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Is there evidence for using anticonvulsants in the prevention and/or treatment of delirium among older adults?

Published online by Cambridge University Press:  24 March 2021

Aarti Gupta ,
Pallavi Joshi ,
Gargi Bhattacharya ,
Melissa Lehman ,
Melissa Funaro ,
Deena J. Tampi  and
Rajesh R. Tampi
Aarti Gupta
Affiliation:
Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
Pallavi Joshi
Affiliation:
Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
Gargi Bhattacharya
Affiliation:
Department of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, USA
Melissa Lehman
Affiliation:
Diamond Healthcare, Richmond, VA, USA
Melissa Funaro
Affiliation:
Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA
Deena J. Tampi
Affiliation:
Co-Founder and Managing Principal, Behavioral Health Advisory Group, Princeton, NJ, USA
Rajesh R. Tampi*
Affiliation:
Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA Department of Psychiatry & Behavioral Sciences, Cleveland Clinic Akron General, Akron, OH, USA Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
*
Correspondence should be addressed to: Rajesh R. Tampi, Department of Psychiatry & Behavioral Sciences, Cleveland Clinic Akron Genera, Akron, OH, 44307, USA; Section for Geriatric Psychiatry, Cleveland Clinic, Cleveland, OH, 44195, USA; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, 44195, USA. Phone: + 809 5223. E-mail: rajesh.tampi@gmail.com.
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Abstract

Objective:

This systematic review aims to identify published randomized controlled trials (RCTs) that evaluated the use of anticonvulsants for the prevention and/or treatment of delirium among older adults.

Methods:

A comprehensive search of databases: MEDLINE ALL (Ovid), Embase (Ovid), PsycINFO (Ovid), Web of Science Core Collection and Cochrane Central Register of Controlled was conducted.

Results:

The search identified four RCTs that evaluated the use of anticonvulsants among older adults with delirium. One RCT evaluated the perioperative use of gabapentin among individuals undergoing spinal surgery and the development of postoperative delirium. One RCT evaluated the relationship between the use of perioperative gabapentin and the development of postoperative delirium among individuals undergoing spinal surgery and hip and knee arthroplasty. Two post-hoc analyses of RCTs evaluated the use of gabapentin and pregabalin among individuals undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA). The perioperative use of gabapentin reduced the incidence of postoperative delirium among older adults undergoing spinal surgery. The perioperative use of gabapentin did not reduce the rates, severity or duration of postoperative delirium among older adults who were undergoing spine and hip and knee arthroplasty. The perioperative use of gabapentin did not reduce the incidence or duration of postoperative delirium among older adults undergoing elective TKA. The perioperative use of pregabalin did not reduce the incidence of postoperative delirium among older adults undergoing elective THA. Gabapentin and pregabalin were well tolerated among the individuals enrolled in these trials. There were no RCTs identified that evaluated the use of other anticonvulsants for the prevention and/or treatment of delirium among older adults.

Conclusions:

Based on current evidence, the routine use of anticonvulsants for the prevention and/or treatment of delirium among older adults cannot be recommended.

Keywords

anticonvulsantsolder adultsdeliriumpreventiontreatmentpregabalingabapentin
Type
Review Article
Information
International Psychogeriatrics , Volume 34 , Special Issue 10: Issue Theme: Pharmacotherapy for Serious Neuropsychiatric Disorders , October 2022 , pp. 889 - 903
Copyright
© International Psychogeriatric Association 2021

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