Abstract
delirium is a frequent neuropsychiatric syndrome affecting medical and surgical elderly patients. Cholinergic dysfunction has been implicated in delirium pathophysiology and plasmatic acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) activities are suppressed in patients with delirium. In this cohort study, we investigated whether these changes emerge during delirium or whether they are present before its onset. plasma activities of AChE and BuChE were measured pre- and postoperatively in consecutive patients ≥60 years old undergoing elective total hip replacement surgery. In addition to a comprehensive clinical and demographic baseline evaluation, venous blood samples were collected from each subject in the morning of hospital admission's day and in the morning of the first postoperative day. Delirium was screened daily with confusion assessment method (confirmed with diagnostic and statistical manual of mental disorders (DSM-IV)-TR). preoperatively, plasma esterase activity was significantly lower in patients who developed delirium compared with the remaining subjects. Following surgery BuChE activity was lower in the delirium group but this difference disappeared after controlling for preoperative values. Plasma cholinesterase activity correlated positively with calcium and haemoglobin and negatively with total bilirubin and international normalised ratio. plasma cholinesterase activity can be a useful candidate biomarker to identify subjects at greater risk of developing postoperative delirium.
Highlights
Delirium is a neuropsychiatric syndrome clinically characterised by a sudden onset and transient impairment of consciousness and attention, with consecutive global cognitive and behavioural disturbance [1]
Failure in cholinergic neurotransmission has long been recognised to be involved in delirium pathophysiology in light of the evidence that cognitive impairment and psychosis are induced by anticholinergic agents [3]
Several studies identified that increased burden of serum anticholinergic activity is associated with both delirium [4, 5] and lower cognitive performance in the elderly [6]
Summary
Delirium is a neuropsychiatric syndrome clinically characterised by a sudden onset and transient impairment of consciousness and attention, with consecutive global cognitive and behavioural disturbance [1]. It is a common postoperative complication in elderly patients undergoing major surgical procedures as a result of the combined action of several risk factors (e.g. medical illness, advanced age and medications) [2]. Can have a unique role in delirium pathophysiology as they represent a point of convergence between the immune and drug metabolising systems
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