA, van de Beek D, Eikelenboom P. Systemic infection and delirium: when cytokines and acetylcholine collide. Lancet (London, England). 2010. doi:10.1016/s0140-6736(09)61158-2. PMID: 20189029.
BibTeX
@article{vangool2010-20189029,
author = {van Gool, W. A. and van de Beek, D. and Eikelenboom, P.},
title = {{Systemic infection and delirium: when cytokines and acetylcholine collide}},
journal = {Lancet (London, England)},
year = {2010},
doi = {10.1016/s0140-6736(09)61158-2},
pmid = {20189029},
url = {https://doi.org/10.1016/s0140-6736(09)61158-2}
}
Later studies that cite this one
10 studies in the alzhub library list this one in their references. Showing the 8 highest-scoring.
Related studies in Inflammation and the immune system
Also tagged “cerebral”
900 studies in the library carry the topic tag “cerebral”; these are this study's neighbours in a fixed, alphabetical-by-hash tour of them, not the closest in content. All 900 tagged studies.