title: Anticholinergic activity in cerebrospinal fluid and serum in individuals with hip fracture with and without delirium.
abstract: OBJECTIVE
  To examine whether anticholinergic activity (AA) in cerebrospinal fluid (CSF) and serum is associated with risk of delirium in individuals with hip fracture.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Two university hospitals in Oslo, Norway, and Edinburgh, UK.
  
  
  METHODS
  Individuals admitted with acute hip fracture (N = 151).
  
  
  METHODS
  Participants were assessed daily for delirium using the Confusion Assessment Method (preoperatively and postoperative days 1-5 (all) or until discharge (participants with delirium)). Prefracture cognitive function was assessed using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Serum was collected preoperatively and CSF at the onset of spinal anesthesia. AA in serum (SAA) and CSF samples was determined according to a muscarinic radio receptor bioassay. The association between AA measures and delirium was evaluated using logistic multivariate analyses.
  
  
  RESULTS
  Fifty-two (54%) of the participants in Oslo and 20 (39%) in Edinburgh developed delirium. There was no statistically significant difference in AA between participants with and without delirium in Oslo (serum: 7.02 vs 6.08 pmol/mL, P = .54; CSF: 0.39 vs 0.48 pmol/mL, P = .26) or in Edinburgh (serum: 1.35 vs 1.62 pmol/mL, P = .76; CSF: 0.36 vs 0.31 pmol/mL, P = .93). Nor was there any difference in SAA (Oslo, P = .74; Edinburgh, P = .51) or CSF AA (Oslo, P = .21; Edinburgh, P = .93) when participants were subdivided into prevalent, incident, subsyndromal, and never delirium. Stratifying participants according to prefracture cognitive status (IQCODE) gave the same results.
  
  
  CONCLUSIONS
  This is the first study of AA in CSF of individuals with and without delirium. The study does not support the hypothesis that central (CSF) or peripheral (serum) AA is an important mechanism of delirium in individuals with hip fracture.
authors.affiliation: Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Leiv Otto
authors.initials: LO
authors.lastname: Watne
authors.forename: Roanna J
authors.initials: RJ
authors.lastname: Hall
authors.forename: Espen
authors.initials: E
authors.lastname: Molden
authors.forename: Johan
authors.initials: J
authors.lastname: Raeder
authors.forename: Frede
authors.initials: F
authors.lastname: Frihagen
authors.forename: Alasdair M J
authors.initials: AM
authors.lastname: MacLullich
authors.forename: Vibeke
authors.initials: V
authors.lastname: Juliebø
authors.forename: Armika
authors.initials: A
authors.lastname: Nyman
authors.forename: David
authors.initials: D
authors.lastname: Meagher
authors.forename: Torgeir B
authors.initials: TB
authors.lastname: Wyller
mesh_terms: D018806:APACHE; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D018680:Cholinergic Antagonists / Q000097:blood* / Q000134:cerebrospinal fluid*; D015897:Comorbidity; D003693:Delirium / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006620:Hip Fractures / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D011446:Prospective Studies; D012606:Scotland; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D018680:Cholinergic Antagonists
keywords: anticholinergic activity; cerebrospinal fluid; delirium; hip fracture