Tags

Type your tag names separated by a space and hit enter

Cholinesterase inhibitors for delirium.
Cochrane Database Syst Rev 2008; (1):CD005317CD

Abstract

BACKGROUND

Delirium is now the preferred term to describe acute confusional states. It is experienced by 10 to 30% of all hospital inpatients. Delirium is potentially reversible and is related to several adverse outcomes, including increased hospital length of stay, poor functional status, persistent cognitive impairment, need for institutional care and probably mortality. Disruption of the cholinergic system has been proposed as a key mechanism of delirium. Cholinesterase inhibitors enhance the cholinergic system and there have been reports that they might be beneficial in treating delirium.

OBJECTIVES

To assess the efficacy and safety of cholinesterase inhibitors in the treatment of delirium.

SEARCH STRATEGY

The Cochrane Dementia and Cognitive Improvement Group's Register of Clinical Trials (which includes records from MEDLINE, EMBASE, PsycINFO, CINAHL, CENTRAL, LILACS and other databases) was searched for relevant randomised controlled trials using the terms: donepezil or aricept, galantamine or reminyl, rivastigmine OR exelon and tacrine OR cognex on 19 April 2005. As this Specialised Register only contains trials relating to dementia and cognitive impairment, in addition all years of MEDLINE, EMBASE, PsycINFO and CINAHL were searched for trials of cholinesterase inhibitors for delirium in non-demented people.

SELECTION CRITERIA

Unconfounded, blinded randomised controlled trials, published or unpublished in which treatment with cholinesterase inhibitors was administered and compared with alternative interventions in patients with delirium are included.

DATA COLLECTION AND ANALYSIS

Two reviewers (RO, SK) independently assessed the quality of the studies according to parameters such as randomisation, blinding and how dropouts were managed. Each cholinesterase inhibitor was to be examined separately and together as a group. The primary outcome measures of interest are length of delirium, severity of delirium and presence and severity of behavioural symptoms (e.g. agitation and hallucinations). Other outcomes of interest include: cognition, need for institutionalisation, length of hospital admission and adverse effects.

MAIN RESULTS

There was one included trial of donepezil compared with placebo in 15 patients. No significant difference between the treatment and placebo groups was found in the duration of delirium. The mean duration of postoperative delirium for the donepezil group was 1.0 day (Standard Error 0.0) while for the placebo group it was 1.3 days (Standard Error 0.19). No other outcomes were measured for the patients who developed delirium.

AUTHORS' CONCLUSIONS

There is currently no evidence from controlled trials that donepezil is effective in the treatment of delirium. Further trials using cholinesterase inhibitors for the treatment of delirium are needed.

Authors+Show Affiliations

2nd Floor Education and Research Centre, Old Age Psychiatry Department, Wythenshawe Hospital, Souhmoor Road, Wythenshawe,Manchester, UK, M23 9LT. rossovershott@hotmail.comNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

18254077

Citation

Overshott, R, et al. "Cholinesterase Inhibitors for Delirium." The Cochrane Database of Systematic Reviews, 2008, p. CD005317.
Overshott R, Karim S, Burns A. Cholinesterase inhibitors for delirium. Cochrane Database Syst Rev. 2008.
Overshott, R., Karim, S., & Burns, A. (2008). Cholinesterase inhibitors for delirium. The Cochrane Database of Systematic Reviews, (1), p. CD005317. doi:10.1002/14651858.CD005317.pub2.
Overshott R, Karim S, Burns A. Cholinesterase Inhibitors for Delirium. Cochrane Database Syst Rev. 2008 Jan 23;(1)CD005317. PubMed PMID: 18254077.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cholinesterase inhibitors for delirium. AU - Overshott,R, AU - Karim,S, AU - Burns,A, Y1 - 2008/01/23/ PY - 2008/2/7/pubmed PY - 2008/4/15/medline PY - 2008/2/7/entrez SP - CD005317 EP - CD005317 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 1 N2 - BACKGROUND: Delirium is now the preferred term to describe acute confusional states. It is experienced by 10 to 30% of all hospital inpatients. Delirium is potentially reversible and is related to several adverse outcomes, including increased hospital length of stay, poor functional status, persistent cognitive impairment, need for institutional care and probably mortality. Disruption of the cholinergic system has been proposed as a key mechanism of delirium. Cholinesterase inhibitors enhance the cholinergic system and there have been reports that they might be beneficial in treating delirium. OBJECTIVES: To assess the efficacy and safety of cholinesterase inhibitors in the treatment of delirium. SEARCH STRATEGY: The Cochrane Dementia and Cognitive Improvement Group's Register of Clinical Trials (which includes records from MEDLINE, EMBASE, PsycINFO, CINAHL, CENTRAL, LILACS and other databases) was searched for relevant randomised controlled trials using the terms: donepezil or aricept, galantamine or reminyl, rivastigmine OR exelon and tacrine OR cognex on 19 April 2005. As this Specialised Register only contains trials relating to dementia and cognitive impairment, in addition all years of MEDLINE, EMBASE, PsycINFO and CINAHL were searched for trials of cholinesterase inhibitors for delirium in non-demented people. SELECTION CRITERIA: Unconfounded, blinded randomised controlled trials, published or unpublished in which treatment with cholinesterase inhibitors was administered and compared with alternative interventions in patients with delirium are included. DATA COLLECTION AND ANALYSIS: Two reviewers (RO, SK) independently assessed the quality of the studies according to parameters such as randomisation, blinding and how dropouts were managed. Each cholinesterase inhibitor was to be examined separately and together as a group. The primary outcome measures of interest are length of delirium, severity of delirium and presence and severity of behavioural symptoms (e.g. agitation and hallucinations). Other outcomes of interest include: cognition, need for institutionalisation, length of hospital admission and adverse effects. MAIN RESULTS: There was one included trial of donepezil compared with placebo in 15 patients. No significant difference between the treatment and placebo groups was found in the duration of delirium. The mean duration of postoperative delirium for the donepezil group was 1.0 day (Standard Error 0.0) while for the placebo group it was 1.3 days (Standard Error 0.19). No other outcomes were measured for the patients who developed delirium. AUTHORS' CONCLUSIONS: There is currently no evidence from controlled trials that donepezil is effective in the treatment of delirium. Further trials using cholinesterase inhibitors for the treatment of delirium are needed. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/18254077/Cholinesterase_inhibitors_for_delirium_ L2 - https://doi.org/10.1002/14651858.CD005317.pub2 DB - PRIME DP - Unbound Medicine ER -