Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-22T19:59:23.420Z Has data issue: false hasContentIssue false
  • English
  • Français

Is there evidence for using anticonvulsants in the prevention and/or treatment of delirium among older adults?

Published online by Cambridge University Press:  24 March 2021

Aarti Gupta ,
Pallavi Joshi ,
Gargi Bhattacharya ,
Melissa Lehman ,
Melissa Funaro ,
Deena J. Tampi  and
Rajesh R. Tampi
Aarti Gupta
Affiliation:
Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
Pallavi Joshi
Affiliation:
Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
Gargi Bhattacharya
Affiliation:
Department of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, USA
Melissa Lehman
Affiliation:
Diamond Healthcare, Richmond, VA, USA
Melissa Funaro
Affiliation:
Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA
Deena J. Tampi
Affiliation:
Co-Founder and Managing Principal, Behavioral Health Advisory Group, Princeton, NJ, USA
Rajesh R. Tampi*
Affiliation:
Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA Department of Psychiatry & Behavioral Sciences, Cleveland Clinic Akron General, Akron, OH, USA Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
*
Correspondence should be addressed to: Rajesh R. Tampi, Department of Psychiatry & Behavioral Sciences, Cleveland Clinic Akron Genera, Akron, OH, 44307, USA; Section for Geriatric Psychiatry, Cleveland Clinic, Cleveland, OH, 44195, USA; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, 44195, USA. Phone: + 809 5223. E-mail: [email protected].
Get access

Abstract

Objective:

This systematic review aims to identify published randomized controlled trials (RCTs) that evaluated the use of anticonvulsants for the prevention and/or treatment of delirium among older adults.

Methods:

A comprehensive search of databases: MEDLINE ALL (Ovid), Embase (Ovid), PsycINFO (Ovid), Web of Science Core Collection and Cochrane Central Register of Controlled was conducted.

Results:

The search identified four RCTs that evaluated the use of anticonvulsants among older adults with delirium. One RCT evaluated the perioperative use of gabapentin among individuals undergoing spinal surgery and the development of postoperative delirium. One RCT evaluated the relationship between the use of perioperative gabapentin and the development of postoperative delirium among individuals undergoing spinal surgery and hip and knee arthroplasty. Two post-hoc analyses of RCTs evaluated the use of gabapentin and pregabalin among individuals undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA). The perioperative use of gabapentin reduced the incidence of postoperative delirium among older adults undergoing spinal surgery. The perioperative use of gabapentin did not reduce the rates, severity or duration of postoperative delirium among older adults who were undergoing spine and hip and knee arthroplasty. The perioperative use of gabapentin did not reduce the incidence or duration of postoperative delirium among older adults undergoing elective TKA. The perioperative use of pregabalin did not reduce the incidence of postoperative delirium among older adults undergoing elective THA. Gabapentin and pregabalin were well tolerated among the individuals enrolled in these trials. There were no RCTs identified that evaluated the use of other anticonvulsants for the prevention and/or treatment of delirium among older adults.

Conclusions:

Based on current evidence, the routine use of anticonvulsants for the prevention and/or treatment of delirium among older adults cannot be recommended.

