Serum anticholinergic activity and cerebral cholinergic dysfunction: an EEG study in frail elderly with and without delirium.
BACKGROUND
Delirium increases morbidity, mortality and healthcare costs especially in the elderly. Serum anticholinergic activity (SAA) is a suggested biomarker for anticholinergic burden and delirium risk, but the association with cerebral cholinergic function remains unclear. To clarify this relationship, we prospectively assessed the correlation of SAA with quantitative electroencephalography (qEEG) power, delirium occurrence, functional and cognitive measures in a cross-sectional sample of acutely hospitalized elderly (> 80 y) with high dementia and delirium prevalence.


METHODS
61 consecutively admitted patients over 80 years underwent an extensive clinical and neuropsychological evaluation. SAA was determined by using radio receptor assay as developed by Tune, and standard as well as quantitative EEGs were obtained.


RESULTS
15 patients had dementia with additional delirium (DD) according to expert consensus using DSM-IV criteria, 31 suffered from dementia without delirium (D), 15 were cognitively unimpaired (CU). SAA was clearly detectable in all patients but one (mean 10.9 +/- 7.1 pmol/ml), but was not associated with expert-panel approved delirium diagnosis or cognitive functions. Delirium-associated EEG abnormalities included occipital slowing, peak power and alpha decrease, delta and theta power increase and slow wave ratio increase during active delirious states. EEG measures correlated significantly with cognitive performance and delirium severity, but not with SAA levels.


CONCLUSIONS
In elderly with acute disease, EEG parameters reliable indicate delirium, but SAA does not seem to reflect cerebral cholinergic function as measured by EEG and is not related to delirium diagnosis.
Thomas
Christine
C
Centre for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Vossstr, Heidelberg, Germany. Christine.Thomas@evkb.de
Hestermann
Ute
U
Kopitz
Juergen
J
Plaschke
Konstanze
K
Oster
Peter
P
Driessen
Martin
M
Mundt
Christoph
C
Weisbrod
Matthias
M
D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D018680:Cholinergic Antagonists / Q000097:blood*; D003072:Cognition Disorders / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology; D003693:Delirium / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D003704:Dementia / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D003937:Diagnosis, Differential; D004569:Electroencephalography; D016330:Frail Elderly; D006801:Humans; D008609:Mental Status Schedule; D019965:Neurocognitive Disorders / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology
D015415:Biomarkers; D018680:Cholinergic Antagonists
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