Cerebrospinal Fluid Phosphate in Delirium after Hip Fracture.

AIMS: Phosphate is essential for neuronal activity. We aimed to investigate whether delirium is associated with altered phosphate concentrations in cerebrospinal fluid (CSF) and serum. METHODS: Seventy-seven patients with hip fracture were assessed for delirium before and after acute surgery. Prefracture dementia was diagnosed by an expert panel. Phosphate was measured in CSF obtained immediately before spinal anesthesia (n = 77) and in serum (n = 47). CSF from 23 cognitively healthy elderly patients undergoing spinal anesthesia was also analyzed. RESULTS: Hip fracture patients with prevalent delirium had higher CSF phosphate concentrations than those without delirium (median 0.63 vs. 0.55 mmol/L, p = 0.001). In analyses stratified on dementia status, this difference was only significant in patients with dementia. Serum phosphate was ∼1 mmol/L; there was no association between serum phosphate concentration and delirium status. CSF phosphate did not correlate with serum levels. CONCLUSION: Patients with delirium superimposed on dementia have elevated phosphate levels.

Preclinical Amyloid-ß and Axonal Degeneration Pathology in Delirium.

BACKGROUND: The clinical relevance of brain ß-amyloidosis in older adults without dementia is not established. As delirium and dementia are strongly related, studies on patients with delirium may give pathophysiological clues. OBJECTIVE: To determine whether the Alzheimer's disease (AD) cerebrospinal fluid (CSF) biomarkers amyloid-ß 1-42 (Aß42), total tau (T-tau), and phosphorylated tau (P-tau) are associated with delirium in hip fracture patients with and without dementia. METHODS: CSF was collected in conjunction to spinal anesthesia in 129 patients. Delirium was assessed using the Confusion Assessment Method once daily in all patients, both pre- and postoperatively. The diagnosis of dementia at admission was based upon clinical consensus. CSF levels of Aß42, T-tau, and P-tau were analyzed. RESULTS: In patients without dementia, we found lower CSF Aß42 levels (median, 310 ng/L versus 489 ng/L, p = 0.006), higher T-tau levels (median, 505 ng/L versus 351 ng/L, p = 0.02), but no change in P-tau in patients who developed delirium (n = 16) compared to those who remained lucid (n = 49). Delirious patients also had lower ratios of Aß42 to T-tau (p < 0.001) and P-tau (p = 0.001) relative to those without delirium. CSF Aß42 and T-tau remained significantly associated with delirium status in adjusted analyses. In patients with dementia, CSF biomarker levels did not differ between those with (n = 54) and without delirium (n = 10). CONCLUSION: The reduction in CSF Aß42, indicating ß-amyloidosis, and increase in T-tau, indicating neurodegeneration, in hip fracture patients without dementia developing delirium indicates that preclinical AD brain pathology is clinically relevant and possibly plays a role in delirium pathophysiology.

[Dosage of ordinary medication prior to elective surgery]. / Dosering av faste legemidler før elektive operasjoner.

Patients will in general benefit from their ordinary medication in the perioperative phase. However, exceptions and special precautions are justified with drugs that may have effects, side-effects or interactions, which are particularly beneficial or harmful during a perioperative course. This includes drugs with thrombotic or bleeding potential, antidiabetics, psychopharmaca and some of the drugs used for prophylaxis and treatment of cardiovascular disease. In such cases individual advice on dosage should be given.