Acetylcholinesterase Inhibitors for Delirium in Older Adults

• Published in: American Journal of Alzheimer's Disease & Other Dementias 2016-06, Vol.31 (4), p.305-310
• Main Authors: Tampi, Rajesh R., Tampi, Deena J., Ghori, Ambreen K.
• Format: Article
• Language: English
• Subjects: Antipsychotic Agents - therapeutic use; Cholinesterase Inhibitors - therapeutic use; Delirium - drug therapy; Delirium - prevention & control; Haloperidol - therapeutic use; Humans; Randomized Controlled Trials as Topic; Review; Rivastigmine - therapeutic use
• ISSN: 1533-3175; 1938-2731
• DOI: 10.1177/1533317515619034

Objectives: The aim of this systematic review is to identify published randomized controlled trials (RCTs) that evaluated the use of acetylcholinesterase inhibitors for delirium in older adults (≥60 years). Methods: A literature search was conducted of PubMed, MEDLINE, EMBASE, PsycINFO, and Cochrane collaboration databases for RCTs in any language that evaluated the use of acetylcholinesterase inhibitors for delirium in older adults (≥60 years). Also, bibliographic databases of the published articles were searched for additional studies. Results: A total of 7 RCTs that evaluated the use of acetylcholinesterase inhibitors for delirium in older adults (≥60 years) were identified. In 5 of the 7 studies, there was no benefit for the acetylcholinesterase inhibitor in either the prevention or the management of delirium. In one study, there was a trend toward benefit for the active drug group on the incidence of delirium and the length of hospital stay, but both outcomes did not attain statistical significance. One study found a longer duration of delirium and a longer length of hospital stay in the active drug group when compared to the placebo group. The acetylcholinesterase inhibitors were well tolerated in 4 of the 7 studies. In 1 study, the mortality rate was found to be almost 3 times higher in the group receiving haloperidol and rivastigmine when compared to the group receiving haloperidol and placebo. Conclusion: Current evidence does not suggest efficacy of acetylcholinesterase inhibitors for the prevention or management of delirium in older adults.