Serum anticholinergic activity changes with acute illness in elderly medical patients
Serum anticholinergic activity changes with acute illness in elderly medical patients
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DOI：
10.1093/gerona/54.1.m12
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发表时间：
1999-01-01
影响因子：
5.1
通讯作者：
Lipsitz, LA
中科院分区：
文献类型：
--
作者：
Flacker, JM;Lipsitz, LA
背景。在针对老年人的横断面研究中，血清抗胆碱能活性水平升高与谵妄有关。这项研究使用了血清抗胆碱能活性水平的一系列测量，以确定这些水平是否在疾病缓解后发生变化，以及这些变化是否是谵妄患者特有的。方法。抽取了 22 名患有发热性疾病的疗养院居民的血清样本，并在急性疾病期间和 1 个月的随访期间评估了是否存在谵妄。使用混乱评估方法诊断谵妄。使用先前描述的放射性核素竞争结合测定法测定血清抗胆碱能活性。结果。 22 名受试者中有 8 名 (36%) 在患病期间出现谵妄，经过 1 个月的随访，除一名住院医师外，所有受试者均已缓解。患病期间血清抗胆碱能活性水平显着高于 1 个月随访时，神志不清者（0.69 +/- 0.85 nM 阿托品当量/200 μL 样品 vs 0.10 +/- 0.16；p = .06）和非神志不清者（0.65 +/- 0.51 nM 阿托品当量/200 μL 样品 vs 0.08 +/- 0.08 +/-） 0.12；p < .001) 组。药物变化似乎与血清抗胆碱能活性的变化无关。结论。在发烧的老年疗养院居民中，血清抗胆碱能活性在患病期间似乎升高，并在疾病康复后下降。这种效应似乎并不是那些患有谵妄的居民所特有的，也似乎与药物治疗的变化无关。
Background. Elevated serum anticholinergic activity levels have been associated with delirium in cross-sectional studies of ill older persons. This study used serial measures of serum anticholinergic activity levels to determine whether these levels change following illness resolution, and if such changes are specific to those with delirium.Methods. Twenty-two nursing home residents with a febrile illness had serum specimens drawn and were evaluated for the presence of delirium during the acute illness and at I-month follow-up. Delirium was diagnosed using the Confusion Assessment Method. Serum anticholinergic activity was determined using a previously described radionuclide competitive-binding assay.Results. Delirium was present during illness in 8 of 22 subjects (36%), and had resolved by 1-month follow-up in all but one resident. Serum anticholinergic activity levels were significantly higher during illness than at 1-month follow-up in both the delirious (0.69 +/- 0.85 nM atropine equivalents/200 mu L sample versus 0.10 +/- 0.16; p = .06) and non-delirious (0.65 +/- 0.51 nM atropine equivalents/200 mu L sample versus 0.08 +/- 0.12; p < .001) groups. Medication changes did not seem to be related to changes in serum anticholinergic activity.Conclusions. In older nursing home residents with a fever, serum anticholinergic activity appears to be elevated during illness, and declines following recovery from illness. This effect does not seem to be specific to those residents with delirium, nor does it seem related to medication changes.