Intervention Review

Cholinesterase inhibitors for delirium

  1. Ross Overshott1,*,
  2. Salman Karim1,
  3. Alistair Burns2

Editorial Group: Cochrane Dementia and Cognitive Improvement Group

Published Online: 23 JAN 2008

Assessed as up-to-date: 6 OCT 2007

DOI: 10.1002/14651858.CD005317.pub2


How to Cite

Overshott R, Karim S, Burns A. Cholinesterase inhibitors for delirium. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD005317. DOI: 10.1002/14651858.CD005317.pub2.

Author Information

  1. 1

    University of Manchester, Psychiatry Research Group, Manchester, UK

  2. 2

    University of Manchester, Psychiatric Research Group, Manchester, UK

*Ross Overshott, Psychiatry Research Group, University of Manchester, 3rd Floor, University Place, Oxford Road, Manchester, M13 9PL, UK. rossovershott@hotmail.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 23 JAN 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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 methods

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.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

No convincing evidence from one trial of the efficacy of cholinesterase inhibitors for delirium

Delirium is a confusional state that is associated with physical illness. Its characteristic features are rapid onset, altered consciousness, reduced attention and global cognitive impairment. Other symptoms are hallucinations (particularly visual hallucinations), disturbed sleep pattern and agitation. Delirium is commonly found in hospital patients and is associated with longer admissions, poor functioning level, persistent cognitive impairment and need for institutional care. Delirium is therefore an important syndrome to recognise and treat. The one included trial, of donepezil compared with placebo in 15 patients, showed no statistically significant difference in length of delirium. No other outcomes were measured.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

乙醯膽鹼酉每抑制劑對瞻妄的治療

瞻妄是一種急性意識混亂狀態,約10%–30%住院病人曾經歷過。瞻妄大都是可逆的,但與某些不良的預後有關,包含住院天數增加,不良的功能狀態,持續的認知缺損或需要機構照顧及可能引起死亡。乙醯膽鹼系統的混亂可能是引起瞻妄的關鍵機制。乙醯膽鹼酉每抑制劑可強化乙醯膽鹼系統,報告指出它可能對瞻妄的治療有益。

目標

評估乙醯膽鹼酉每抑制劑對瞻妄的療效和安全性。

搜尋策略

在2005年4月19日使用以下字彙:donepezil 或 aricept, galantamine 或 reminyl, rivastigmine 或 exelon, tacrine 或 cognex,搜尋Cochrane Dementia and Cognitive Improvement Group's Register of Clinical Trials 資料庫,包含MEDLINE, EMBASE, PsycINFO, CINAHL, CENTRAL, LILACS和其他資料庫相關的隨機對照試驗(randomised controlled trials)。由於上述特定登錄僅含失智症及認知缺損的試驗,我們也搜尋了所有其他年份的資料庫包含:MEDLINE, EMBASE, PsycINFO, CINAHL,以搜尋非失智症病患使用乙醯膽鹼酉每抑制劑治療瞻妄的試驗。

選擇標準

選取已發表或未刊登的未發表的、遮盲隨機對照試驗,以乙醯膽鹼酉每抑制劑治療瞻妄病人的研究並與替代療法做比較。

資料收集與分析

兩位回顧者(RO, SK)根據ㄧ些參數,例如隨機方式、遮盲、及試驗退出處置等來評估研究品質。每個特定的乙醯膽鹼酉每抑制劑都要接受個別的及群組的檢驗。初步結論項目包含瞻妄日數、瞻妄嚴重度、行為異常(如躁動與幻覺)出現與否及其的嚴重度。其他有興趣的結果還包括認知功能、機構照顧的需求、住院天數和副作用。

主要結論

有一篇使用donepezil與安慰劑來治療15位瞻妄病人的對照研究。瞻妄持續期間在兩組比較並無不同。使用donepezil治療手術後瞻妄其持續期平均是一天(標準差0.0),而對照組則為1.3天(標準差0.19)。本研究並無統計其他變項。

作者結論

從包含控制組的試驗並無足夠實證可証明donepezil能有效治療瞻妄。使用乙醯膽鹼酉每抑制劑來治療瞻妄仍需更進一步的試驗證明。

翻譯人

本摘要由高雄長庚醫院吳怡珊翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

沒有一個具說服力的證據可証實乙醯膽鹼酉每抑制劑對瞻妄狀態的療效。瞻妄是一種身體疾病引起的意識混亂狀態。它的主要特徵包括急性發作、意識改變、注意力不集中及整體認知缺損。其他症狀包括幻覺(特別是視幻覺),睡眠障礙及躁動。瞻妄在住院病人常見,且與較長的住院天數、身體功能不良、持續認知缺損、及需要長期照護有關。因此瞻妄是一個需要辨識及治療的症候群。本回顧包含一個以donepezil安慰劑治療15個瞻妄病人,並顯示兩組之瞻妄期間並無統計上之差異,其他的結果項目則未加以測量。