4 These associations are very likely due to the vulnerability to delirium caused by preclinical neuropathologic processes and to the worsening of dementia associated with an increased likelihood of delirium. 3 Furthermore, delirium reportedly increases the risk of incident dementia and is associated with worsening dementia severity, deterioration in global functioning score, and loss of 1 point or more per year on the Mini-Mental State Examination (95% CI, 0.11-1.89) compared with those with no history of delirium. Delirium has been shown to be independently associated with an increased risk of death. 1, 2 Although delirium has traditionally been considered transient, a growing body of literature suggests that this is not necessarily true. * Corresponding author: Kotaro Hatta, MD, PhD, Department of Psychiatry, Juntendo University Nerima Hospital, Takanodai 3-1-10, Nerima-ku, Tokyo 177-8521, Japan ( fundamental concept of delirium involves altered consciousness and fluctuations caused by the direct physiologic consequence of another medical condition, substance intoxication or withdrawal, or exposure to a toxin delirium can also be the result of multiple etiologies. KDepartment of Environmental and Preventive Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan JDepartment of Psychiatry, Kurume University School of Medicine, Kurume, Japan IDepartment of Psychiatry and Neurosciences, Hiroshima University Hospital, Hiroshima, Japan HDepartment of Psychiatry, Kurashiki Central Hospital, Kurashiki, Japan GDepartment of Psychiatry, Fukuyama City Hospital, Fukuyama, Japan © Copyright 2019 Physicians Postgraduate Press, Inc.ĪDepartment of Psychiatry, Juntendo University Nerima Hospital, Tokyo, JapanīDepartment of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kawasaki, JapanĬDepartment of Psychiatry, Hiroshima City Hospital, Hiroshima, JapanĭDepartment of Psychiatry, Tokyo Medical and Dental University, Tokyo, JapanĮDepartment of Psychiatry, Tokushima Prefectural Central Hospital, Tokushima, JapanįDepartment of Psycho-oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
Real-world effectiveness of ramelteon and suvorexant for delirium prevention in 948 patients with delirium risk factors. To cite: Hatta K, Kishi Y, Wada K, et al. 0001).Ĭonclusions: Ramelteon and suvorexant appear to be effective for delirium prevention in real-world practice. Results: Among 526 patients at risk, those taking ramelteon and/or suvorexant developed delirium significantly less frequently than those who did not, after control for the effects of risk factors on the estimate of an independent association between the effects of ramelteon and/or suvorexant and the outcome of developing delirium (15.7% vs 24.0% odds ratio = 0.48, 95% CI, 0.29-0.80 P =.
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The primary outcome was incidence of delirium based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, during the first 7 days. The decision to take medication was left to the discretion of each patient. Patients who were aged 65 years or older and hospitalized because of acute diseases or elective surgery, had risk factors for delirium, and had insomnia or delirium on the night before the consultation were prescribed ramelteon and/or suvorexant. Methods: This multicenter, prospective, observational study was conducted by trained psychiatrists at consultation-liaison psychiatric services from October 1, 2017, to October 7, 2018. It explored whether ramelteon and/or suvorexant would affect delirium prevention among both patients at risk for but without delirium (patients at risk) and those with delirium the night before a consultation. Objective: The aim of this study was to examine the effectiveness of ramelteon and suvorexant for delirium prevention in real-world practice.