title: APOE and cytokines as biological markers for recovery of prevalent delirium in elderly medical inpatients.
abstract: BACKGROUND
  Delirium frequently occurs in the context of infection and other inflammatory conditions associated with elevated levels of cytokines. Cytokines used therapeutically can induce symptoms of delirium as an adverse effect. We hypothesized that a causal relationship might exist between delirium and cytokine production during illness. Further, we speculated that the APOE genotype of patients might influence their rate of recovery from delirium given that APOE is associated with amyloid deposition, increased susceptibility to exogenous neurotoxins, and can affect the immune response.
  
  
  METHODS
  A cohort of 164 acutely ill patients, 70 years or older, admitted to an elderly medical unit were studied within 3 days of hospital admission and re-assessed twice weekly until their discharge, to identify and follow the clinical course of delirium. The APOE genotype and the level of circulating cytokines were determined for 116 and 60 patients respectively.
  
  
  RESULTS
  Prevalent delirium was significantly (p < 0.05) associated with a previous history of dementia, age, illness severity, disability and low levels of circulating IGF-I. Recovery was significantly associated (p < 0.05) with lack of APOE 4 allele and higher initial IFN-gamma. A model incorporating gender, APOE epsilon 4 status and IGF-I levels predicted recovery or not from delirium in 76.5% of cases, with a sensitivity 0.77 and specificity 0.75.
  
  
  CONCLUSIONS
  A relationship between delirium with APOE genotype, IFN-gamma, and IGF-I, but not with IL-6, IL-1, TNF-alpha, and LIF was found. A predictive model of recovery was derived from gender, APOE status, and IGF-I levels. This model needs replication with further studies.
authors.affiliation: Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London. dimaadamis@yahoo.com
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Adamis
authors.forename: Adrian
authors.initials: A
authors.lastname: Treloar
authors.forename: Finbarr C
authors.initials: FC
authors.lastname: Martin
authors.forename: Norman
authors.initials: N
authors.lastname: Gregson
authors.forename: Gillian
authors.initials: G
authors.lastname: Hamilton
authors.forename: Alastair J D
authors.initials: AJ
authors.lastname: Macdonald
mesh_terms: D018806:APACHE; D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000483:Alleles; D000544:Alzheimer Disease / Q000097:blood / Q000453:epidemiology / Q000235:genetics; D053327:Apolipoprotein E4 / Q000097:blood / Q000235:genetics; D001057:Apolipoproteins E / Q000097:blood / Q000235:genetics*; D003430:Cross-Sectional Studies; D016207:Cytokines / Q000097:blood / Q000235:genetics*; D003693:Delirium / Q000097:blood / Q000453:epidemiology / Q000235:genetics*; D004185:Disability Evaluation; D005260:Female; D005819:Genetic Markers / Q000235:genetics; D005838:Genotype; D006760:Hospitalization; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000235:genetics; D007371:Interferon-gamma / Q000097:blood / Q000235:genetics; D008297:Male; D008609:Mental Status Schedule; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors
chemical_list: D053327:Apolipoprotein E4; D001057:Apolipoproteins E; D016207:Cytokines; D005819:Genetic Markers; D007334:Insulin-Like Growth Factor I; D007371:Interferon-gamma