Donepezil in the Prevention and Treatment of Post-Surgical Delirium

Liptzin, Benjamin; Laki, Agnes; Garb, Jane; Fingeroth, Richard J.; Krushell, Robert J.

doi:10.1097/00019442-200512000-00010

Cited by 150 publications

(84 citation statements)

References 12 publications

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“…To date, three studies (Levkoff et al, 1996;Cole et al, 2003;Liptzin et al, 2005) have defined SSD as the presence of one or more symptoms of delirium; the symptoms were inattention, altered level of consciousness, disorientation, and perceptual disturbances. Five studies (Marcantonio et al, 2002;Bourdel-Marchasson et al, 2004;Tan et al, 2008;Leonard et al, 2009;Cole et al, 2011) have defined SSD as the presence of one or more Confusion Assessment Method (CAM) core symptoms of delirium; the CAM core symptoms were acute onset and fluctuation, inattention, disorganized thinking, and altered level of consciousness.…”

Section: Types Of Symptoms Of Deliriummentioning

confidence: 99%

Subsyndromal delirium in old age: conceptual and methodological issues

Cole¹

2013

Int. Psychogeriatr.

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Delirium is a cognitive disorder characterized by acute onset, fluctuating course, altered level of consciousness, inattention, disorganized thinking, disorientation, memory impairment, and perceptual and motor disturbances (American Psychiatric Association, 2000; World Health Organization, 2010). It occurs in hyperactive, hypoactive, or mixed forms in up to 42% of older hospital inpatients (Siddiqi et al., 2006) and 70% of older long-term care residents (McCusker et al., 2011). In both settings, delirium is independently associated with poor outcomes (Siddiqi et al., 2006; McCusker et al., 2010; Witlox et al., 2010).

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Section: Types Of Symptoms Of Deliriummentioning

confidence: 99%

Subsyndromal delirium in old age: conceptual and methodological issues

Cole¹

2013

Int. Psychogeriatr.

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“…Donepezil 5 mg once daily was compared with placebo in a double-blind RCT for the prevention and treatment of postoperative delirium in patients undergoing total joint replacement surgery. 35 Donepezil or placebo was started 14 days before surgery and continued for 14 days after surgery. Neither the incidence of delirium nor the mean duration of delirium was different between groups.…”

Section: Pharmacologic Agentsmentioning

confidence: 99%

“…Le donepezil 5 mg, administré une fois par jour, a été comparé à un placebo dans une étude randomisée contrôlée à double insu pour la prévention et le traitement du delirium postopératoire chez les patients subissant une arthroplastie totale. 35 Le donepézil ou le placebo était commencé 14 jours avant l'intervention et poursuivi 14 jours après. Ni l'incidence du delirium, ni sa durée moyenne n'ont été différentes entre les deux groupes.…”

Section: Agents Pharmacologiquesunclassified

Postoperative delirium: risk factors and management: Continuing Professional Development

Chaput

Bryson

2012

Can J Anesth/J Can Anesth

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Purpose Postoperative delirium often remains undiagnosed and therefore untreated. The purpose of this continuing professional development module is to identify patients at high risk of developing delirium following noncardiac surgery and to provide tools to aid in the diagnosis of delirium at the bedside. Optimal prevention and treatment strategies are recommended. Principal findings Delirium is characterized by an acute onset and a fluctuating course, inattention, disorganized thinking and an altered level of consciousness, and occurs in up to 40% of patients in the perioperative period. The pathophysiology of delirium is multifactorial, but it is believed to be related to inflammation, altered neurotransmission, and stress in the patient who has had surgery. Acetylcholine and dopamine appear to play a significant role. There is an increased risk of a poor outcome in patients who develop delirium, including a longer hospital stay and death. Surgical and patient factors play a significant role in predicting who will subsequently develop delirium. Prevention is much more effective than treatment in the management of delirium. The most effective prevention strategies include proactive geriatric assessment and care of the patient on a geriatrics surgical ward as well as prophylactic low-dose antipsychotic agents. From an anesthetic perspective, evidence in some surgical populations would support the use of regional techniques and minimal sedation. If delirium develops, treatment with lowdose oral antipsychotics appears to be most effective.Conclusions Delirium is a serious condition that must be recognized early and treated promptly to minimize deleterious outcomes. In order to institute prevention strategies and treat the condition effectively when it occurs, the anesthesiologist must be vigilant in identifying patients at risk and in screening for this condition. Objectives of this Continuing Professional Development (CPD) module:After reading this module, the reader should be able to:1. Define delirium in the context of other cognitive changes following non-cardiac surgery. 2. Understand the incidence and adverse outcomes associated with delirium. 3. List predisposing and precipitating factors of postoperative delirium and identify the patient at risk. 4. Explain the underlying pathophysiologic mechanisms believed to be implicated in causing delirium. 5. Formulate an anesthetic plan that minimizes the risk of developing postoperative delirium. 6. Devise a management plan to treat postoperative delirium most effectively while minimizing the adverse effects of treatment.Like other Western nations, Canada's population is aging rapidly. Over the past 50 years, the proportion of Canadians over the age of 65 has risen from 7.7% to 13.7%. A Statistics Canada estimates that the proportion of seniors will double 123Can J Anesth/J Can Anesth (2012) 59:304-320 DOI 10.1007 yet again by 2036 and will represent 23-25% of Canada's population. B This rapid demographic shift will impact anesthesiologists and hospitals ...