Keywords

anticonvulsantsolder adultsdeliriumpreventiontreatmentpregabalingabapentin
Type
Review Article
Information
International Psychogeriatrics , Volume 34 , Special Issue 10: Issue Theme: Pharmacotherapy for Serious Neuropsychiatric Disorders , October 2022 , pp. 889 - 903
Copyright
© International Psychogeriatric Association 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Al-Qadheeb, N. S. et al. (2016). Preventing ICU subsyndromal delirium conversion to delirium with low-dose IV haloperidol: a double-blind, placebo-controlled pilot study. Critical Care Medicine, 44, 583–591.CrossRefGoogle ScholarPubMed
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.Google Scholar
Atalan, N. et al. (2013). Morphine is a reasonable alternative to haloperidol in the treatment of postoperative hyperactive-type delirium after cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia, 27, 933–938.CrossRefGoogle ScholarPubMed
Bakri, M., Ismail, E. and Ibrahim, A. (2015). Comparison of dexmedetomidine or ondansetron with haloperidol for treatment of postoperative delirium in trauma patients admitted to intensive care unit: randomized controlled trial. Anaesthesia, Pain & Intesive Care, 19 Google Scholar
Barron, E. A. and Holmes, J. (2013). Delirium within the emergency care setting, occurrence and detection: a systematic review. Emergency Medicine Journal, 30, 263–268.CrossRefGoogle ScholarPubMed
Bourgeois, J. A. et al. (2005). Adjunctive valproic acid for delirium and/or agitation on a consultation-liaison service: a report of six cases. The Journal of Neuropsychiatry and Clinical Neurosciences, 17, 232–238.CrossRefGoogle ScholarPubMed
Burry, L. et al. (2019). Pharmacological interventions for the treatment of delirium in critically ill adults. The Cochrane Database of Systematic Reviews, 9, Cd011749.Google ScholarPubMed
Cerveira, C. C. T. et al. (2017). Delirium in the elderly: a systematic review of pharmacological and non-pharmacological treatments. Dement Neuropsychol, 11, 270–275.CrossRefGoogle ScholarPubMed
Clarke, H. A. et al. (2014). Perioperative gabapentin reduces 24 h opioid consumption and improves in-hospital rehabilitation but not post-discharge outcomes after total knee arthroplasty with peripheral nerve block. British Journal of Anaesthesia, 113, 855–864.CrossRefGoogle Scholar
Clarke, H. et al. (2015). Pregabalin reduces postoperative opioid consumption and pain for 1 week after hospital discharge, but does not affect function at 6 weeks or 3 months after total hip arthroplasty. British Journal of Anaesthesia, 115, 903–911.CrossRefGoogle ScholarPubMed
Dasgupta, M. and Brymer, C. (2014). Prognosis of delirium in hospitalized elderly: worse than we thought. International Journal of Geriatric Psychiatry, 29, 497–505.CrossRefGoogle ScholarPubMed
Devlin, J. W. et al. (2010). Efficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicenter, randomized, double-blind, placebo-controlled pilot study. Critical Care Medicine, 38, 419–427.CrossRefGoogle ScholarPubMed
Dighe, K. et al. (2014). Perioperative gabapentin and delirium following total knee arthroplasty: a post-hoc analysis of a double-blind randomized placebo-controlled trial. Canadian Journal of Anesthesia, 61, 1136–1137.CrossRefGoogle ScholarPubMed
Ely, E. W. et al. (2001). Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Critical Care Medicine, 29, 1370–1379.CrossRefGoogle Scholar
Farlinger, C., Clarke, H. and Wong, C. L. (2018). Perioperative pregabalin and delirium following total hip arthroplasty: a post hoc analysis of a double-blind randomized placebo-controlled trial. Canadian Journal of Anesthesia, 65, 1269–1270.CrossRefGoogle ScholarPubMed
Fong, T. G., Tulebaev, S. R. and Inouye, S. K. (2009). Delirium in elderly adults: diagnosis, prevention and treatment. Nature Reviews Neurology, 5, 210–220.CrossRefGoogle Scholar
Gagnon, D. J. et al. (2017). Valproate for agitation in critically ill patients: a retrospective study. Journal of Critical Care, 37, 119–125.CrossRefGoogle ScholarPubMed
