Increased CSF levels of aromatic amino acids in hip fracture patients with delirium suggests higher monoaminergic activity

Watne, Leiv Otto; Idland, Ane‐Victoria; Fekkes, Durk; Ræder, Johan; Frihagen, Frede; Ranhoff, Anette Hylen; Chaudhry, Farrukh A.; Engedal, Knut; Wyller, Torgeir Bruun; Hassel, Bjørnar

doi:10.1186/s12877-016-0324-0

Cited by 36 publications

(29 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The results in Koponen et al () support an excess of serotonin in delirium. The findings of increased levels of precursor amino acids in Watne et al () suggest a downstream role for serotonin and for a generally higher monoaminergic tone in delirium. The association of high dopamine metabolites with psychotic features in Ramirez‐Bermudez et al () supports a role in these symptoms of delirium, if not the whole syndrome.…”

Section: Discussionmentioning

confidence: 91%

“…Timing of CSF sampling according to different phases of delirium was associated with different biomarker findings. CSF collection before delirium was associated with reduced IL‐6, IL‐1ra, Flt‐3 L (Westhoff et al, ), increased IL‐1β (Cape et al, ), neopterin (Hall et al, ) and 5‐HIAA and amino acid levels (Watne et al, ), and a low Aβ/tau ratio (Xie et al, ) conferred an increased risk of delirium. Collection during delirium was associated with reduced BLI (Koponen and Riekkinen, ) and SLI (Koponen et al, ), increased IL‐1ra (Cape et al, ), neopterin (Hall et al, ), lactate, protein (Caplan et al, ), α1‐glycoprotein (Poljak et al, ) and S100B (Beishuizen et al, ), lower NSE (Caplan et al, ) and in those without prior cognitive impairment, higher CRP (Neerland et al, ).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

CSF biomarkers in delirium: a systematic review

Hall

Watne

Cunningham³

et al. 2017

Int J Geriat Psychiatry

Self Cite

View full text Add to dashboard Cite

Key points:1. Delirium is a major public health concern, and research on pathophysiological mechanisms is urgently needed.2. Some biochemical changes in the brain are to an extent reflected in the cerebrospinal fluid (CSF) and in recent years there has been a blossoming of studies examining CSF as a method of studying the pathophysiology of delirium.3. The 22 studies identified in this review reveal a small but growing literature, in which many of the important hypotheses in delirium pathogenesis have been examined, but from which few firm conclusions can currently be drawn. Nevertheless, the overall interpretation of the literature supports the vulnerable brain concept. 4. A concerted effort is now required to standardise several aspects of the methodology and reporting of these studies, in order to advance this highly promising direction in delirium research. Funding: The Norwegian Association for Public Health AbstractObjective In recent years there has been a blossoming of studies examining cerebrospinal fluid (CSF) as a method of studying the pathophysiology of delirium. We systematically reviewed the literature for CSF studies in delirium and provide here a summary of the implications for our understanding of delirium pathophysiology. We also summarise the methods used for CSF analysis and discuss challenges and implications for future studies.Methods In this systematic review we screened MEDLINE, EMBASE, PsycINFO, Web of Science, PubMed and the Cochrane Library for articles on CSF biomarkers in delirium, published to September 3 rd 2016. Studies were required to use DSM or ICD criteria for delirium, or a validated tool. We excluded case reports. There were no other restrictions on study type. ResultsWe identified 3280 articles from our initial search and 22 articles were included in this review. All studies were prospective, including over 400 patients with delirium and 700 controls. More than 70 different biomarkers were studied. Studies could not be compared with each other for meta-analysis because of their heterogeneity, and varied widely in their risk of bias and quality assessments. ConclusionsThe 22 studies identified in this review reveal a small but growing literature, in which many of the important hypotheses in delirium pathogenesis have been examined, but from which few firm conclusions can currently be drawn. Nevertheless, the overall interpretation of the literature supports the vulnerable brain concept, that is that biomarker 4 evidence of for example Alzheimer's disease pathology and/or neuroinflammation is associated with delirium.

show abstract

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

CSF biomarkers in delirium: a systematic review

Hall

Watne

Cunningham³

et al. 2017

Int J Geriat Psychiatry

Self Cite

View full text Add to dashboard Cite

show abstract

“…Although its incidence in the general surgical population is 2e3%, it has been reported to occur in up to 50e70% of high-risk patient groups. 1,2 In addition, the occurrence of postoperative delirium is associated with considerably raised morbidity and mortality, and increased healthcare resource expenditure.…”

Section: Editor's Key Pointsmentioning

confidence: 99%

Postoperative delirium: perioperative assessment, risk reduction, and management

Jin

2020

British Journal of Anaesthesia

374

263

View full text Add to dashboard Cite

Postoperative delirium is a relatively common and serious complication. It increases hospital stay by 2e3 days and is associated with a 30-day mortality of 7e10%. It is most prevalent in older patients, those with existing neurocognitive disorders, and those undergoing complex or emergency procedures. Preclinical and clinical research in recent years has uncovered more about the pathophysiology of postoperative delirium and may yield more potential therapeutic options. Using the enhanced recovery pathway framework of risk stratification, risk reduction, and rescue treatment, we have reviewed the current clinical evidence on the validity of delirium prediction scores for the surgical population, the effectiveness of perioperative delirium risk reduction interventions, and management options for established delirium. Effective perioperative interventions include depth of anaesthesia monitoring, intraoperative dexmedetomidine infusion, and multimodal analgesia. Choice of general anaesthetic agent may not be associated with significant difference in delirium risk. Several other factors, such as preoperative fasting, temperature control, and blood pressure management have some association with the risk of postoperative delirium; these will require further studies. Because of the limited treatment options available for established delirium, we propose that risk assessment and perioperative risk reduction may be the most effective approaches in managing postoperative delirium.

show abstract

“…Sample selection in the hip fracture cohort is the same as in a previously published article [ 17 ]. CSF was obtained from 143 patients with hip fracture.…”

Section: Methodsmentioning

confidence: 99%

Cerebrospinal Fluid Phosphate in Delirium after Hip Fracture

Idland

Wyller

Støen

et al. 2017

Dement Geriatr Cogn Disord Extra

Self Cite

View full text Add to dashboard Cite

Aims: Phosphate is essential for neuronal activity. We aimed to investigate whether delirium is associated with altered phosphate concentrations in cerebrospinal fluid (CSF) and serum. Methods: Seventy-seven patients with hip fracture were assessed for delirium before and after acute surgery. Prefracture dementia was diagnosed by an expert panel. Phosphate was measured in CSF obtained immediately before spinal anesthesia (n = 77) and in serum (n = 47). CSF from 23 cognitively healthy elderly patients undergoing spinal anesthesia was also analyzed. Results: Hip fracture patients with prevalent delirium had higher CSF phosphate concentrations than those without delirium (median 0.63 vs. 0.55 mmol/L, p = 0.001). In analyses stratified on dementia status, this difference was only significant in patients with dementia. Serum phosphate was ∼1 mmol/L; there was no association between serum phosphate concentration and delirium status. CSF phosphate did not correlate with serum levels. Conclusion: Patients with delirium superimposed on dementia have elevated phosphate levels.

show abstract

Increased CSF levels of aromatic amino acids in hip fracture patients with delirium suggests higher monoaminergic activity

Cited by 36 publications

References 41 publications

CSF biomarkers in delirium: a systematic review

CSF biomarkers in delirium: a systematic review

Postoperative delirium: perioperative assessment, risk reduction, and management

Cerebrospinal Fluid Phosphate in Delirium after Hip Fracture

Contact Info

Product

Resources

About