Cholinesterase inhibitor treatment in patients with delirium

Pont, Anne-Cornélie Jm de; Geer, M A van; Schultz, Marcus J.

doi:10.1016/s0140-6736(11)60342-5

Cited by 6 publications

(2 citation statements)

References 4 publications

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“…31 The study assessed the use of rivastigmine in critically ill patients admitted to the intensive care unit; however, the authors noted that rivastigmine did not decrease the duration of delirium and may have actually increased patient mortality, leading to halting of the study. 31 There were some problems and concerns voiced about the trial, including the design of the study and subject selection, 32,33 but these results have prompted fresh concerns about this treatment approach, especially in critically ill patients. Furthermore, almost one-third (29%) of the patients cannot take these memory-enhancing drugs due to gastrointestinal side effects, such as nausea, vomiting, and diarrhea.…”

Section: Discussionmentioning

confidence: 99%

Can donepezil hydrochloride reduce the role of neuroleptic drugs in delirium? A case report

Hughes

McKay²

2013

MSRJ

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Background: Recent evidence shows that a confirmed diagnosis of delirium increases both patient morbidity and mortality. Importantly, these increases are independent of patient age, and presence of co-morbid disease. In the last few years, there has been evidence that acetylcholinesterase inhibitors may have a limited role in managing episodes of mild/moderate delirium. Methods: This case study reports a patient whose behavioral disturbances caused by delirium, responded well to donepezil hydrochloride in a nursing home in Dundee, United Kingdom. Results: Our clinical case focuses on a patient who was diagnosed with a mixed picture delirium after developing PUO. This case report notes that Mr A, a patient already prescribed donepezil hydrochloride, saw an improvement in his behavioral symptoms after an increase in his dose. This enabled the patient to avoid receiving neuroleptic or benzodiazepine medication, known to be particularly problematic in older patients. Conclusion: The authors tentatively propose that patients in community care already prescribed acetylcholinesterase inhibitors, may benefit from an increased dose in cases of mild delirium (where there is no clear cause or requirement for hospital admission). In line with the significant impact that delirium has upon older patients in community care, we would call for further studies looking at the influence that these medications may have on the sequelae of delirium in patients in the community.

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Section: Discussionmentioning

confidence: 99%

Can donepezil hydrochloride reduce the role of neuroleptic drugs in delirium? A case report

Hughes

McKay²

2013

MSRJ

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“…A number of agents have been looked at for prophylaxis of delirium including haloperidol, risperidone, olanzapine and the cholinesterase inhibitor rivastigmine [67]. At present there is no convincing, reproducible evidence that any of these are clearly effective in the prevention of delirium.…”

Section: Preventionmentioning

confidence: 99%

Imaging

Sundram¹,

Meagher²,

Jauhari³

2019

Seminars in Old Age Psychiatry

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Disturbed brain function in the context of physical or bodily illness has been recognised in the medical literature for over two millennia. The actual term delirium was not introduced until the first century AD, when Aulus Cornelius Celsus, a Roman, described it in his medical encyclopedia De Medicina. The word is thought to originate from the Latin de (meaning 'out of') and lira (meaning 'furrow'). In his work, Celsus used the term delirium to describe the acute confusional states that could occur after wound infections or head injuries. However, more than 400 years before that, Hippocrates used about 16 different words to describe to the clinical syndrome that we now call delirium, with the terms lethargus and phrenitis largely consistent with the present-day concepts of hypoactive and hyperactive clinical presentations [1]. These early descriptions emphasised the occurrence of psychosis and impaired arousal in patients with morbidity that was often distant from the brain (typically infectious). They thus include an awareness of the connection between body wellness and brain function that has been somewhat downplayed until relatively recent times with the greater recognition of the inherent connectivity of mind and bodyan interface that is exemplified by the delirious state where pathology often very peripheral to the central nervous system (CNS) can cause globalised cognitive and neuropsychiatric disturbances.Thereafter, the clinical meaning of delirium remained quite consistent until the nineteenth century where, partly for linguistic reasons, especially in France where 'delire' was used to refer to a variety of psychotic states, the term confusion mentale was applied by Chaslin [2] to distinguish causes with an organic basis. In fact, the Irish psychiatrist Conolly Norman [3] had provided a compelling description of delirium as 'acute confusional insanity' a full two years prior to this and the term confusion as a synonym for delirium remains in widespread use in all countries to this day. Also in the nineteenth century, there was greater focus upon the distinct psychopathology of delirium, which prompted the German clinician Georg Greiner to introduce the concept of 'clouding of consciousness' (Verdunkelung des Bewusstseins) to denote the altered mental state of delirious patients [4]. Greiner believed that fever caused disturbances in the organ of consciousness in the brain and that delirium represented a state of dreaming whilst awake.In the twentieth century, with increased specialisation of medical activity, a plethora of labels (e.g., acute confusional state, brain failure, toxic encephalopathy, intensive care psychosis: see Box 5.1) emerged to describe patients with acute widespread disturbance of brain function [5], but it was recognised that these mostly reflected the population, clinical setting or presumed etiology for the delirium with little evidence to support such concepts as separate scientific entities (i.e., they merely reflect the syndrome of delirium occurring in 54 terms of use, availabl...

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