Abstract
Aims: Cholinergic deficiency is commonly implicated in the pathophysiology of delirium. We aimed to investigate the relationship between directly measured serum AChE activity and (1) clinical features of delirium and (2) outcomes, among older hospital patients with delirium. Methods: Hospitalized patients with delirium were recruited and delirium motor subtype, severity and duration of delirium were measured. Serum AChE activity was measured using a colorimetric assay. Results: The mean AChE activity for the whole sample was 2.46 μmol/μml/min (SD 1.75). Higher AChE activity was associated with increased likelihood of hypoactive delirium rather than the hyperactive or mixed subtype (OR 1.98, CI 1.10-3.59). Conclusion: Higher AChE activity was associated with hypoactive delirium, but did not predict outcomes. Simple enhancement of cholinergic neurotransmission may not be sufficient to treat delirium
Highlights
Delirium is an acute neuropsychiatric syndrome of acutely altered mental status characterised by inattention, other cognitive deficits, altered level of arousal, psychotic features, and other disturbances
There was no difference in demographics between those recruited and those not (Figure 1). 37 (62%) had dementia, of whom five (8%) were on cholinesterase inhibitor drugs so were excluded from the final analysis, leaving a final study sample of 55
We have demonstrated for the first time an association between elevated serum AChE enzyme activity and the hypoactive subtype of delirium
Summary
Delirium is an acute neuropsychiatric syndrome of acutely altered mental status characterised by inattention, other cognitive deficits, altered level of arousal, psychotic features, and other disturbances. Dysfunction of cholinergic neurons and neuronal loss has been found to lead to low levels of the neurotransmitter acetylcholine (Ach) in both dementia and delirium[6]. Delirium has been demonstrated in animals through both the administration of anticholinergic drugs [7] and following septic challenge in animals with cholinergic neurons selectively removed [8]. Drugs with anticholinergic effects are associated with delirium in humans [9] as well as being associated with a higher risk of developing both short and long term cognitive impairment [10]. Serum anticholinergic activity has been associated with delirium [11] though not all studies confirm this[12]
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