Caplan Gideon A, Tai JIan, Mohd Hanizan Fazrul, McVeigh Catherine L, Hill Mark A, Poljak Anne
Department of Geriatric Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia.
Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
Dement Geriatr Cogn Dis Extra. 2017 Jul 11;7(2):240-248. doi: 10.1159/000477847. eCollection 2017 May-Aug.
BACKGROUND/AIMS: Delirium and the apolipoprotein E ε4 allele are risk factors for late-onset Alzheimer disease (LOAD), but the connection is unclear. We looked for an association.
Inpatients with delirium ( = 18) were compared with LOAD outpatients ( = 19), assaying blood and cerebrospinal fluid (CSF) using multiplex ELISA.
The patients with delirium had a higher Confusion Assessment Method (CAM) score (5.6 ± 1.2 vs. 0.0 ± 0.0; < 0.001) and Delirium Index (13.1 ± 4.0 vs. 2.9 ± 1.2; = 0.001) but a lower Mini-Mental State Examination (MMSE) score (14.3 ± 6.8 vs. 20.8 ± 4.6; = 0.003). There was a reduction in absolute CSF apolipoprotein E level during delirium (median [interquartile range]: 9.55 μg/mL [5.65-15.05] vs. 16.86 μg/mL [14.82-20.88]; = 0.016) but no differences in apolipoprotein A1, B, C3, H, and J. There were no differences in blood apolipoprotein levels, and no correlations between blood and CSF apolipoprotein levels. CSF apolipoprotein E correlated negatively with the CAM score ( = -0.354; = 0.034) and Delirium Index ( = -0.341; = 0.042) but not with the Acute Physiology and Chronic Health Evaluation (APACHE) index, or the MMSE or Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE).
Reduced CSF apolipoprotein E levels during delirium may be a mechanistic link between two important risk factors for LOAD.
背景/目的：谵妄和载脂蛋白Eε4等位基因是晚发型阿尔茨海默病（LOAD）的危险因素，但二者之间的联系尚不清楚。我们探究了它们之间的关联。
将18例谵妄住院患者与19例LOAD门诊患者进行比较，采用多重酶联免疫吸附测定法检测血液和脑脊液（CSF）。
谵妄患者的意识错乱评估法（CAM）评分更高（5.6±1.2 vs. 0.0±0.0；P<0.001），谵妄指数更高（13.1±4.0 vs. 2.9±1.2；P=0.001），但简易精神状态检查表（MMSE）评分更低（14.3±6.8 vs. 20.8±4.6；P=0.003）。谵妄期间脑脊液载脂蛋白E的绝对水平降低（中位数[四分位间距]：9.55μg/mL[5.65 - 15.05] vs. 16.86μg/mL[14.82 - 20.88]；P=0.016），但载脂蛋白A1、B、C3、H和J无差异。血液载脂蛋白水平无差异，血液和脑脊液载脂蛋白水平之间无相关性。脑脊液载脂蛋白E与CAM评分呈负相关（r=-0.354；P=0.034），与谵妄指数呈负相关（r=-0.341；P=0.042），但与急性生理与慢性健康状况评价系统（APACHE）指数、MMSE或老年人认知功能减退知情者问卷（IQCODE）无关。
谵妄期间脑脊液载脂蛋白E水平降低可能是LOAD两个重要危险因素之间的机制性联系。
