Delirium treatment: an unmet challenge.

摘要

Rivastigmine, a cholinesterase inhibitor, has been used to treat delirium in elderly patients with stroke. A biologically plausible premise-that impaired cholinergic transmission might either cause or worsen delirium-led to a randomised, placebo-controlled, double-blind trial by Maarten van Eijk and colleagues in The Lancet in which they added rivastigmine or placebo to usual treatment of patients in intensive care. The trial was halted at 104 patients by the drug safety and monitoring board (DSMB) because of increased mortality (12/54 in the rivastigmine group, 4/50 in the placebo group; p=0.07) and a worse outcome. The rivastigmine group had a longer median duration of delirium (5.0 days vs 3.0 days, albeit with a p value of 0.06). Additionally, delirium severity seemed worse in the rivastigmine group. Because of the small numbers, long-term outcomes were not assessed.