Gallagher, D. and Herrmann, N. (2014). Antiepileptic drugs for the treatment of agitation and aggression in dementia: do they have a place in therapy?. Drugs, 74, 1747–1755.CrossRefGoogle ScholarPubMed
Girard, T. D. et al. (2018). Haloperidol and Ziprasidone for treatment of delirium in critical illness. The New England Journal of Medicine, 379, 2506–2516.CrossRefGoogle ScholarPubMed
Girard, T. D. et al. (2010). Feasibility, efficacy, and safety of antipsychotics for intensive care unit delirium: the MIND randomized, placebo-controlled trial. Critical Care Medicine, 38, 428–437.CrossRefGoogle ScholarPubMed
Grossetta Nardini, H. and Wang, L. (2019). The Yale MeSh Analyzer [Online]. Available at: http://mesh.med.yale.edu/; last accessed 13 August 2018.Google Scholar
Hakim, S. M., Othman, A. I. and Naoum, D. O. (2012). Early treatment with risperidone for subsyndromal delirium after on-pump cardiac surgery in the elderly: a randomized trial. Anesthesiology, 116, 987–997.CrossRefGoogle ScholarPubMed
Hey, J. et al. (2015). Delirium in palliative care: detection, documentation and management in three settings. Palliative & Supportive Care, 13, 1541–1545.CrossRefGoogle ScholarPubMed
Hshieh, T. T. et al. (2008). Cholinergic deficiency hypothesis in delirium: a synthesis of current evidence. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 63, 764–772.CrossRefGoogle ScholarPubMed
Hshieh, T. T., Inouye, S. K. and Oh, E. S. (2020). Delirium in the elderly. Clinics in Geriatric Medicine, 36, 183–199.CrossRefGoogle ScholarPubMed
Inouye, S. K., Westendorp, R. G. and Saczynski, J. S. (2014). Delirium in elderly people. Lancet (London, England), 383, 911–922.CrossRefGoogle ScholarPubMed
Inouye, S. K. and Charpentier, P. A. (1996). Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. The Journal of the American Medical Association, 275, 852–857.CrossRefGoogle ScholarPubMed
Inouye, S. K. et al. (2005). A chart-based method for identification of delirium: validation compared with interviewer ratings using the confusion assessment method. Journal of the American Geriatrics Society, 53, 312–318.CrossRefGoogle ScholarPubMed
Lefebvre, C., Manheimer, E. and Glanville, J. (2011). Chapter 6: Searching for Studies. Hoboken, NJ: John Wiley & Sons.Google Scholar
Leslie, D. L. et al. (2008). One-year health care costs associated with delirium in the elderly population. Archives of Internal Medicine, 168, 27–32.CrossRefGoogle ScholarPubMed
Leung, J. M. et al. (2017). Perioperative gabapentin does not reduce postoperative delirium in older surgical patients: a randomized clinical trial. Anesthesiology, 127, 633–644.CrossRefGoogle Scholar
Leung, J. M. et al. (2006). Pilot clinical trial of gabapentin to decrease postoperative delirium in older patients. Neurology, 67, 1251–1253.CrossRefGoogle ScholarPubMed
Levkoff, S. E. et al. (1992). Delirium. The occurrence and persistence of symptoms among elderly hospitalized patients. Archives of Internal Medicine, 152, 334–340.CrossRefGoogle ScholarPubMed
Lin, S. M. et al. (2004). The impact of delirium on the survival of mechanically ventilated patients. Critical Care Medicine, 32, 2254–2259.CrossRefGoogle ScholarPubMed
Lorenzl, S., Fusgen, I. and Noachtar, S. (2012). Acute confusional States in the elderly--diagnosis and treatment. Deutsches Arzteblatt International, 109, 391–399; quiz400.Google ScholarPubMed
Maclullich, A. M. et al. (2008). Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses. Journal of Psychosomatic Research, 65, 229–238.CrossRefGoogle ScholarPubMed
Mittal, V. et al. (2011). Review: delirium in the elderly: a comprehensive review. American Journal of Alzheimer’s Disease and other Dementias, 26, 97–109.CrossRefGoogle ScholarPubMed
Moher, D. et al. (2009). PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of Internal Medicine, 151, 264–269.CrossRefGoogle ScholarPubMed
