Anticholinergic Activity in Cerebrospinal Fluid and Serum in Individuals with Hip Fracture with and without Delirium. Issue 1 (2nd January 2014)

• Record Type: Journal Article
• Authors: Watne, Leiv Otto; Hall, Roanna J.; Molden, Espen; Ræder, Johan; Frihagen, Frede; MacLullich, Alasdair M. J.; Juliebø, Vibeke; Nyman, Armika; Meagher, David; Wyller, Torgeir B.
• Is Part Of: Journal of the American Geriatrics Society. Volume 62:Issue 1(2014:Jan.)
• Page Start: 94
• Page End: 102
• Publication Date: 2014-01-02
• Subjects: Geriatrics -- Periodicals; 618.97
• DOI: 10.1111/jgs.12612
• Languages: English
• ISSNs: 0002-8614

Abstract

<abstract abstract-type="main" id="jgs12612-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jgs12612-sec-0001" sec-type="section"> <title>Objectives</title> <p>To examine whether anticholinergic activity (AA) in cerebrospinal fluid (CSF) and serum is associated with risk of delirium in individuals with hip fracture.</p> </sec> <sec id="jgs12612-sec-0002" sec-type="section"> <title>Design</title> <p>Prospective cohort study.</p> </sec> <sec id="jgs12612-sec-0003" sec-type="section"> <title>Setting</title> <p>Two university hospitals in Oslo, Norway, and Edinburgh, UK.</p> </sec> <sec id="jgs12612-sec-0004" sec-type="section"> <title>Participants</title> <p>Individuals admitted with acute hip fracture (N = 151).</p> </sec> <sec id="jgs12612-sec-0005" sec-type="section"> <title>Measurements</title> <p>Participants were assessed daily for delirium using the Confusion Assessment Method (preoperatively and postoperative days 1–5 (all) or until discharge (participants with delirium)). Prefracture cognitive function was assessed using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Serum was collected preoperatively and CSF at the onset of spinal anesthesia. AA in serum (SAA) and CSF samples was determined according to a muscarinic radio receptor bioassay. The association between AA measures and delirium was evaluated using logistic multivariate analyses.</p> </sec> <sec id="jgs12612-sec-0006" sec-type="section"> <title>Results</title> <p>Fifty‐two (54%) of the participants in Oslo and 20 (39%) in Edinburgh developed delirium. There was no statistically significant difference in AA between participants with and without delirium in Oslo (serum: 7.02 vs 6.08 pmol/mL, <italic>P</italic> = .54; CSF: 0.39 vs 0.48 pmol/mL, <italic>P</italic> = .26) or in Edinburgh (serum: 1.35 vs 1.62 pmol/mL, <italic>P</italic> = .76; CSF: 0.36 vs 0.31 pmol/mL, <italic>P</italic> = .93). Nor was there any difference in SAA (Oslo, <italic>P</italic> = .74; Edinburgh, <italic>P</italic> = .51) or CSF AA (Oslo, <italic>P</italic> = .21; Edinburgh, <italic>P</italic> = .93) when participants were subdivided into prevalent, incident, subsyndromal, and never delirium. Stratifying participants according to prefracture cognitive status (IQCODE) gave the same results.</p> </sec> <sec id="jgs12612-sec-0007" sec-type="section"> <title>Conclusion</title> <p>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.</p> </sec> </abstract>