The Association of Serum Anticholinergic Activity With Delirium in Elderly Medical Patients

Flacker, Jonathan M.; Cummings, Virginia; Mach, John; Bettin, Kris M.; Kiely, Dan K.; Wei, Jeanne Y.

doi:10.1097/00019442-199800610-00005

Cited by 114 publications

(114 citation statements)

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“…Increasing acetylcholine levels by use of cholinesterase inhibitors such as physostigmine has been shown to reverse delirium associated with anticholinergic drugs 17–19. Serum anticholinergic activity, which reflects anticholinergic influences of both endogenous and exogenous drugs and their metabolites, has been shown in some studies to be increased in patients with delirium and to decline with the resolution of delirium 20–22. By contrast, other studies did not find a clear association between serum anticholinergic activity and delirium,23,24 but this might be because serum anticholinergic activity does not accurately reflect central cholinergic function.…”

Section: Pathophysiologymentioning

confidence: 99%

Delirium in elderly adults: diagnosis, prevention and treatment

2009

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Delirium is a common and serious acute neuropsychiatric syndrome with core features of inattention and global cognitive dysfunction. The etiologies of delirium are diverse and multifactorial and often reflect the pathophysiological consequences of an acute medical illness, medical complication or drug intoxication. Delirium can have a widely variable presentation, and is often missed and underdiagnosed as a result. At present, the diagnosis of delirium is clinically based and depends on the presence or absence of certain features. Management strategies for delirium are focused on prevention and symptom management. This article reviews current clinical practice in delirium in elderly individuals, including the diagnosis, treatment, outcomes and economic impact of this syndrome. Areas of future research are also discussed.

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Section: Pathophysiologymentioning

confidence: 99%

Delirium in elderly adults: diagnosis, prevention and treatment

2009

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“…Anticholinergic activity is also associated with the occurrence and severity of delirium. 1 2 A number of studies have shown that anticholinergic medication use is a common precipitating risk factor. 3 4 While delirium is a multifactorial process, it is estimated that medications alone may account for 12%-39% of all cases of delirium.…”

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confidence: 99%

An approach to drug induced delirium in the elderly

Alagiakrishnan

Wiens

2004

Postgraduate Medical Journal

285

202

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Drugs have been associated with the development of delirium in the elderly. Successful treatment of delirium depends on identifying the reversible contributing factors, and drugs are the most common reversible cause of delirium. Anticholinergic medications, benzodiazepines, and narcotics in high doses are common causes of drug induced delirium. This article provides an approach for clinicians to prevent, recognise, and manage drug induced delirium. It also reviews the mechanisms for this condition, especially the neurotransmitter imbalances involving acetylcholine, dopamine, and gamma aminobutyric acid and discusses the age related changes that may contribute to altered pharmacological effects which have a role in delirium. Specific interventions for high risk elderly with the goal of preventing drug induced delirium are discussed.

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“…A state of cholinergic deficiency is one of the leading hypothetical mechanisms for delirium23 and elevated anticholinergic activity correlates positively with delirium severity 47. Anticholinergic medications and prior dementia, in which cerebral cholinergic deficiency is prominent, both predict delirium 48.…”

Section: Methodsmentioning

confidence: 99%

“…Flacker et al 47 found SAA levels to be more than doubled in delirium, and increased levels of SAA were also associated with a higher burden of delirium symptoms. Further work by the same group found that SAA levels were significantly higher during acute illness than at 1-month follow-up, with a decline in SAA levels with the resolution of delirium 78.…”

Section: Methodsmentioning

confidence: 99%

Delirium and dementia with Lewy bodies: distinct diagnoses or part of the same spectrum?

Gore

Vardy

O’Brien

2014

J Neurol Neurosurg Psychiatry

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Dementia with Lewy bodies (DLB) is recognised as the second most common form of dementia in older people. Delirium is a condition of acute brain dysfunction for which a pre-existing diagnosis of dementia is a risk factor. Conversely delirium is associated with an increased risk of developing dementia. The reasons for this bidirectional relationship are not well understood. Our aim was to review possible similarities in the clinical presentation and pathophysiology between delirium and DLB, and explore possible links between these diagnoses. A systematic search using Medline, Embase and Psychinfo was performed. References were scanned for relevant articles, supplemented by articles identified from reference lists and those known to the authors. 94 articles were selected for inclusion in the review. Delirium and DLB share a number of clinical similarities, including global impairment of cognition, fluctuations in attention and perceptual abnormalities. Delirium is a frequent presenting feature of DLB. In terms of pathophysiological mechanisms, cholinergic dysfunction and genetics may provide a common link. Neuroimaging studies suggest a brain vulnerability in delirium which may also occur in dementia. The basal ganglia, which play a key role in DLB, have also been implicated in delirium. The role of Cerebrospinal fluid (CSF) and serum biomarkers for both diagnoses is an interesting area although some results are conflicting and further work in this area is needed. Delirium and DLB share a number of features and we hypothesise that delirium may, in some cases, represent early or 'prodromal' DLB. Further research is needed to test the novel hypothesis that delirium may be an early marker for future DLB, which would aid early diagnosis of DLB and identify those at high risk.

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The Association of Serum Anticholinergic Activity With Delirium in Elderly Medical Patients

Cited by 114 publications

References 0 publications

Delirium in elderly adults: diagnosis, prevention and treatment

Delirium in elderly adults: diagnosis, prevention and treatment

An approach to drug induced delirium in the elderly

Delirium and dementia with Lewy bodies: distinct diagnoses or part of the same spectrum?

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