Can donepezil hydrochloride reduce the role of neuroleptic drugs in delirium? A case report

Background: Recent evidence shows that a confirmed diagnosis of delerium increases both patient morbidity and mortality. Importantly, these increases are independent of patient age, and presence of co-morbid disease. In the last few years, there has been evidence that acetylcholinesterase inhibitors may have a limited role in managing episodes of mild/moderate delirium. Methods: This case study reports a patient, whose behavioral disturbances caused by delirium, responded well to donepezil hydrochloride in a nursing home in Dundee, United Kingdom. Methods: Our clinical case focuses on a patient who was diagnosed with a mixed picture delirium after developing PUO. This case report notes that Mr A, a patient already prescribed donepezil hydrochloride, saw an improvement in his behavioral symptoms after an increase in his dose. This enabled the patient to avoid receiving neuroleptic or benzodiazepine medication, known to be particularly problematic in older patients. Conclusion: The authors tentatively propose that patients in community care already prescribed acetylcholinesterase inhibitors, may benefit from an increased dose in cases of mild delirium (where there is no clear cause or requirement for hospital admission). In line with the significant impact that delerium has upon older patients in community care, we would call for further studies looking at the inflience that these medications may have on the sequelae of delirium in patients in the community.