TY - JOUR
T1 - Anticholinergic activity in cerebrospinal fluid and serum in individuals with hip fracture with and without delirium
AU - Watne, Leiv Otto
AU - Hall, Roanna J.
AU - Molden, Espen
AU - Ræder, Johan
AU - Frihagen, Frede
AU - MacLullich, Alasdair M.J.
AU - Juliebø, Vibeke
AU - Nyman, Armika
AU - Meagher, David
AU - Wyller, Torgeir B.
N1 - © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.
PY - 2014/1
Y1 - 2014/1
N2 - Objectives To examine whether anticholinergic activity (AA) in cerebrospinal fluid (CSF) and serum is associated with risk of delirium in individuals with hip fracture. Design Prospective cohort study. Setting Two university hospitals in Oslo, Norway, and Edinburgh, UK. Participants Individuals admitted with acute hip fracture (N = 151). Measurements 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. Results 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, P =.54; CSF: 0.39 vs 0.48 pmol/mL, P =.26) or in Edinburgh (serum: 1.35 vs 1.62 pmol/mL, P =.76; CSF: 0.36 vs 0.31 pmol/mL, P =.93). Nor was there any difference in SAA (Oslo, P =.74; Edinburgh, P =.51) or CSF AA (Oslo, P =.21; Edinburgh, P =.93) when participants were subdivided into prevalent, incident, subsyndromal, and never delirium. Stratifying participants according to prefracture cognitive status (IQCODE) gave the same results. Conclusion 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.
AB - Objectives To examine whether anticholinergic activity (AA) in cerebrospinal fluid (CSF) and serum is associated with risk of delirium in individuals with hip fracture. Design Prospective cohort study. Setting Two university hospitals in Oslo, Norway, and Edinburgh, UK. Participants Individuals admitted with acute hip fracture (N = 151). Measurements 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. Results 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, P =.54; CSF: 0.39 vs 0.48 pmol/mL, P =.26) or in Edinburgh (serum: 1.35 vs 1.62 pmol/mL, P =.76; CSF: 0.36 vs 0.31 pmol/mL, P =.93). Nor was there any difference in SAA (Oslo, P =.74; Edinburgh, P =.51) or CSF AA (Oslo, P =.21; Edinburgh, P =.93) when participants were subdivided into prevalent, incident, subsyndromal, and never delirium. Stratifying participants according to prefracture cognitive status (IQCODE) gave the same results. Conclusion 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.
KW - anticholinergic activity
KW - cerebrospinal fluid
KW - delirium
KW - hip fracture
UR - http://www.scopus.com/inward/record.url?scp=84892832664&partnerID=8YFLogxK
U2 - 10.1111/jgs.12612
DO - 10.1111/jgs.12612
M3 - Article
C2 - 24383557
AN - SCOPUS:84892832664
SN - 0002-8614
VL - 62
SP - 94
EP - 102
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 1
ER -