Longitudinal assessment of serum anticholinergic activity in delirium of the elderly

Munster, Barbara C. Van; Thomas, Christine; Kreisel, Stefan H.; Brouwer, J.; Nanninga, Stephanie; Kopitz, Juergen; Rooij, Sophia E. de

doi:10.1016/j.jpsychires.2012.06.015

Cited by 25 publications

(23 citation statements)

References 43 publications

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“…Together, these studies along with the current study, in which the median age was 84, suggest that SAA may be less important in the pathogenesis of delirium in the oldest adults. Only one other study has assessed SAA and delirium in individuals with hip fracture, and like the current study, did not find any association …”

Section: Discussionsupporting

confidence: 58%

“…In only one of these studies was the mean age >80 . In three other studies with mean age >80, no association between SAA and delirium was found. Together, these studies along with the current study, in which the median age was 84, suggest that SAA may be less important in the pathogenesis of delirium in the oldest adults.…”

Section: Discussionmentioning

confidence: 88%

“…Several studies have found an association between high SAA and chronic (dementia and mild cognitive impairment) and acute (delirium) cognitive deficits . A positive association between SAA and delirium severity has also been reported, but there are also studies reporting no such association …”

mentioning

confidence: 94%

“…12,13 A positive association between SAA and delirium severity has also been reported, 14 but there are also studies reporting no such association. 15,16 Most studies assessing delirium and SAA are crosssectional, but a study of longitudinal assessments of the relationship between SAA and delirium was recently published. 16 Individuals with hip fracture (N = 142) were followed for delirium pre-and postoperatively, and SAA was measured in serum taken at up to four different time points.…”

mentioning

confidence: 99%

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

Watne

Hall

Molden

et al. 2014

J American Geriatrics Society

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 88%

mentioning

confidence: 94%

mentioning

confidence: 99%

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

Watne

Hall

Molden

et al. 2014

J American Geriatrics Society

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“…These events seem rare given the frequency of use of these medications, but they do reflect that they should be used with care, particularly in those who might be considered cognitively at risk. As a class, drugs with anticholinergic properties can precipitate delirium in older people, particularly when the anticholinergic load is changed [87].…”

Section: Bladder Antimuscarinics and Deliriummentioning

confidence: 99%

Managing Urinary Incontinence in Patients with Dementia: Pharmacological Treatment Options and Considerations

et al. 2015

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Urinary incontinence and lower urinary tract symptoms are highly prevalent in late life and are strongly associated with dementia and frailty. Incontinence is extremely common among those living in long-term care and is most commonly due to urgency incontinence. Although national and international guidelines for continence care exist, they often fail to consider the complex comorbidity found in patients with dementia and are often not followed; continence practices in long-term care may promote rather than prevent incontinence. The majority of those with dementia living in the community can be managed successfully with standard treatments, both pharmacological and non-pharmacological; the expectations and aims of treatment of both the patient and their caregivers should be considered. A dementia diagnosis does not preclude management of incontinence, but treatment options may be more limited in those with advanced dementia who are unable to retain information and modify behaviors. High-quality data to guide the choice of pharmacological agent in those with dementia are lacking. Oxybutynin has been shown to have significant adverse cognitive effects, but data to support the use of trospium, solifenacin, darifenacin, and fesoterodine are limited. No data are available for mirabegron. Neither age, frailty, nor dementia should be considered a barrier to pharmacological management, but consideration should be given to the total anticholinergic load. Evidence to guide the treatment of incontinence in this vulnerable patient group is scarce, and available guidelines adapted for each individual's situation should be applied.

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Predisposing and Precipitating Factors Associated With Delirium

et al. 2023

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ImportanceDespite discrete etiologies leading to delirium, it is treated as a common end point in hospital and in clinical trials, and delirium research may be hampered by the attempt to treat all instances of delirium similarly, leaving delirium management as an unmet need. An individualized approach based on unique patterns of delirium pathophysiology, as reflected in predisposing factors and precipitants, may be necessary, but there exists no accepted method of grouping delirium into distinct etiologic subgroups.ObjectiveTo conduct a systematic review to identify potential predisposing and precipitating factors associated with delirium in adult patients agnostic to setting.Evidence ReviewA literature search was performed of PubMed, Embase, Web of Science, and PsycINFO from database inception to December 2021 using search Medical Subject Headings (MeSH) terms consciousness disorders, confusion, causality, and disease susceptibility, with constraints of cohort or case-control studies. Two reviewers selected studies that met the following criteria for inclusion: published in English, prospective cohort or case-control study, at least 50 participants, delirium assessment in person by a physician or trained research personnel using a reference standard, and results including a multivariable model to identify independent factors associated with delirium.FindingsA total of 315 studies were included with a mean (SD) Newcastle-Ottawa Scale score of 8.3 (0.8) out of 9. Across 101 144 patients (50 006 [50.0%] male and 49 766 [49.1%] female patients) represented (24 015 with delirium), studies reported 33 predisposing and 112 precipitating factors associated with delirium. There was a diversity of factors associated with delirium, with substantial physiological heterogeneity.Conclusions and RelevanceIn this systematic review, a comprehensive list of potential predisposing and precipitating factors associated with delirium was found across all clinical settings. These findings may be used to inform more precise study of delirium’s heterogeneous pathophysiology and treatment.

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Longitudinal assessment of serum anticholinergic activity in delirium of the elderly

Cited by 25 publications

References 43 publications

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

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

Managing Urinary Incontinence in Patients with Dementia: Pharmacological Treatment Options and Considerations

Predisposing and Precipitating Factors Associated With Delirium

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