Rivastigmine as a treatment in delirium; a pilot study

Background:

Delirium is a common disorder in the early phase of stroke. Given the presumed cholinergic deficiency in delirium, we tested treatment with the acetylcholinesterase inhibitor rivastigmine.


Methods:

This pilot study was performed within an epidemiological study. In 527 consecutive stroke patients presence of delirium was assessed during the first week with the confusion assessment method. Severity was scored with the delirium rating scale (DRS). Sixty-two patients developed a delirium in the acute phase of stroke. Only patients with a severe and persistent delirium were enrolled in the present study. In total 26 fulfilled these criteria of whom 17 were treated with orally administered rivastigmine. Eight patients could not be treated because of dysphagia and one because of early discharge.


Results:
No major side effects were recorded. In 16 patients there was a considerable decrease in severity of delirium. The mean duration of delirium was 6.7 days (range; 2-17).


Conclusions:

Rivastigmine is safe in stroke patients with delirium even after rapid titration. In the majority of patients the delirium improved after treatment. A randomized controlled trial is needed to establish the usefulness of rivastigmine in delirium after stroke.

Given the presumed cholinergic deficiency the cholinergic drug rivastigmine might be a suitable drug for treatment of delirium

- Each treated patient was followed untill the delirium was gone

Rivastigmine 1.5 b.i.d, with an increase every other day with 3 mg to a maximum of 6 mg b.i.d