Prospective study of predictors of the diagnosis of delirium or future development of the delirium: the association between serum anticholinergic levels and dignosis or future development of delirium in palliative care patients with advanced cancer.

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Delirium is common in patients with advanced cancer, and presents with symptoms of disturbed sleep, attention, and/or memory; and restlessness or drowsiness. The cause of this is believed to be due to a disturbance of the cholinergic transmitter system in the brain. This could be due to anticholinergic activity of medication, or substances produced in acute illness. It is not possible to measure these abnormalities in the brain in the clinical setting, so a surrogate marker(s) that is routinely measured would be useful. A serum anticholinergic assay can quantify anticholinergic activity in the blood. We aim to measure this on admission to a palliative care unit, and at an episode of delirium, and look at its levels in relation to its ability to predict the occurrence of delirium. We will also look for associations with other simple clinical and investigational measures, so a model can be developed to more accurately predict those at risk of delirium so preventive strategies and early identification can be utilised.

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