Cholinesterase inhibitors for the treatment of delirium in non‐ICU settings

Ailan Yu; Shanshan Wu; Zongwang Zhang; Tom Dening; Sai Zhao; Gillian Pinner; Jun Xia; Daogui Yang

doi:10.1002/14651858.CD012494.pub2

Cochrane Database of Systematic Reviews

Inhibidores de la colinesterasa para el tratamiento del delirio en ámbitos fuera de la UCI

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DOI:

https://doi.org/10.1002/14651858.CD012494.pub2 Copiar DOI

Base de datos:

Cochrane Database of Systematic Reviews

Versión publicada:

28 junio 2018see what's new

Tipo:

Intervention

Etapa:

Review

Grupo Editorial Cochrane:

Grupo Cochrane de Demencia y trastornos cognitivos

Copyright:

Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Contraer

Autores

Ailan Yu

Anaesthesiology, Liaocheng People's Hospital, Liaocheng City, China
Shanshan Wu

Anaesthesiology, Liaocheng People's Hospital, Liaocheng City, China
Zongwang Zhang

Correspondencia a: Anaesthesiology, Liaocheng People's Hospital, Liaocheng City, China

[email protected]
Tom Dening

Division of Psychiatry & Applied Psychology, The University of Nottingham, Nottingham, UK
Sai Zhao

Systematic Review Solutions Ltd, The Ingenuity Centre, The University of Nottingham, Nottingham, UK
Gillian Pinner

Old Age Psychiatry, The University of Nottingham, Nottingham, UK
Jun Xia

Cochrane Schizophrenia Group, Institute of Mental Health, University of Nottingham, Nottingham, UK
Daogui Yang

Department of Gastrointestinal Surgery, Liaocheng People's Hospital, Liaocheng, China

Contributions of authors

SW: protocol development, selection of studies and data extraction, drafted parts of the review

ZZ: protocol development, reviewed and drafted parts of the review

TD: content expert, protocol development

SZ: protocol development, reviewed and drafted parts of the review

GP: content expert, protocol development

JX: project management, protocol development, Methodological Expectations of Cochrane Intervention Reviews (MECIR) guidance

AY: protocol development, selection of studies and data extraction, drafted parts of the review

DY: content expert, protocol development

Sources of support

Internal sources

NSFC, China.

This review was supported by National Natural Science Foundation of China: 20873999

External sources

NIHR, UK.

This review was supported by the National Institute for Health Research (NIHR), via Cochrane Infrastructure funding to the Cochrane Dementia and Cognitive Improvement group. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, National Health Service, or the Department of Health

Declarations of interest

SW: none known

ZZ: none known

TD: none known

SZ: none known

GP: none known

JX: none known

AY: none known

DY: none known

Acknowledgements

We would like to thank the Cochrane Dementia and Cognitive Improvement Group and their peer reviewers and editorial team for their help and editorial advice throughout the completion of this Cochrane Review.

We would like to thank Systematic Review Solutions Ltd. for their effort in providing methodological guidance. We also thank Margueritte Mabry White (MD, medical writer) for her help in the proofreading of this review.

Version history

Published

Title

Stage

Authors

Version

2018 Jun 28

Cholinesterase inhibitors for the treatment of delirium in non‐ICU settings

Review

Ailan Yu, Shanshan Wu, Zongwang Zhang, Tom Dening, Sai Zhao, Gillian Pinner, Jun Xia, Daogui Yang

https://doi.org/10.1002/14651858.CD012494.pub2

2017 Jan 11

Cholinesterase inhibitors for the treatment of delirium in non‐ICU settings

Protocol

Shanshan Wu, Zongwang Zhang, Tom Dening, Sai Zhao, Gillian Pinner, Jun Xia, Ailan Yu, Daogui Yang

https://doi.org/10.1002/14651858.CD012494

Differences between protocol and review

None.

Notes

None.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Aged, 80 and over; Female; Humans; Male;

PICO

Population

Intervention

Comparison

Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Figure 1

Study flow diagram.

