Acetylcholinesterase Activity Measurement and Clinical Features of Delirium

Jackson, Thomas; Moorey, Hannah; Sheehan, Bart; MacLullich, Alasdair M.J.; Gladman, John; Lord, Janet M.

doi:10.1159/000452832

Cited by 10 publications

(6 citation statements)

References 33 publications

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“…Dawson et al proposed the use in anticholinergic delirium that did not respond to non-pharmacological delirium management [16]. In contrast, Jackson et al assumed that simple enhancement of cholinergic neurotransmission may not be sufficient enough to treat delirium [23]. Most studies which were previously performed did not include patients undergoing cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Acetylcholinesterase and butyrylcholinesterase in cardiosurgical patients with postoperative delirium

et al. 2017

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BackgroundPatients in intensive care units (ICU) are often diagnosed with postoperative delirium; the duration of which has a relevant negative impact on various clinical outcomes. Recent research found a potentially important role of acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) in delirium of critically ill patients on non-surgical ICU or in non-cardiac-surgery patients. We tested the hypothesis that AChE and BChE have an impact on patients after cardiac surgery with postoperative delirium.MethodsAfter obtaining approval from the local ethics committee, this mechanistic study gathered data of all 217 patients included in a randomized controlled trial testing non-pharmacological modifications of care in the cardiac surgical ICU to reduce delirium.Delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Nursing Delirium Screening Scale (Nu-DESC) twice a day for the first 3 days after surgery. Further outcome variables were somatic laboratory parameters and variables regarding surgery, anesthesia, and postsurgical recovery. 10 μl venous or arterial blood was drawn and AChE and BChE were determined with ChE check mobile from Securetec.ResultsOf 217 patients, 60 (27.6%) developed postsurgical delirium (POD). Patients with POD were older (p = 0.005), had anemia (p = 0.01), and worse kidney function (p = 0.006). Furthermore, these patients had lower intraoperative cerebral saturation (NIRS) (p < 0.001) and higher intraoperative need of catecholamines (p = 0.03). Delirious patients showed more inflammatory response (p < 0.001). AChE and BChE values were mainly inside the norm. Patients with values outside the norm did not have POD more often than others. Regarding AChE and BChE patients did not differ in having delirium or not (p > 0.10).ConclusionsPostoperative measurement of AChE and BChE did not discern between patients with and without POD. The effect of the cardiac surgical procedure on AChE and BChE remains unclear. Further studies with patients in cardiac surgery are needed to evaluate a possible combination of delirium and the cholinergic transmitter system. There might be possible interactions with AChE/BChE and blood products and the use of cardiopulmonary bypass, which should be investigated more intensively.Trial registrationGerman Clinical Trials Register, DRKS00006217

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Section: Discussionmentioning

confidence: 99%

Acetylcholinesterase and butyrylcholinesterase in cardiosurgical patients with postoperative delirium

et al. 2017

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“…Quercetin and naringenin also inhibit the activity of acetylcholinesterase and improve cholinergic neurotransmission [ 187 ]. Of note, disorders in cholinergic neurotransmission are considered as important pathomechanisms for delirium, and the elevated acetylcholinesterase activity was associated with hypoactive delirium in cardiac surgery patients [ 188 , 189 ].…”

Section: Management Principlesmentioning

confidence: 99%

Challenges of Delirium Management in Patients with Traumatic Brain Injury: From Pathophysiology to Clinical Practice

Roberson¹,

Patel²,

Dąbrowski

et al. 2021

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: Traumatic brain injury (TBI) can initiate a very complex disease of the central nervous system (CNS) starting with the primary pathology of the inciting trauma and subsequent inflammatory and CNS tissue response. Delirium has long been regarded as an almost inevitable consequence of moderate to severe TBI, but more recently has been recognized as an organ dysfunction syndrome with potentially mitigating interventions. The diagnosis of delirium is independently associated with prolonged hospitalization, increased mortality and worse cognitive outcome across critically ill populations. Investigation of the unique problems and management challenges of TBI patients is needed to reduce the burden of delirium in this population. In this narrative review, possible etiologic mechanisms behind post-traumatic delirium are discussed, including primary injury to structures mediating arousal and attention and secondary injury due to progressive inflammatory destruction ofthe brain parenchyma. Other potential etiologic contributors include dysregulation of neurotransmission due to intravenous sedatives, seizures, organ failure, sleep cycle disruption or other delirium risk factors. Delirium screening canbe accomplished in TBI patients and presence of delirium portends worse outcomes. There is evidence that multicomponent care bundles including an analgesia-prioritized sedation algorithm, regular spontaneous awakening and breathing trials, protocolized delirium assessment, early mobility and family engagement can reduce the burden of ICU delirium. The aim of this review is to summarize the approach to delirium in TBI patients with an emphasis on pathogenesis and management. Emerging CNS-active drug therapies that show promise in preclinicalstudies are highlighted.

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“…Bakhtiari et al [16] suggests that further studies must investigate the AchE activity according to the severity of the patients' disease (mild, moderate, and severe) and furthermore consider a standardization of the study design. In addition, it should be considered that different variables, such as sex, AchE inhibitor therapy, delirium, and stress, can affect AchE activity [16, 30, 31].…”

Section: Discussionmentioning

confidence: 99%

Biomarkers for Alzheimer’s Disease in Saliva: A Systematic Review

2019

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Background. The histopathological changes of Alzheimer’s disease (AD) are detectable decades prior to its clinical expression. However, there is a need for an early, inexpensive, noninvasive diagnostic biomarker to detect specific Alzheimer pathology. Recently developed neuroimaging biomarkers show promising results, but these methods are expensive and cause radiation. Furthermore, the analysis of cerebrospinal fluid (CSF) biomarkers requires an invasive lumbar puncture. Saliva is an easily obtained body fluid, and a stable saliva biomarker would therefore be a promising candidate for a future method for diagnosing AD. The purpose of this systematic review was to investigate studies of biomarkers in saliva samples for the diagnosis of AD. Methods. The included articles were identified through a literature search in PubMed and Google Scholar for all articles until November 1st, 2018, and furthermore, all reference lists of included articles were reviewed by hand. We included articles written in English investigating saliva from patients with AD and a control group. Results. A total of 65 studies were identified, whereof 16 studies met the inclusion criteria and were included in the systematic review. A plethora of different biomarkers were investigated, and ten out of the sixteen studies showed a statistical significance in biomarkers between patients with AD and healthy, elderly controls, among these biomarkers for specific AD pathology (amyloid beta 1-42 (Aβ42) and tau). Conclusion. Aβ42 and tau seem to be worthy candidates for future salivary biomarkers for AD, but other biomarkers such as lactoferrin and selected metabolites also have potential. More studies must be carried out with larger sample sizes and a standardization of the sampling and processing method. Factors such as diurnal variation, AD patients’ decreased ability of oral self-care, and salivary flowrates must be taken into consideration.

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Acetylcholinesterase Activity Measurement and Clinical Features of Delirium

Cited by 10 publications

References 33 publications

Acetylcholinesterase and butyrylcholinesterase in cardiosurgical patients with postoperative delirium

Acetylcholinesterase and butyrylcholinesterase in cardiosurgical patients with postoperative delirium

Challenges of Delirium Management in Patients with Traumatic Brain Injury: From Pathophysiology to Clinical Practice

Biomarkers for Alzheimer’s Disease in Saliva: A Systematic Review

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