A long-term follow-up study of cerebrospinal fluid 5-hydroxyindoleacetic acid in delirium

  • Hannu J. Koponen
  • Ulla Lepola
  • Esa Leinonen
Original Paper


Cerebrospinal fluid 5-hydroxyindoleacetic acid (CSF 5-HIAA) was determined for elderly delirious patients during the acute stage and after a 1-year follow-up period, and the 5-HIAA levels were compared with age-equivalent controls. As compared with the controls, the 5-HIAA levels were significantly higher at the beginning of the index admission in patients with multi-infarct dementia and patients with no apparent CNS disease. The 5-HIAA levels were also higher in the latter subgroup in the 1-year sampling, but no other differences between delirious patients and controls were observed. The one-way procedure showed no differences between the subgroup means of delirious patients when divided according to the severity of cognitive decline or type of delirium in any of the samples. The 5-HIAA levels measured during the index admission correlated with the length of life after delirium suggesting that serotonergic dysfunction may have prognostic significance in delirious patients.

Key words

Cerebrospinal fluid delirium dementia 5-hydroxyindoleacetic acid serotonin 


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  1. American Psychiatric Association (1980) Diagnostic and statistical manual of mental disorders (3 rd ed.). APA: Washington, DCGoogle Scholar
  2. Banks CM, Vojnik M (1978) Comparative simultaneous measurement of cerebrospinal fluid 5-hydroxyindoleacetic acid and blood serotonin levels in delirium tremens and clozapine-induced delirious reaction. J Neurol Neurosurg Psychiatry 41:420–424PubMedGoogle Scholar
  3. Coccaro EF (1989) Central serotonin and impulsive aggression. Br J Psychiatry 155 [Suppl 8]:52–62Google Scholar
  4. Duara R, Grady C, Haxby J, Sundaram M, Cutler NR, Heston L, Moore A, Schlageter N, Larson S, Rapoport SI (1986) Positron emission tomography in Alzheimer's disease. Neurology 36:879–887PubMedGoogle Scholar
  5. Ferrarese C, Bassi S, Frattola L, Locatelli P, Piolti R, Trabucchi M (1986) Different patterns of CSF neurotransmitter metabolism in patients with left or right hemispheric stroke. Acta Neurol Scand 3:581–585Google Scholar
  6. Folstein MF, Folstein SE, McHugh PR (1975) MlsMini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198CrossRefPubMedGoogle Scholar
  7. Gibson GE, Blass JP, Huang H-M, Freeman GB (1991) The cellular basis of delirium and its relevance to age-related disorders inculding Alzheimer's disease. Int Psychogeriatrics 2:373–395CrossRefGoogle Scholar
  8. Hoehn MM, Yahr MD (1967) Parkonsonism: onset, progression, and mortality. Neurology 17:427–442PubMedGoogle Scholar
  9. Jolkkonen J, Lehtinen M, Soininen H, Sennef C, Riekkinen P (1987) Enhanced monoaminergic neurotransmission by desglycinamide-arginine-vasopressin in human subjects. Neurosci Lett 76:312–315CrossRefPubMedGoogle Scholar
  10. Koponen H, Riekkinen PJ (1993) A prospective study of delirium in elderly patients admitted to a psychiatric hospital. Psychol Med 23:103–109PubMedGoogle Scholar
  11. Levkoff SE, Evans DA, Liptzin B, Cleary PD, Lipsitz LA, Wetle TT, Reilly CH, Pilgrim DM, Schor J, Rowe J (1992) Delirium. The occurrence and persistence of symptoms among elderly hospitalized patients. Arch Intern Med 152:334–340CrossRefPubMedGoogle Scholar
  12. Lindesay J, Macdonald A, Starke I (1990) Delirium in the elderly. Oxford University Press, OxfordGoogle Scholar
  13. Lipowski ZJ (1980) Delirium: Acute brain failure in man. Charles C. Thomas, SpringfieldGoogle Scholar
  14. Lipowski ZJ (1983) Transient cognitive disorders (delirium, acute confusional states) in the elderly. Am J Psychiatry 140:1426–1436PubMedGoogle Scholar
  15. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM (1984) Clinical diagnosis of Alzheimer's disease: Report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease. Neurology 34:939–944PubMedGoogle Scholar
  16. Mesulam M-M (1986) Principles of behavioral neurology. F. A. Davis Company, PhiladelphiaGoogle Scholar
  17. van Praag HM, de Haan S (1979) Central serotonin metabolism and frequency of depression. Psychiatry Press 1:219–224CrossRefGoogle Scholar
  18. Reinikainen KJ, Paljärvi L, Huuskonen M, Soininen H, Laakso M, Riekkinen PJ (1988) A post-mortem study of noradrenergic, serotonergic and GABAergic neurons in Alzheimer's disease. J Neurol Sci 84:101–116CrossRefPubMedGoogle Scholar
  19. Seeldrayers P, Messina D, Desmedt D, Dalesio O, Hildebrand J (1985) CSF levels of neurotransmitters in Alzheimer-type dementia. Effects of ergoloid mesylate. Acta Neurol Scand 71:411–414PubMedGoogle Scholar
  20. Soininen H, McDonald E, Rekonen M, Riekkinen PJ (1981) Homovanillic acid and 5-hydroxyindoleacetic acid levels in cerebrospinal fluid of patients with senile dementia of Alzheimer type. Acta Neurol Scand 64:101–107PubMedGoogle Scholar
  21. Trzepacz PT, Teague GB, Lipowski ZJ (1985) Delirium and other organic mental disorders in a general hospital. Gen Hosp Psychiatry 7:101–106CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • Hannu J. Koponen
    • 1
  • Ulla Lepola
    • 2
  • Esa Leinonen
    • 2
  1. 1.Moisio HospitalMikkeliFinland
  2. 2.Psychiatric Research Clinic of KuopioKuopioFinland

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