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BMC Neurology
Published in: BMC Neurology 1/2009

Open Access 01-12-2009 | Research article

Markers of cerebral damage during delirium in elderly patients with hip fracture

Authors: Barbara C van Munster, Catharina M Korse, Sophia E de Rooij, Johannes M Bonfrer, Aeilko H Zwinderman, Johanna C Korevaar

Published in: BMC Neurology | Issue 1/2009

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Abstract

Background

S100B protein and Neuron Specific Enolase (NSE) can increase due to brain cell damage and/or increased permeability of the blood-brain-barrier. Elevation of these proteins has been shown after various neurological diseases with cognitive dysfunction. Delirium is characterized by temporal cognitive deficits and is an important risk factor for dementia. The aim of this study was to compare the level of S100B and NSE of patients before, during and after delirium with patients without delirium and investigate the possible associations with different subtypes of delirium.

Methods

The study population were patients aged 65 years or more acutely admitted after hip fracture. Delirium was diagnosed by the Confusion Assessment Method and the subtype by Delirium Symptom interview. In maximal four serum samples per patient S100B and NSE levels were determined by electrochemiluminescence immunoassay.

Results

Of 120 included patients with mean age 83.9 years, 62 experienced delirium. Delirious patients had more frequently pre-existing cognitive impairment (67% vs. 18%, p < 0.001). Comparing the first samples during delirium to samples of non-delirious patients, a difference was observed in S100B (median 0.16 versus 0.10 μg/L, p = < 0.001), but not in NSE (median 11.7 versus 11.7 ng/L, p = 0.97). Delirious state (before, during, after) (p < 0.001), day of blood withdrawal (p < 0.001), pre- or postoperative status (p = 0.001) and type of fracture (p = 0.036) were all associated with S100B level. The highest S100B levels were found 'during' delirium. S100B levels 'before' and 'after' delirium were still higher than those from 'non-delirious' patients. No significant difference in S100B (p = 0.43) or NSE levels (p = 0.41) was seen between the hyperactive, hypoactive and mixed subtype of delirium.

Conclusion

Delirium was associated with increased level of S100B which could indicate cerebral damage either due to delirium or leading to delirium. The possible association between higher levels of S100B during delirium and the higher risk of developing dementia after delirium is an interesting field for future research. More studies are needed to elucidate the role of S100B proteins in the pathophysiological pathway leading to delirium and to investigate its possibility as biomarker for delirium.
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Metadata
Title
Markers of cerebral damage during delirium in elderly patients with hip fracture
Authors
Barbara C van Munster
Catharina M Korse
Sophia E de Rooij
Johannes M Bonfrer
Aeilko H Zwinderman
Johanna C Korevaar
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2009
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/1471-2377-9-21

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