Anticholinergic Activity in Cerebrospinal Fluid and Serum in Individuals with Hip Fracture with and without Delirium

Watne, Leiv Otto; Hall, Roanna J.; Molden, Espen; Ræder, Johan; Frihagen, Frede; MacLullich, Alasdair M.J.; Juliebø, Vibeke; Nyman, Armika; Meagher, David; Wyller, Torgeir Bruun

doi:10.1111/jgs.12612

Cited by 33 publications

(32 citation statements)

References 53 publications

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“…Similarly, it remains unclear from these data whether there is a difference in the risk of delirium between admission onto an orthogeriatric ward or a standard orthopaedic ward. This has been previously reported in one trial suggesting no difference in incident delirium rates ( p = 0.51) (Watne et al ., 2014); however, further specific exploration of the influence of this on delirium rates is warranted.…”

Section: Discussionsupporting

confidence: 82%

“…The most commonly used delirium assessment tool was the CAM (Inouye et al ., ), which was used alone in 20 studies (Table ). The CAM was used in conjunction with the Delirium Rating Scale‐Revised‐98 (DRS‐R‐98) tool in two further studies (Nie et al ., ; Westhoff et al ., ), and in addition to the DRS‐R‐98 and Memorial Delirium Assessment Scale in Watne et al . (2014).…”

Section: Resultsmentioning

confidence: 99%

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Factors predicting incidence of post‐operative delirium in older people following hip fracture surgery: a systematic review and meta‐analysis

Smith

Cooper

Peryer

et al. 2017

Int J Geriat Psychiatry

126

104

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Objective: Delirium is one of the most common complications following hip fracture surgery in older people. This study identified pre-and peri-operative factors associated with the development of post-operative delirium following hip fracture surgery. Methods:Published and unpublished literature were searched to identify all evidence reporting variables on patient characteristics, on-admission, intra-operative and post-operative management assessing incident delirium in older people following hip fracture surgery. Pooled odds ratio (OR) and mean difference (MD) of those who experienced delirium compared to those who did not were calculated for each variable. Evidence was assessed using the Downs and Black appraisal tool and interpreted using the GRADE approach.Results: 6704 people (2090 people with post-operative delirium) from 32 studies were analysed.There was moderate evidence of nearly a two-times greater probability of post-operative delirium for those aged 80 years and over (OR: 1.77; 95% CI: 1.09, 2.87), whether patients lived in a care institution pre-admission (OR: 2.65; 95% CI: 1.79, 3.92), and a six-times greater probability of developing post-operative delirium with a pre-admission diagnosis of dementia (OR: 6.07, 95% CI: 4.84, 7.62). There was no association with intra-operative variables and probability of delirium. Conclusion:Clinicians treating people with a hip fracture should be vigilant towards postoperative delirium if their patients are older, have pre-existing cognitive impairment and poorer overall general health. This is also the case for those who experience post-operative complications such as pneumonia or a urinary tract infection.

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Section: Discussionsupporting

confidence: 82%

Section: Resultsmentioning

confidence: 99%

Factors predicting incidence of post‐operative delirium in older people following hip fracture surgery: a systematic review and meta‐analysis

Smith

Cooper

Peryer

et al. 2017

Int J Geriat Psychiatry

126

104

View full text Add to dashboard Cite

show abstract

“…Existe evidencia contundente de una disminución sustancial de la IL-15, IL-1ra e IL-6, así como un aumento en la IL-10, lo que genera una posible explicación del cuadro basado en dos posibilidades, que el delirio se deba a un aumento de la respuesta pro inflamatoria o a un descenso de la antinflamatoria (18) .…”

Section: Fisiopatologíaunclassified

“…A pesar de esto, se considera necesario realizar más estudios control para validar la relación entre una respuesta antinflamatoria inadecuada solamente o un desbalance neuroinflamatorio, dentro de la patogénesis de éste síndrome (18) .…”

Section: Conclusiones Y Recomendacionesunclassified

TEMA 9-2014: Delirio postquirúrgico en fractura de cadera del paciente adulto mayor

Zamora

2014

RC_UCR-HSJD

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“…Fourth, drugs with anticholinergic effects are associated with delirium in humans [9] as well as being associated with a higher risk of developing both short- and long-term cognitive impairment [10]. Finally, serum anticholinergic activity has been associated with delirium [11], though not all studies confirm this [12]. …”

Section: Introductionmentioning

confidence: 97%

Acetylcholinesterase Activity Measurement and Clinical Features of Delirium

Jackson

Moorey

Sheehan

et al. 2016

Dement Geriatr Cogn Disord

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Aims: Cholinergic deficiency is commonly implicated in the pathophysiology of delirium. We aimed to investigate the relationship between directly measured serum acetylcholinesterase (AChE) activity and (1) clinical features of delirium and (2) outcomes among older hospital patients with delirium. Methods: Hospitalised patients with delirium were recruited, and delirium motor subtype, severity and duration of delirium were measured. Serum AChE activity was measured using a colorimetric assay. Results: The mean AChE activity for the whole sample was 2.46 μmol/μL/min (standard deviation 1.75). Higher AChE activity was associated with increased likelihood of hypoactive delirium rather than the hyperactive or mixed subtype (odds ratio 1.98, 95% confidence interval 1.10-3.59). Conclusion: Higher AChE activity was associated with hypoactive delirium but did not predict outcomes. Simple enhancement of cholinergic neurotransmission may not be sufficient to treat delirium.

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Anticholinergic Activity in Cerebrospinal Fluid and Serum in Individuals with Hip Fracture with and without Delirium

Abstract: This is the first study of AA in CSF of individuals with and without delirium. The study does not support the hypothesis that central (CSF) or peripheral (serum) AA is an important mechanism of delirium in individuals with hip fracture.

Cited by 33 publications

References 53 publications

Factors predicting incidence of post‐operative delirium in older people following hip fracture surgery: a systematic review and meta‐analysis

Factors predicting incidence of post‐operative delirium in older people following hip fracture surgery: a systematic review and meta‐analysis

TEMA 9-2014: Delirio postquirúrgico en fractura de cadera del paciente adulto mayor

Acetylcholinesterase Activity Measurement and Clinical Features of Delirium

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