The Impact of Plasma Cholinergic Enzyme Activity and Other Risk Factors for the Development of Delirium in Patients Receiving Palliative Care  Konstanze Plaschke, PhD, Katharina A. Petersen, MD, Susanne Frankenhauser, MD, Markus A. Weigand, MD, Jürgen Kopitz, PhD, Hubert J. Bardenheuer, MD  Journal of Pain and Symptom Management  Volume 52, Issue 4, Pages 525-532 (October 2016) DOI: 10.1016/j.jpainsymman.2016.05.015 Copyright © 2016 American Academy of Hospice and Palliative Medicine Terms and Conditions

Fig. 1 Effect of medication on cholinesterase activity. a) ACHE and b) BuCHE. Mean ± SEM of a) ACHE and b) BuCHE activity in relation to the number of anticholinergic medications. First column shows summarized values from additional 4 age-matched control patients without any medication and was significant (*P < 0.05) versus all other columns. ACHE = acetylcholinesterase; BuCHE = butyrylcholinesterase. Journal of Pain and Symptom Management 2016 52, 525-532DOI: (10.1016/j.jpainsymman.2016.05.015) Copyright © 2016 American Academy of Hospice and Palliative Medicine Terms and Conditions

Fig. 2 In vitro effect of midazolam on CHE activity. a) ACHE and b) BuCHE. The figure represents the dose-dependent inhibition curve of CHE activity (a: ACHE, measured in units per gram of hemoglobin [Hb] and b: butyrylcholinesterase measured in units per liter) as means ± SEM of 3 experiments after different concentrations of midazolam. Significance (*P < 0.05) was detected for 50 μg/mL versus all other midazolam concentrations. ACHE = acetylcholinesterase; BuCHE = butyrylcholinesterase; CHE = cholinesterase. Journal of Pain and Symptom Management 2016 52, 525-532DOI: (10.1016/j.jpainsymman.2016.05.015) Copyright © 2016 American Academy of Hospice and Palliative Medicine Terms and Conditions