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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Study	Interventions	N	MD	95% CI	P value
Overshott 2010	Cholinesterase inhibitors (rivastigmine) versus placebo	15	‐3.6	‐15.6 to 8.4	0.5

Analysis 1.1

Comparison 1 Cholinesterase inhibitors (rivastigmine) versus placebo, Outcome 1 Duration of delirium (days).

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Analysis 1.2

Comparison 1 Cholinesterase inhibitors (rivastigmine) versus placebo, Outcome 2 Adverse events (nausea).

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Analysis 1.3

Comparison 1 Cholinesterase inhibitors (rivastigmine) versus placebo, Outcome 3 Use of rescue medications.

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Analysis 1.4

Comparison 1 Cholinesterase inhibitors (rivastigmine) versus placebo, Outcome 4 Mortality.

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Analysis 1.5

Comparison 1 Cholinesterase inhibitors (rivastigmine) versus placebo, Outcome 5 Leaving the study early.

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Summary of findings for the main comparison. Cholinesterase inhibitors (rivastigmine) compared to placebo for the treatment of delirium in non‐ICU settings

Cholinesterase inhibitors (rivastigmine) compared to placebo for the treatment of delirium in non‐ICU settings
Patient or population: people with delirium Settings: non‐ICU Intervention: cholinesterase inhibitors (rivastigmine)* Comparison: placebo
Outcomes	Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No. of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Placebo	Cholinesterase inhibitors (rivastigmine)
Duration of delirium days Follow‐up: 42 days	The mean duration was 9.9 days	The mean duration was 3.6 days lower (15.6 lower to 8.4 higher)	Not estimable	15 (1 study)	⊕⊕⊝⊝ Low¹	The data were reported by Overshott 2010. The study was grossly underpowered, and the data were skewed.
Severity of delirium CAM negative Follow‐up: 28 days	See comment	See comment	See comment	See comment	See comment	No study reported this outcome.
Adverse events nausea Follow‐up: 42 days	143 per 1000	43 per 1000 (1 to 899)	RR 0.3 (0.01 to 6.29)	15 (1 study)	⊕⊕⊝⊝ Low¹
Persistent cognitive impairment	See comment	See comment	See comment	See comment	See comment	No study reported this outcome.
Length of hospitalisation	See comment	See comment	See comment	See comment	See comment	No study reported this outcome.
Mortality Follow‐up: 42 days	571 per 1000	57 per 1000 (6 to 891)	RR 0.1 (0.01 to 1.56)	15 (1 study)	⊕⊕⊝⊝ Low¹
Cost of intervention	See comment	See comment	See comment	See comment	See comment	No study reported this outcome.
The dose of intervention: 1.5 mg once a day increasing to 1.5 mg twice a day after 7 days. The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CAM: Confusion Assessment Method; CI: confidence interval; ICU: intensive care unit; RR: risk ratio
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of effect, but there is a possibility that it is substantially different. Low quality: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low quality: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
¹Downgraded twice for imprecision due to very small sample size.

Summary of findings for the main comparison. Cholinesterase inhibitors (rivastigmine) compared to placebo for the treatment of delirium in non‐ICU settings

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Comparison 1. Cholinesterase inhibitors (rivastigmine) versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Duration of delirium (days) Show forest plot			Other data	No numeric data

2 Adverse events (nausea) Show forest plot	1	15	Risk Ratio (M‐H, Random, 95% CI)	0.30 [0.01, 6.29]

3 Use of rescue medications Show forest plot	1	15	Risk Ratio (M‐H, Random, 95% CI)	0.13 [0.01, 2.10]

4 Mortality Show forest plot	1	15	Risk Ratio (M‐H, Random, 95% CI)	0.10 [0.01, 1.56]

5 Leaving the study early Show forest plot	1	15	Risk Ratio (M‐H, Random, 95% CI)	0.88 [0.07, 11.54]

Comparison 1. Cholinesterase inhibitors (rivastigmine) versus placebo

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Inhibidores de la colinesterasa para el tratamiento del delirio en ámbitos fuera de la UCI

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