Importance of Serum Anticholinergic Activity in the Assessment of Elderly Patients with Delirium

Abstract

To evaluate the importance of serum anticholinergic activity (SAA) in elderly patients who developed delirium following hospital admission, we performed a cross-sectional study with consecutively referred inpatients in a university geriatric medical ward. Sixty-one patients aged 66 to 95 years (mean age: 79.2+/-11.6; 54% females) were recruited. Delirium was assessed by means of the Confusion Assessment Method, SAA determination, questionnaire for current drug treatment, past medical history and clinical examination, and blood chemistries. Patients were divided into two groups according to the absence (N = 49) or the presence (N = 12) of delirium. Delirious patients showed a significantly higher SAA (23.0 vs 3.9 pmol/mL atropine equivalents, P < .004); they were using antibiotics (P < .05), neuroleptics (P < .002), barbiturates (P < .004), and benzodiazepines (P < .005) more frequently. Subjects with delirium were more likely to have infections and a lower Body Mass Index; they had higher plasma glucose and creatinine. The multivariate analysis identified SAA and use of neuroleptics, and benzodiazepines as the most important features independently associated with delirium. SAA may be a suitable marker for identifying people at risk of developing delirium. Moreover, neuroleptics and benzodiazepines must be carefully used in the elderly because of their relationship with the onset of delirium.

EEG changes and serum anticholinergic activity measured in patients with delirium in the intensive care unit

“…The SAA levels reported in the literature were measured with comparable methods but produced widely differing results that appear to be due to the different patient populations studied. In normal young healthy individuals who are not hospitalised, SAA levels are undetectable or low [25]; surgical patients and the elderly showed the highest SAA values [11,26,27]. However, some workers have found much lower SAA levels in similar patient groups [13,28].…”

Pathophysiology of Delirium in the Intensive Care Unit

“…Furthermore, the prevalence of delirium in this study [96] jumped from 8% to 62% when comparing patients with the highest and lowest SAA levels (top and bottom 20th percentile). Mussi and colleagues [104] also reported a link between the incidence of delirium and SAA levels (P!.004) while controlling for other risk factors such as the use of antipsychotics and benzodiazepine. Additionally, all of the patients who had SAA profiles greater than 20.0 pmol/mL [104] were found to be delirious as defined by the Confusion Assessment Method for the ICU [106].…”

“…The assay required to measure SAA was first developed in 1980 by Tune and Coyle [105]. Following this development, several clinical investigations found relationships between SAA levels and the development of delirium [102][103][104]. Thomas and colleagues [102] reported that SAA levels were higher in delirious patients when compared with non-delirious individuals in a sample of surgical patients in the ICU.…”

“…SAA is believed to cross the blood-brain barrier and has been linked to the depth of delirium in several studies [102][103][104]. The assay required to measure SAA was first developed in 1980 by Tune and Coyle [105].…”

Post stroke delirium

“…Наиболее часто причиной делирия считают наруше-ние функционирования холинергической системы [29], и это обосновывается целым рядом факторов [35][36][37][38][39][40][41]. Есть также упоминание [42] о нарушении функционирования дофаминергической системы, а также о дисбалансе дофаминовой и холинергиче-ской систем.…”