Underrepresentation of patients with pre-existing cognitive impairment in pharmaceutical trials on prophylactic or therapeutic treatments for delirium: A systematic review

Annemarieke de Jonghe*, Esther M. M. van de Glind, Barbara C. van Munster, Sophia E. de Rooij

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

7 Citations (Scopus)

Abstract

Objective: Representation of hospitalized patients with pre-existing cognitive impairment in pharmaceutical delirium trials is important because these patients are at high risk for developing delirium. The aim of this systematic review is to investigate whether patients with cognitive impairment were included in studies on pharmacological prophylaxis or treatment of delirium and to explore the motivations for their exclusion (if they were excluded).

Study design: This study was a systematic review. A MEDLINE search was performed for publications dated from 1 January 1985 to 15 November 2012. Randomized and non-randomized controlled trials that investigated medication to prevent or treat delirium were included. The number of patients with cognitive impairment was counted, and if they were excluded, motivations were noted.

Results: The search yielded 4293 hits, ultimately resulting in 31 studies that met the inclusion criteria. Of these, five studies explicitly mentioned the percentage of patients with cognitive impairment that were included. These patients comprised a total of 8% (n = 279 patients) of the 3476 patients included in all 31 studies. Ten studies might have included cognitively impaired patients but did not mention the exact percentage, and sixteen studies excluded all patients with cognitive impairment. The motivations for exclusion varied, but most were related to the influence of dementia on delirium.

Conclusion: The exclusion of patients with pre-existing cognitive impairment hampers the generalizability of the results of these trials and leaves clinicians with limited evidence about the pharmacological treatment of this group of vulnerable patients who have an increased risk of side effects. (C) 2014 Elsevier Inc. All rights reserved.

Original languageEnglish
Pages (from-to)193-199
Number of pages7
JournalJournal of Psychosomatic Research
Volume76
Issue number3
DOIs
Publication statusPublished - Mar-2014
Externally publishedYes

Keywords

  • Dementia
  • Delirium
  • Treatment
  • Prophylaxis
  • Trials
  • Underrepresentation
  • Cognitive impairment
  • RANDOMIZED CONTROLLED-TRIAL
  • PLACEBO-CONTROLLED TRIAL
  • ASSESSMENT METHOD CAM
  • DOUBLE-BLIND TRIAL
  • POSTOPERATIVE DELIRIUM
  • ELDERLY-PATIENTS
  • CARDIAC-SURGERY
  • GASTROINTESTINAL SURGERY
  • HALOPERIDOL PROPHYLAXIS
  • DONEPEZIL HYDROCHLORIDE

Cite this