Cholinesterase inhibitors for delirium

  • Review
  • Intervention




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.


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Unconfounded, blinded randomised controlled trials, published or unpublished in which treatment with cholinesterase inhibitors was administered and compared with alternative interventions in patients with delirium are included.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








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。




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。







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



Plain language summary

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.