International Psychogeriatrics

GUEST EDITORIAL

Cholinesterase inhibitors for delirium: what is the evidence?

N. Mukadama1, C. W. Ritchiea2 and E. L. Sampsona3

a1 Metabolic and Clinical Trials Unit, Department of Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, London, U.K.

a2 Department of Psychological Medicine, Division of Neuroscience, Imperial College London, U.K.

a3 MRC Research Fellow, Department of Mental Health Sciences, Royal Free and University College Medical School, London, U.K. Email: esampson@medsch.ucl.ac.uk

The current therapeutic agents advocated for the treatment of delirium (Meagher, 2001) have not been developed from an understanding of the underlying pathophysiology of this condition. Rather, they have emerged from “off label” clinical practice which has sought to reduce the distress experienced by both patients and clinicians. Accordingly, their use has not developed from a strong, specific evidence base, and nor is it now supported by large, well-designed clinical trials. It is also the case that these drug treatments will address the management (usually by sedation) of patients with florid, psychotic or “positive” delirium whilst quiet or “negative” delirium remains under-diagnosed and is poorly managed despite the distress it causes patients.

(Online publication September 21 2007)