title: Cerebrospinal fluid cortisol levels are higher in patients with delirium versus controls.
abstract: BACKGROUND
  High plasma cortisol levels can cause acute cognitive and neuropsychiatric dysfunction, and have been linked with delirium. CSF cortisol levels more closely reflect brain exposure to cortisol, but there are no studies of CSF cortisol levels in delirium. In this pilot study we acquired CSF specimens at the onset of spinal anaesthesia in patients undergoing hip fracture surgery, and compared CSF and plasma cortisol levels in delirium cases versus controls.
  
  
  RESULTS
  Delirium assessments were performed the evening before or on the morning of operation with a standard battery comprising cognitive tests, mental status assessments and the Confusion Assessment Method. CSF and plasma samples were obtained at the onset of the operation and cortisol levels measured. Twenty patients (15 female, 5 male) aged 62 - 93 years were studied. Seven patients were diagnosed with delirium. The mean ages of cases (81.4 (SD 7.2)) and controls (80.5 (SD 8.7)) were not significantly different (p = 0.88). The median (interquartile range) CSF cortisol levels were significantly higher in cases (63.9 (40.4-102.1) nmol/L) than controls (31.4 (21.7-43.3) nmol/L; Mann-Whitney U, p = 0.029). The median (interquartile range) of plasma cortisol was also significantly higher in cases (968.8 (886.2-1394.4) nmol/L, than controls (809.4 (544.0-986.4) nmol/L; Mann Whitney U, p = 0.036).
  
  
  CONCLUSIONS
  These findings support an association between higher CSF cortisol levels and delirium. This extends previous findings linking higher plasma cortisol and delirium, and suggests that more definitive studies of the relationship between cortisol levels and delirium are now required.
authors.affiliation: Geriatric Medicine, University of Edinburgh, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Pearson
authors.forename: Annick
authors.initials: A
authors.lastname: de Vries
authors.forename: Scott D
authors.initials: SD
authors.lastname: Middleton
authors.forename: Fiona
authors.initials: F
authors.lastname: Gillies
authors.forename: Timothy O
authors.initials: TO
authors.lastname: White
authors.forename: Ian R
authors.initials: IR
authors.lastname: Armstrong
authors.forename: Ruth
authors.initials: R
authors.lastname: Andrew
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Seckl
authors.forename: Alasdair Mj
authors.initials: AM
authors.lastname: MacLullich