Acetylcholinesterase Inhibitors for Delirium Prevention: A Systematic Review and Meta-Analysis.

Area of Science:

• Geriatrics
• Pharmacology
• Critical Care Medicine

Background:

• Delirium is a common and serious complication in hospitalized patients, especially older adults, leading to increased morbidity and mortality.
• Acetylcholinesterase inhibitors (AChEIs) are being investigated for their potential to prevent and treat delirium.

Purpose of the Study:

• To evaluate the efficacy of acetylcholinesterase inhibitors (AChEIs) for both the prophylaxis and treatment of delirium in hospitalized patients.
• To assess the impact of AChEIs on delirium occurrence, duration, severity, and hospital length of stay.

Main Methods:

• A systematic review and meta-analysis of studies comparing AChEIs with placebo for delirium in hospitalized patients.
• Searches were conducted in PubMed, Embase, and Web of Science. Ten studies involving 731 patients were included.

Main Results:

• AChEIs significantly reduced the overall occurrence of delirium (risk ratio = 0.68 [0.47-0.98]; p = 0.039).
• No significant effects were observed for delirium duration, severity, or hospital length of stay.
• Subgroup analysis indicated a significant reduction in delirium duration when AChEIs were used prophylactically (SMD= -0.32 [-0.56 to -0.07]; p < 0.01).

Conclusions:

• Acetylcholinesterase inhibitors are effective in reducing the occurrence of delirium, particularly when administered prophylactically in patients undergoing elective surgery.
• AChEIs did not significantly impact delirium duration, severity, or hospital length of stay.
• Further research is warranted to explore the benefits and risks of AChEIs in diverse patient populations and clinical settings.