Association of Delirium Response and Safety of Pharmacological Interventions for the Management and Prevention of Delirium: A Network Meta-analysis
Open accessAbstract
Importance: Although several pharmacological interventions for delirium have been investigated, their overall benefit and safety remain unclear. Objective: To evaluate evidence regarding pharmacological interventions for delirium treatment and prevention. Data Sources: PubMed, Embase, ProQuest, ScienceDirect, Cochrane Central, Web of Science, ClinicalKey, and ClinicalTrials.gov from inception to May 17, 2018. Study Selection: Randomized clinical trials (RCTs) examining pharmacological interventions for delirium treatment and prevention. Data Extraction and Synthesis: To extract data according to a predetermined list of interests, the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines were applied, and all meta-analytic procedures were conducted using a random-effects model. Main Outcomes and Measures: The primary outcomes were treatment response in patients with delirium and the incidence of delirium in patients at risk of delirium. Results: A total of 58 RCTs were included, in which 20 RCTs with 1435 participants (mean age, 63.5 years; 65.1% male) compared the outcomes of treatment and 38 RCTs with 8168 participants (mean age, 70.2 years; 53.4% male) examined the prevention of delirium. A network meta-analysis demonstrated that haloperidol plus lorazepam provided the best response rate for delirium treatment (odds ratio [OR], 28.13; 95% CI, 2.38-333.08) compared with placebo/control. For delirium prevention, the ramelteon, olanzapine, risperidone, and dexmedetomidine hydrochloride groups had significantly lower delirium occurrence rates than placebo/control (OR, 0.07; 95% CI, 0.01-0.66 for ramelteon; OR, 0.25; 95% CI, 0.09-0.69 for olanzapine; OR, 0.27; 95% CI, 0.07-0.99 for risperidone; and OR, 0.50; 95% CI, 0.31-0.80 for dexmedetomidine hydrochloride). None of the pharmacological treatments were significantly associated with a higher risk of all-cause mortality compared with placebo/control. Conclusions and Relevance: This network meta-analysis demonstrated that haloperidol plus lorazepam might be the best treatment and ramelteon the best preventive medicine for delirium. None of the pharmacological interventions for treatment or prophylaxis increased the all-cause mortality.
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People with similar neuropathology show faster cognitive decline if they develop delirium than if they do not.
“People with similar neuropathology show faster cognitive decline if they develop delirium than if they do not.284”
From Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (2020) · cites this paper as [284]
The introduction (section D; page unavailable) says delirium is associated with permanent cognitive decline. It does not compare the rate of decline in people with similar neuropathology who do and do not develop delirium; the paper instead examines pharmacological interventions for delirium. (LLM, conf=0.85)
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Dementia prevention, intervention, and care: 2020 report of the Lancet Commission
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- Authors
- Wu, Y.-C., Tseng, P.-T., Tu, Y.-K., Hsu, C.-Y., Liang, C.-S., Yeh, T.-C., Chen, T.-Y., Chu, C.-S., Matsuoka, Y. J., Stubbs, B., Carvalho, A. F., Wada, S., Lin, P.-Y., Chen, Y.-W., & Su, K.-P.
- Affiliations
- Chang Gung Memorial Hospital (TW)
- WinShine Clinics in Specialty of Psychiatry, Kaohsiung City, Taiwan
- National Taiwan University (TW)
- Kaohsiung Medical University (TW)
- Tri-Service General Hospital (TW)
- Kaohsiung Veterans General Hospital (TW)
- National Cancer Centre Japan (JP)
- National Health Service (GB)
- Centre for Addiction and Mental Health (CA)
- Chang Gung University (TW)
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan
- China Medical University (TW)
- Corresponding author
- Su, Kuan-Pin
- ORCID
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2019-05-01
- Volume
- 76
- Issue
- 5
- Pages
- 526
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC6495351
- OpenAlex
- W2915429756
- Cited by
- 148
- References
- 50
- Citations by year
- 2026: 9 · 2025: 23 · 2024: 11 · 2023: 25 · 2022: 24 · 2021: 23 · 2020: 25 · 2019: 8
- FWCI
- 18.60
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Psychiatry (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Anglia Ruskin Research Online (Anglia Ruskin University) (acceptedVersion)
- Figshare (submittedVersion, cc-by-nc-nd)
- Research Portal (King's College London) (submittedVersion)
- Funders
- National Institute for Health and Care Research (ICA-CL-2017-03-001, NIHR-INF-0685)
- Ministry of Science and Technology, Taiwan (MOST106-2314-B038-049, MOST106-2314-B039-027-MY3, NHRI-EX105-10528NI, MOST 106)
- National Health Research Institutes (DMR-107-091, NHRI-EX105-10528NI, CRS-106-063, DMR-107-204, CRS-106-063, DMR-107-202, DRM-107-097, DMR-107-202, EX105)
- China Medical University
- China Medical University, Taiwan (DMR-107-091, DMR-107-202, CRS-106-063, DMR-107-204, DRM-107-097)
- Division of Materials Research
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Health Sciences › Medicine › Neurology › Alcoholism and Thiamine Deficiency
- Keywords
- delirium, delirium prevention, pharmacological interventions, treatment response, drug safety, haloperidol, lorazepam, ramelteon, olanzapine, risperidone, dexmedetomidine, antipsychotic drugs, benzodiazepines, adverse effects, delirium incidence, older adults, critically ill patients
- MeSH terms
- Network Meta-Analysis, Delirium, Drug Therapy, Combination, Haloperidol, Humans, Indenes, Lorazepam, Antipsychotic Agents, Treatment Outcome
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