Rivastigmine in the Management of Delirium

Launched by ASSISTANCE PUBLIQUE - HÔPITAUX DE PARIS · Dec 6, 2011

Keywords

ClinConnect Summary

Delirium affects up to 50% of hospitalized patients aged 75 and over. Delirium increases risk of comorbid illness, hospital length of stay, institutionalization, and death. Patients with diagnosed or undiagnosed cognitive impairment are at risk to develop delirium. In a prospective study, half of elderly patients with delirium seen in the emergency department had cognitive impairment.

Hypothesis: cholinesterase inhibitors reduce duration and severity of delirium

Main objective:

- to assess the efficacy of cholinesterase inhibitors in patients aged 75 and over hospitalized with delirium

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Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Patients aged 75 and over
• • Hospitalization for delirium not correlated to surgery for less than 48 hours
• • Patients with delirium requiring the presence of features 1 (acute onset and fluctuation course), 2 (inattention), 3 (disorganized thinking) and 4 (altered level of consciousness) of the Confusion Assessment Model and DRS R-98 \> 10
• • Absence of any contraindications to a cholinesterase inhibitor treatment
• • Health insurance affiliation
• • Having signed an informed consent form
• • Caregiver/informant to provide information on patient
• Exclusion Criteria:
• • Use of IAchE or memantine medication
• • Contraindication to IAchE medication
• • Frontotemporal dementia
• • Diseases involving the short-term survival
• • Digestive bleeding
• • Ischemic and hemorrhagic stroke related to actual onset (including hemorrhagic contusion)
• • Natremia ≤120 mmol/l at the time of hospitalization
• • Post epileptic confusion
• • Hepato-cellular failure
• • Cardiorespiratory impairment at risk of transfer to intensive care unit
• • Major sensory deficits that could interfere with cognitive assessment (visual and auditory)
• • Not fluent in French
• • Being under guardianship
• • Absence of caregiver/informant to sign informed consent form