Monti, B., Polazzi, E. and Contestabile, A. (2009). Biochemical, molecular and epigenetic mechanisms of valproic acid neuroprotection. Current Molecular Pharmacology, 2, 95–109.CrossRefGoogle ScholarPubMed
Needham, D. M. et al. (2016). Rosuvastatin versus placebo for delirium in intensive care and subsequent cognitive impairment in patients with sepsis-associated acute respiratory distress syndrome: an ancillary study to a randomised controlled trial. The Lancet Respiratory Medicine, 4, 203–212.CrossRefGoogle ScholarPubMed
Numan, T. et al. (2019). Delirium detection using relative delta power based on 1-minute single-channel EEG: a multicentre study. British Journal of Anaesthesia, 122, 60–68.CrossRefGoogle ScholarPubMed
Oldenbeuving, A. W. et al. (2011). Delirium in the acute phase after stroke: incidence, risk factors, and outcome. Neurology, 76, 993–999.CrossRefGoogle ScholarPubMed
Page, V. J. et al. (2017). Evaluation of early administration of simvastatin in the prevention and treatment of delirium in critically ill patients undergoing mechanical ventilation (MoDUS): a randomised, double-blind, placebo-controlled trial. The Lancet Respiratory Medicine, 5, 727–737.CrossRefGoogle ScholarPubMed
Page, V. J. et al. (2013). Effect of intravenous haloperidol on the duration of delirium and coma in critically ill patients (Hope-ICU): a randomised, double-blind, placebo-controlled trial. The Lancet Respiratory Medicine, 1, 515–523.CrossRefGoogle ScholarPubMed
Reade, M. C. et al. (2016). Effect of dexmedetomidine added to standard care on ventilator-free time in patients with agitated delirium: a randomized clinical trial. The Journal of the American Medical Association, 315, 1460–1468.CrossRefGoogle ScholarPubMed
Reade, M. C. et al. (2009). Dexmedetomidine vs. haloperidol in delirious, agitated, intubated patients: a randomised open-label trial. Critical Care (London, England), 13, R75.CrossRefGoogle ScholarPubMed
Rockwood, K. et al. (1999). The risk of dementia and death after delirium. Age Ageing, 28, 551–556.CrossRefGoogle ScholarPubMed
Saxena, S. and Lawley, D. (2009). Delirium in the elderly: a clinical review. Postgraduate Medical Journal, 85, 405–413.CrossRefGoogle ScholarPubMed
Shenkin, S. D. et al. (2019). Delirium detection in older acute medical inpatients: a multicentre prospective comparative diagnostic test accuracy study of the 4AT and the confusion assessment method. BMC Medicine, 17, 138.CrossRefGoogle ScholarPubMed
Sher, Y. et al. (2015). Valproic acid for treatment of hyperactive or mixed delirium: rationale and literature review. Psychosomatics, 56, 615–625.CrossRefGoogle ScholarPubMed
Siddiqi, N., House, A. O. and Holmes, J. D. (2006). Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age Ageing, 35, 350–364.CrossRefGoogle ScholarPubMed
Skrobik, Y. K. et al. (2004). Olanzapine vs haloperidol: treating delirium in a critical care setting. Intensive Care Medicine, 30, 444–449.CrossRefGoogle Scholar
Van Der Kooi, A. W. et al. (2015). Delirium detection using EEG: what and how to measure. Chest, 147, 94–101.CrossRefGoogle ScholarPubMed
Van Eijk, M. M. et al. (2010). Effect of rivastigmine as an adjunct to usual care with haloperidol on duration of delirium and mortality in critically ill patients: a multicentre, double-blind, placebo-controlled randomised trial. Lancet (London, England), 376, 1829–1837.CrossRefGoogle ScholarPubMed
Vasilevskis, E. E. et al. (2012). Epidemiology and risk factors for delirium across hospital settings. Best Practice & Research: Clinical Anaesthesiology, 26, 277–287.Google ScholarPubMed
Wei, L. A. et al. (2008). The confusion assessment method: a systematic review of current usage. Journal of the American Geriatrics Society, 56, 823–830.CrossRefGoogle ScholarPubMed
Witlox, J. et al. (2010). Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. The Journal of the American Medical Association, 304, 443–451.CrossRefGoogle ScholarPubMed