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“…Three randomized, double-blind, placebo-controlled studies of ChEI therapy given before and after elective inpatient surgery found that neither rivastigmine 10 nor donepezil 11,12 were able to reduce the incidence of delirium in hospitalized patients. Most strikingly, a multicenter, randomized, double-blind, placebo-controlled trial of rivastigmine for the treatment of delirium in critically ill patients was prematurely terminated because rivastigmine was associated with a sharp trend toward increased mortality (22% vs 8%, P 5 0.07), longer duration of delirium (median days, 5 vs 3, P 5 0.06), and increased hospital length of stay (LOS) (median days, 29 vs 25, P 5 0.06) compared with placebo.…”

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confidence: 99%

Incidence of cholinesterase inhibitor therapy initiation among hospitalized patients

Swan

Wagle

Thompson-Moore

et al. 2013

Journal of Hospital Medicine

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BACKGROUND Initiation of cholinesterase inhibitor (ChEI) therapy for delirium during hospitalization is ineffective and may be associated with increased morbidity and mortality. OBJECTIVE To describe the incidence of initiating ChEI therapy during hospitalization. DESIGN A retrospective cross‐sectional study. SETTING A tertiary‐care academic medical center. PATIENTS Inpatient admissions from September 2010 through March 2011 with ChEI administration. INTERVENTION None. MEASUREMENTS Incidence of ChEI exposure, initiation of ChEI therapy, initiation of antipsychotics and benzodiazepines, infection, in‐hospital mortality, and hospital length of stay. RESULTS The incidence of adult admissions with ChEI exposure and ChEI initiation was 23.2 (95% confidence interval: 21.2–25.4) and 2 (95% confidence interval 1.5‐2.8) per 1000 admissions, respectively. Of 476 admissions receiving ChEI, 9% (n = 42) initiated therapy during the hospital stay and 91% (n = 434) continued on previously started therapy. Patients initiated on ChEI therapy frequently had infection (20 of 42) and were commonly initiated on antipsychotics (14 of 42) and benzodiazepines (13 of 42). Patients were hospitalized for a median of 2 days (interquartile range, 1–4) before initiation of ChEI and were exposed to therapy for a median of 3 days (interquartile range, 2–6). Of the 41 patients discharged from the hospital, 90% (n = 37) had orders to continue the ChEI postdischarge. CONCLUSIONS Despite a lack of evidence to support the practice, 9% of patients who received ChEI therapy were initiated during the inpatient setting. These patients were not routinely screened for delirium and frequently received treatments associated with delirium. Journal of Hospital Medicine 2013;8:304–308. © 2013 Society of Hospital Medicine.

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Donepezil in the Prevention and Treatment of Post-Surgical Delirium

Cited by 150 publications

References 12 publications

Subsyndromal delirium in old age: conceptual and methodological issues

Subsyndromal delirium in old age: conceptual and methodological issues

Postoperative delirium: risk factors and management: Continuing Professional Development

Incidence of cholinesterase inhibitor therapy initiation among hospitalized patients

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