Cholinesterase inhibitors for delirium

Area of Science:

• Gerontology
• Pharmacology
• Clinical Medicine

Background:

• Delirium, an acute confusional state, affects 10-30% of hospital inpatients.
• It is linked to adverse outcomes like prolonged hospital stays and cognitive impairment.
• Disruption of the cholinergic system is a proposed mechanism, suggesting cholinesterase inhibitors may help.

Purpose of the Study:

• To evaluate the efficacy and safety of cholinesterase inhibitors for treating delirium.
• To synthesize evidence from randomized controlled trials on their use in delirium management.

Main Methods:

• Comprehensive search of multiple databases (MEDLINE, EMBASE, PsycINFO, etc.) for relevant randomized controlled trials (RCTs).
• Inclusion of unconfounded, blinded RCTs, published or unpublished, comparing cholinesterase inhibitors with alternative interventions.
• Independent quality assessment of studies and separate/grouped analysis of cholinesterase inhibitors, focusing on delirium duration, severity, and adverse effects.

Main Results:

• One RCT involving 15 patients treated with donepezil versus placebo was included.
• No significant difference was found in the duration of delirium between the donepezil and placebo groups.
• The mean duration of postoperative delirium was 1.0 day with donepezil versus 1.3 days with placebo; no other outcomes were reported for delirium patients.

Conclusions:

• Current evidence from controlled trials does not support the effectiveness of donepezil in treating delirium.
• Further research and clinical trials are necessary to explore the potential of cholinesterase inhibitors for delirium treatment.